The Cautious Case for Omicron Optimism


As the world awaits more data on Omicron, early reports out of South Africa — where the coronavirus variant was first reported and is driving a massive spike in new cases — have consistently characterized symptoms from most cases as either nonexistent or relatively mild. On Tuesday, Dr. Anthony Fauci described Omicron as “almost certainly” not as severe as Delta, based on the preliminary data.

What should we make of very early data, or Dr. Fauci’s comments today, that suggest Omicron may be less deadly than Delta?

It’s very encouraging that ten days after Omicron was first reported, physicians on the ground in South Africa are still saying that most of the people who were hospitalized were unvaccinated and mostly seem to have very mild disease. That’s kind of persistent. It’s not changing. That is not what happened with Delta. In March, there was a 4 percent vaccination rate in India, and there was not this prolonged period where people were like, “Oh, it isn’t that bad.” It was really very terrible in terms of hospitalizations, severe illness, oxygen requirements, and deaths. This is a very different feeling. I find it really funny that people are saying, “Oh, well, it’s early. Let’s not trust them.” Why wouldn’t I trust my South African colleagues? I’m a long-standing HIV doctor and researcher who knows many of these investigators. I think that we should trust them.

I think there are two reasons that this could be happening. One is that the virus could have evolved to become less virulent, which we’ll need experiments to show. Or the second reason is that there’s just more immunity now, in December 2021, so it manifests more mildly. I don’t think we know the answer yet.

You talked a bit about your colleagues in South Africa, and you’ve done research there. At this point, do we know enough about Omicron, and the people who are getting sick in South Africa, to know what to expect in the United States?

A lot of people have said over the last couple of days that there’s a younger population in South Africa than in the U.S. The median age in South Africa is 28 or 29. But the median age in India is 28.4 and what we saw in India at the beginning of Delta was not subtle. As an Indian America-based physician, I really want to be clear that India was an utter disaster. Four percent of the population was vaccinated and young people, my own relatives, died. India has the same median age as South Africa and, if you look at the graphs, cases in India went up like a wall, not because they suddenly started testing but because people were flooding the hospitals with illness. So Omicron in South Africa is very different than what we saw with Delta in India, with the same median age.