When it comes to Omicron, hope is not a plan

OPINION: Is it more transmissible? Are outcomes less severe? Can it evade vaccines? We don’t know yet. But we do know our ICU capacity remains finite
By John Michael McGrath - Published on Nov 30, 2021
Just as Ontario starts vaccinating kids age five to 11, the province has to reckon with a new variant of concern. (Cole Burston/CP)

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If we start the count according to when the index patient in Wuhan, China, first developed symptoms of what we now call COVID-19 — December 1, 2019 — then Tuesday marks the last day of the second year of this pandemic, and Wednesday will mark the first day of Year Three. Ten thousand deaths in Ontario alone is the most obvious and visible cruelty of the pandemic, but the list of hardships includes livelihoods ruined, careers (professional and academic) interrupted, and countless other unanticipated obstacles thrown in our paths.

Given that long, long list of suffering, making it all the way to what felt like a finish line for some of us — finally vaccinating kids age five to 11 — only to learn of a new variant that might be able to evade some of the protection that vaccines offer felt like a cruel little irony.

What do we know about Omicron, the latest variant of SARS-COV-2 determined to be concerning enough that it warrants its own Greek letter? Not much, as I write this. It might be more transmissible than previous variants, or it might not. It might cause less severe outcomes than the current variants floating around Ontario, or it might not. Its numerous mutations might enable it to at least partially evade the vaccines currently available to us, or they might not. There’s really not much we can say about the variant itself until we have more hard data.

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What we do know is that Ontario’s intensive-care capacity remains finite, and that’s still the ultimate limiting factor to how long and how far we go without imposing new public-health restrictions. If Omicron generates fewer severe cases than previous variants, that would be good news, of a sort. But if it’s more transmissible — and particularly if it can evade prior immunity, even in part — the relentless math of exponential growth means it’s entirely possible that Omicron will produce fewer ICU cases on average than previous variants while still producing enough to strain our hospital system, which can still handle only 250 to 300 COVID-19 patients in intensive care before non-COVID-19 care starts being restricted. And we might not want to test that limit: a new brief from Ontario’s science table warns that “it may be more challenging for the critical care system to rapidly increase capacity as it did during the height of wave 3, due to staffing shortages” and health-care worker burnout. 

Two weeks from now, this may all end up looking like a comical overreaction — the evidence might show that Omicron is mild, doesn’t spread more easily than other variants, and is reasonably well controlled by existing vaccines. Sincerely, I hope that’s all true. But hope is not a plan.

Even if it we dodge this bullet, it would still leave us … with the Delta variant, which is no picnic: the Algoma public-health unit (which includes Sault Ste. Marie and the wider area) has as many active cases per 100,000 residents today (282) as the entire province recorded at the peak of the third wave (288) on April 16. The local medical officer of health started reimposing public-health measures more than two weeks ago and reinforced her order last week. For everyone about to yell at their screens that case counts don’t matter, well, severe outcomes do: the number of people in northern Ontario’s ICU beds has predictably started to climb.

Whether Ontario’s current approach to the pandemic — letting local public-health units handle regional outbreaks — remains workable will be determined in large part by whether the measures taken by local medical officers in Algoma and elsewhere actually help control the spread of the virus. So Queen’s Park has more than the obvious reasons to hope that the outbreaks will be brought under control soon.

Ontario’s chief medical officer of health, Kieran Moore, insisted Monday that he doesn’t see any reason to reimpose public-health measures provincially because of Omicron or Delta, citing the province’s reasonably good performance relative to the 12 other provinces and territories during this particular phase of the pandemic. (If you live in the most heavily affected areas of the province, which now include parts of southwestern Ontario, you’re back to living with indoor-capacity restrictions from your local medical officer of health.) Instead, as expected, the province is gambling on the rollout of children’s vaccinations and an expanded eligibility for third doses, expected to be announced sometime this week. Moore also pointed to different vaccines that might appeal to the hesitant and to the therapeutic drugs from Merck and Pfizer that are currently working their way through the approvals process in the United States.

The vaccines are here and work against Delta, and third doses for those 50 and older will buttress the protections they already offer (it’s indeed frustrating that the province hasn’t moved with more urgency to get them into arms). The therapeutics are farther off, and it’s uncertain when they’ll arrive in Canada. And we still don’t know enough about Omicron to know what comes next. Not for the first time in this pandemic, we’re left with little to do right now except wait.

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