COVID-19 Omicron variant has taken over US in 3 weeks by doubling every 1.5-3 days. It is more transmissible and evades vaccination. We need a new vaccine, now.

The Centers for Disease Control and Prevention (CDC) has announced that the Omicron variant has increased as a proportion of new isolates from less than 1% to 2.9% to 73% in the US over the last three weeks. The Delta variant continues to account for a significant proportion of new COVID infections, but it is expected that Delta will essentially disappear in the next couple of weeks.

Omicron is estimated to be three times as contagious as Delta and is much less susceptible to blockage by any of the vaccines currently available.

The Omicron variant has more than 30 mutations in its spike protein as compared to the original strain isolated just two years ago. The sequence of the original strain was reported by the Chinese researchers early in January 2020. This enabled US vaccine makers to create a new type of vaccine based on messenger ribonucleic acid (mRNA). mRNA has been studied for the last two decades as a candidate for producing new vaccines, but had never before been carried through to an actual operating vaccine for humans. The spike protein of COVID was selected as a target because it is the most prominent protein that the virus has, and antibody binding to the spike protein was expected to inactivate the virus.

The existence of so many mutations in the spike protein has allowed Omicron to evade protection provided by vaccines based on the original strain. Studies over the last two months have revealed that Omicron requires three doses of the mRNA vaccine to provide significant protection against severe disease. Even three doses does not fully protect against infection, although breakthrough infections appear to be relatively mild. Vaccines other than mRNA based ones appear to be ineffective.

Unfortunately, only a small proportion of US persons have received booster doses of vaccines; about 30% of all adults are thought to have obtained the total of three doses including the booster.

Experience in South Africa, where the Omicron variant appears to have completely taken over the new infections, suggests that those who have previously had infections with other COVID variants plus vaccinations are suffering from mild symptoms. A large proportion, perhaps 70%, of South Africans have already had COVID infections, while fewer than 30% have gotten any vaccines.

There has been speculation, including in this Scientific American article, that a large number of mutations may have occurred relatively quickly by subacute infection in an immunocompromised person. For example, someone living with human immunodeficiency virus (HIV) that is partially suppressed by antiviral treatment could be involved. In such a person, COVID infection may last for weeks or months– not just “long COVID” (in which the virus has been eliminated but symptoms persist.) An active COVID infection that lasts longer than “normal” may provide the opportunity for multiple variants to arise in a single person. If the infection is then passed on to another person, multiple mutations may appear in a single case.

What must we do to end the pandemic?

The companies creating mRNA vaccines now will develop ones based on the Omicron variant. This can be done relatively quickly; last year, a turnaround time of six weeks was claimed for a completely new mRNA vaccine. After a new mRNA vaccine is developed, it must go through testing and production has to be ramped up. This could take six months before a significant amount of new vaccine is widely available.

Pfizer, the maker of one of the mRNA vaccines, promised in June to be able to ready a completely new vaccine in 100 days.

The companies that make mRNA vaccines are ethically required to waive patent protection for them but have not yet done so. They must help to establish widely spread production facilities that can provide quantities of vaccine for the rest of the world. If accelerated production of effective vaccine is not pursued on an emergency basis, by the time a large proportion of the global population can be vaccinated, a new variant will appear. Then we will be back to square one.

We can now anticipate that the COVID pandemic will continue for at least another two years. The total death toll will at least double. For reference, 5.3 million deaths and 275 million infections have been attributed to COVID-19 so far. The case and death counts are considered to be significant underestimates, although the factor by which the virus’s toll has been undercounted could be as little as 1.5 times or as much as 12 times, depending on which scientist you consult.

There will be continued pressure on the medical care system, with cumulative long-term damage as well as acute care shortages. Without dramatic steps to reduce medical burnout, there will be further significant losses of trained personnel that cannot be made up by recruitment and training.

It is likely that our political system will be negatively affected by the pandemic. While I am not qualified to fully analyze the damages to our politics, it seems obvious to me that democratic governance will suffer. Whether this has the effect of disenfranchising Democratic voters and enabling Republican autarchy has not yet been set in stone.

The steps that Republican politicians are taking to suppress Democratic voting will likely result in loss of Democratic representation. In particular, the use of gerrymandering by state governments has already resulted in minority rule in several states and is likely to get worse unless it is stopped.

There is no excuse for the tilted representation results in a number of states which allow minority Republicans to pack their legislatures with a majority of the representatives. If just one voting law were passed by our federal Congress that outlawed the gerrymander, it would outweigh all the other issues combined.

The Supreme Court has been complicit in allowing the gerrymander to continue. Only legislative action at the federal level can help at this time.

Specific critical measures that must be taken now

We must get small-d democratic control of our State legislatures by eliminating the gerrymander. We must get serious about wearing high-quality masks (think N95). We must develop a specific vaccine for the Omicron variant and see to it that 95% or more of the population is jabbed. If we do not do all of these things, the quality of life in this country will deteriorate in a horrific fashion. Other countries will suffer as well; if foreigners cannot look to the US for enlightened leadership, the globe will be much worse off.

“The sleep of reason begets monsters”– Francisco Goya