Omicron Variant — A Framework for Decision-Making

First off, I am not a medical doctor or epidemiologist.

However, I am a logical and fact-based individual, and both logic and facts apply to medicine, epidemiology, and pretty much every field.

In this article, I won’t be making any medical or epidemiological conclusions. I will simply make logical ones.

Before I get into the logical/factual, let’s first discuss the psychology and incentives.

The first thing you have to realize is that the news media outlets and social media content promotion algorithms are both advertising-based businesses. Their business model is predicated on two things:

1) Getting you to pay attention.
2) Presenting advertising to you while you pay attention to something else.

This is their revenue model.

What has been true since the start of humanity is that threats command more attention than non-threats. So news producers, editors in chief, and machine-learning-based social media content promotion algorithms are heavily geared toward sharing information about threats. They do this because it generates more revenue.

Next, we need to look at the financial incentives of CEOs of vaccine companies. They make money by selling more drugs and vaccines. Pfizer is on pace to generate $36 billion in revenue from their COVID-19 vaccine in 2021.

Finally, political leaders are incentivized to look like they are taking action to protect their citizens. There is doing the right thing… and there is looking like one is doing the right thing. Sometimes, the latter is considered as important as the former.

With all these various incentives and biases defined explicitly, now let’s think through the Omicron variant on a logical level.

There are four relevant issues:

1) Mechanism of Transmission
2) Degree of Transmissibility
3) Severity of Illness
4) Immune Response Effectiveness

With the Omicron variant, there have been no reports of, concerns of, or evidence of a change in the mechanism of transmission. One potentially gets the Omicron variant the same way one might get the Delta, Beta, or Alpha variants. In other words, things like social distancing, gathering outdoors vs. indoors, wearing masks vs. no masks are the same preventative measures that apply to this variant as the others.

While there is plenty of debate on whether such measures should be required or not, there is zero debate on whether the Omicron variant is inherently transmitted in a different way (such as blood contamination, feces contamination) compared to the other variants.

In other words, on Issue #1, there is no change from the status quo.

There are three remaining relevant issues:

Issue #2: How easy is it to get Omicron?
Issue #3: How sick does one get with Omicron?
Issue #4: How well do our immune systems respond to Omicron?

Knowing this information informs us as to what to do next.

If it’s hard to get Omicron because it doesn’t easily transmit from a contagious patient, then it’s less of a concern than if it’s highly contagious.

If Omicron is highly contagious, but the symptoms are universally and consistently very mild, then, again, it’s less of a concern than if Omicron is highly lethal.

Finally, if existing natural immunity and vaccine-derived immunity are highly protective against Omicron, then there’s less of a concern than if natural and vaccine-derived immunity from and related to prior variants are completely ineffective.

These are the unknowns.

Unknowns are not always bad. Unknowns are not always good. Unknowns are simply just that… unknown.

The single most important action to take when faced with highly relevant unknowns is to work really hard to make the unknowns… well known.

From everything I’ve seen and read (I don’t read news articles on anything COVID related; I tend to pull my data from the pre-print academic papers and PDF copies of research data submitted to the United States Food and Drug Administration), there is a ton of effort amongst virologists, epidemiologists, and medical researchers to gather more data.

• There is data being gathered to determine Omicron transmissibility.
• There is data being gathered to determine Omicron disease severity.
• There is data being gathered to determine immune response effectiveness against Omicron.

On the last issue, immune response, it looks like virology labs require about two weeks to receive and replicate or simulate the Omicron variant and a week to test the variant against blood samples of those with various levels and sources of immunity (e.g., naturally acquired Alpha, naturally acquired Delta, vaccine, etc.).

In short, within three to four weeks of the initial discovery of Omicron, we should have a lot more data by which to make informed decisions at the societal, communal, and individual levels.

I think, of all the organizations involved, the World Health Organization (WHO) characterized Omicron correctly. It is a “variant of concern.”

Would I want the top virology labs in the world to have access to the latest data on Omicron? Absolutely.

Would I want the top epidemiologists to gather case data and run scenarios and models with sensitivity analyses? Absolutely.

Would I want to make sure the top researchers have the resources, staffing, and personnel to run immune system effectiveness experiments against the Omicron variant? Absolutely.

Would I want my friends, family, and political leaders to make extreme personal, medical, and policy decisions based on the data that was available in the first 48 hours after the news of Omicron’s discovery? I personally would not.

Personally, I would want to expedite getting more data. I would want an estimate of how long it would take to get that data (which looks like around three weeks). I would want to know the downside cost of waiting the time needed to get the desired data. And if that cost were not extraordinarily high, I would wait to get the facts. I’d also ask those who are tasked with getting the data if there are any administrative, logistical, or other obstacles getting in the way of doing their jobs in a timely manner.

After that, I would simply wait. Sometimes, waiting to get better data is the right move. That isn’t universally true.

It depends on:

1) How much time it takes to get data.
2) The likelihood of obtaining data that could dramatically change the appropriate next step.
3) The cost of waiting.

If the data takes two years to get, forget it. We’d need to make decisions now based on imperfect data. If we lack the ability or capacity to get useful data, then it’s better to make a “good enough” decision now with imperfect data. If it’s going to cost 100,000 lives in the waiting time needed to get the data, then, again, it’s better to make a decision now based on imperfect information.

In the case of Omicron, none of these appear to be the case. Hence, waiting three to four weeks to get relevant data before making a next-step decision seems reasonable and appropriate to me.