The fear is ramping up again. Articles are appearing talking up the threat from Omicron. Leading U.S. scientist Dr. Eric Topol, Director of Scripps Research in California, has produced a classic of the genre. Titled “The Covid Capitulation“, it lambasts the U.S. and other world governments for trying to move on from the pandemic, criticising the CDC in particular for propagating “delusional thinking” and “conveniently feeding the myth that the pandemic is over”.
New Omicron subvariants like BA.2 and BA.2.12.1 are surging in the U.S. and around the world, he says, and the “real number of cases [in the U.S.] is likely at least 500,000 per day, far greater than any of the U.S. prior waves except Omicron”.
But Omicron is mild, right? Dr. Topol is having none of it. Infections spread like wildfire, he says, and “beget Long Covid, they beget sickness, hospitalisations and deaths. They are also the underpinning of new variants”.
At the heart of his worries is the immune evasion of Omicron and its fast-appearing subvariants, particularly BA.2.12.1 which is becoming dominant in the U.S, and BA.4 and BA.5 in South Africa. He argues that Omicron subvariants are producing larger and more frequent Covid waves than earlier variants owing to “more immune evasion” – evasion so marked that he suggests Omicron should really be considered a new virus, approvingly quoting Dr. Linfa Wang that, “based on its immunological profile, it should be called SARS-3”.
Dr. Topol goes so far as to say that even Omicron BA.1 infection does not protect against infection with Omicron subvariants such as BA.2.12.1 – at least not without vaccination, which he seems to think makes natural immunity work better against subvariants, even though it produces a narrower immune response based only on the Spike protein from the original strain.
Both BA.2.12.1 and BA.4/BA.5 pose a further challenge to our immune system recognition, with minimal cross-immunity derived from BA.1. That is especially noteworthy since 40-50% of Americans were infected with BA.1 (or BA.1.1) and without added protection from vaccination, they will be vulnerable to BA.2.12.1 infections.
Nonetheless, he’s doubtful of the efficacy of Omicron-specific vaccines, due out in July, which are focused on BA.1 and “may not provide strong protection against BA.2.12.1 or whatever new Omicron subvariant (or not Omicron related) we will be dealing with this summer”. For some reason he fails to mention that the development of Omicron-specific vaccines has been seriously hampered by antigenic imprinting (or ‘original antigenic sin’), which has seen them fail to produce detectable Omicron-specific immune responses in the previously vaccinated.
As to the current vaccines, Dr. Topol is frank about their poor efficacy: “We are seeing people with four shots who are getting breakthrough infections, even at one to two weeks from their most recent shot, when there should be the maximal level of neutralising antibodies induced.” He also notes a decline against severe disease, from “90-95%” to “approximately 80%”, which he says is clear “from multiple reports, including the UK Health Security Agency and Kaiser Permanente“. That seems a generous estimate.
While he thinks BA.2.12.2 and BA.4/BA.5 variants will likely have similar, rather than more, immune evasion against severe disease compared to BA.1 and BA.2 “because we haven’t seen substantial increases in hospitalisations”, he cautions “no data are yet available and it’s still early”. He repeats his claim that natural immunity without vaccination is little help, saying “those without vaccination, relying on infection-acquired immunity, and at advanced age, are at considerable risk for the Omicron subvariants because their prior exposure only led to narrow BA.1 protection”, though gives no sources for the claim.
He then ramps up the alarm further, saying the world must plan for something worse than the Omicron variants, which are “providing further seeding grounds for more variants of concern”, a path “further facilitated by tens of millions of immunocompromised people around the world, multiple and massive animal reservoirs and increased frequency of recombinants – the hybrid versions of the virus that we are seeing from co-infections”.
This “highly unfavourable picture” he summarises as:
(1) accelerated evolution of the virus; (2) increased immune escape of new variants; (2) progressively higher transmissibility and infectiousness; (4) substantially less protection from transmission by vaccines and boosters; (5) some reduction on vaccine/booster protection against hospitalisation and death; (6) high vulnerability from infection-acquired immunity only; and (7) likelihood of more noxious new variants in the months ahead.
Given the failings of the vaccines and the hopelessness of producing timely, variant-specific ones, what does he think should be done? New, different kinds of vaccines, seems to be the main answer, which he evidently hopes will do better than the current crop. He calls for a “warp speed” programme to complete the development of nasal vaccines, which he thinks will “markedly ameliorate our problems of transmission, no less the alluring aspect of achieving mucosal immunity and being variant-proof”, plus a “pan-beta coronavirus vaccine“.
Similarly, while he doesn’t have much praise for the current Covid treatments – noting Paxlovid is “increasingly being recognised to have a liability of rebound with infectiousness in many people after the five-day blister pill pack”, while “most of the monoclonal antibodies that were previously highly effective” have not aged well with new variants – he insists that treatments which do work well are just around the corner. No mention of repurposed medicines, of course.
He dismisses Zero Covid as “untenable with Omicron” (or otherwise, many would say), but nonetheless urges a new policy of “Zero Covid Deaths”. Despite being dismissive of the efficacy of the vaccines against Omicron and future variants, this mainly appears to boil down to increasing third and fourth dose coverage with the current vaccines. He also argues that “we absolutely need an aggressive stance to get ahead of the virus”, as despite Covid vaccines and medications being “an order of magnitude more effective than what we have for influenza”, the current level of U.S. deaths (over 175,000 so far in 2022) is still “more than 10-fold in excess of seasonal flu (about 30,000 per year)”. While he says this is “totally unacceptable, nearly totally preventable loss of lives at scale”, exactly what he wants to be done about it is not clear. As far as I can tell the article is primarily an appeal for funding to continue the development of Covid drugs and vaccines rather than just (as he sees it) pretending Covid has gone away. However, in the process he’s painted a frightening picture that will spook many of his readers and risks pushing us back towards social restrictions.
In fact, despite his dire warnings about BA.4 and BA.5, South Africa reported infections appear to be peaking.
In the U.K., the Omicron variant waves have not yet produced a wave of excess deaths – though admittedly some other countries have seen moderate waves of varying sizes.
Dr. Topol is right that a disease like Covid ought to receive decent funding to find effective and safe treatments and vaccines for those at higher risk. However, given that the first crop of these have been disappointing, even for proponents like Dr. Topol, let alone for those suspicious of the safety of the rushed vaccines, hopes and expectations ought to be moderated. Better designed trials not designed to fail ought also to be run for repurposed drugs.
Perhaps most importantly, though, leading scientists like Dr. Topol ought to avoid spreading alarm, which as we have seen can readily lead the world into a headlong rush into folly and disaster.
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