— There’s an urgent need to prepare for future variants

by Anna Bershteyn, PhD 

The narrative around Omicron is full of resignation. Be cautious, but don’t panic. Get vaccinated, test often, reschedule what you’re willing to, but don’t aim for zero risk. That resignation carries into how we discuss life after Omicron. COVID-19 could become endemic but mild. We might need vaccinations periodically. New variants will come, but life will go on.

The thing is, life might not go on.

In the world of coronaviruses, there is a wide range of contagiousness, and also a wide range of deadliness. Some coronaviruses, like MERS, kill one-third of the people they infect. There is no biological rule that more contagious variants have to be milder. The virus does its transmitting before serious symptoms arrive, sometimes before any symptoms arrive, so its ability to spread is more-or-less indifferent to our survival. Omicron’s mildness was lucky. Next time, our luck could run out.

Omicron did something we didn’t realize was possible: It hit “fast-forward” on evolution, suddenly acquiring fifty mutations. Some believe this happened inside a person with a weakened immune system. Others think the virus jumped into animals and back. Neither of these are likely to be one-off events. People with weakened immune systems are being infected by the millions, and innumerable animals have been infected — cats, bats, mice, mink, deer, the list goes on.

Omicron begs the question, “Could you stop me?” If a future variant were as contagious as Omicron, but much deadlier, could we contain it? This points to an urgent agenda. We need dependable variant detection. That includes incentivizing countries to sound the alarm, rather than punishing them with travel bans. We need to update vaccines faster. We can’t spend 3 months in lockdown. We need to learn outbreak containment. Some countries have contained explosive outbreaks, but the U.S. has failed every attempt so far. If we must resort to lockdowns, we need planning to minimize their pain and inequity. Lockdown laws, procedures, and technologies shouldn’t be invented on the fly.

We already know what it takes to detect variants quickly: political will and genetic sequencing. A very deadly variant should catch the attention of local doctors, but leaders are disincentivized to sound the alarm. We need policies that cushion the economic blow of travel bans, reward data sharing, and help science-friendly leaders stay in office.

Genetic sequencing, previously too expensive to do routinely, is soaring in high-income countries. Yet, low-income countries need it most: they have high human-animal contact, high rates of immune suppression (such as untreated HIV/AIDS), and are behind in receiving vaccines. Plus, low-income countries could make the best use of sequencing other diseases during the “low tides” between COVID-19 waves. For example, malaria is on the rise because it evolved resistance to drugs, bed nets, and even diagnostic tests. Tracking its mutations can direct updated products where they’re needed, spot new mutations, and even reveal how to stop malaria transmission.

Vaccine and drug updates need to be ten times faster. Regulators, manufacturers, and distributors need to pre-think decisions, prepare manufacturing facilities, and chart distribution plans for a worst-case variant. Collaborations, such as sharing proprietary drug libraries, must be pre-negotiated. Biosafety labs must be prepared, potential study volunteers registered, a whole scientific infrastructure readied for unprecedented efficiency.

We must learn to contain outbreaks. Travel restrictions aren’t enough for a country our size. The recipe for containing outbreaks — such as South Korea’s Shincheonji Church outbreak — includes small-scale lockdowns, contact tracing, and digital systems that instantly notify exposed people, even if they’re strangers, using data such as credit card transactions and phone locations. We need ready-to-go systems that are as privacy-respecting as possible, but powerful enough to work. We can even use current viruses as “target practice.”

If these tactics fail, lockdown would be dreadful, but preparing for better lockdowns doesn’t need to be. Strengthening safety nets would help the most vulnerable among us right now. The ability to switch to remote work or school can help in extenuating circumstances — like the broken leg that made my child miss weeks of school. PPE stockpiles can reassure essential workers that they are seen as essential.

We’re tired. We want recovery. The last thing anyone wants to think about is a worse variant. But the virus doesn’t care. With Omicron, the virus flexed a new muscle we can’t ignore. Despite the havoc Omicron caused, we can consider ourselves lucky for the warning it gave us, if we listen.

Anna Bershteyn, PhD, is an assistant professor in the Department of Population Health at NYU Grossman School of Medicine in New York City. Bershteyn co-leads NYU Langone Health’s COVID modeling, and is also a consulting analyst to the New York City Department of Health & Mental Hygiene and the Department of Education on modeling the spread of COVID-19.

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