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Dear John,

It has been three weeks since the first report of the omicron variant. The newspapers are filled with headlines with contradictory information. If you feel confused, you are not alone.

What should one do about omicron?

First, take a deep breath.

We have the playbook for this. It is called layered defense. In 2020, we did not know how Covid spread, what measures could block the spread. We didn’t have vaccines, immunoglobulins, and oral medications.

We also learned that lockdowns in First World didn’t work. They caused social and political disruptions, significant psychological damage to the elderly and children. First World lockdowns deprived the Third world of medical supplies and food, causing non-Covid deaths. We now realize the virus will continue to circulate regardless of any of our efforts, but its damage can be contained. Read the Great Barrington Declaration. (

We know the drill for airborne pathogens. Cut the exposure with ventilation, masks, and social distancing indoors. This worked so well last year there was no seasonal flu. When Covid is flaring, quarantine is needed for nursing home populations and other susceptible individuals

Get your vaccines. The media focus on every minor defect of the vaccines, contributing to vaccine hesitancy. A recent headline trumpeted “Rare Cases of Myocarditis Linked to Pfizer, Moderna Covid-19 Vaccines.” The actual tally was 44 cases among 7.6 million immunized US military personnel and the citizens of Denmark. The cases, however, were self-limited, all but one spontaneously recovered. One is six times more likely to be struck by lightning than have this complication. As my father once said about the New York Post, if cows could fly it would be raining bullsh**.

Be careful about indoor spaces! Omicron is phenomenally contagious. For an individual, most cases produce a minor respiratory illness. However, for the US population, with limited immunity and anti-vaccination types, omicron might touch one hundred million citizens.  It could be the culling of the herd. We aren’t out these woods by any means. The first peak of Omicron is estimated to be mid-January. Stay tuned.

It is important to understand that Omicron is different. Below is an illustration of all mutations found in the coronavirus since the beginning of the epidemic. You can see that Omicron has “jumped” up the mutation tree.

covid phylogenetic tree

Phylogenic tree. More:

This unique displacement of mutations means we don’t know what to expect.  We are certain it is more infectious; we are not certain about severity.

However severe Omicron may be, “layered defense” remains the key. It starts with vaccination. Colorado’s Democrat Governor Jared Polis recently declared that the widespread availability of vaccines spells “the end of the medical emergency.” He has no plans for lockdowns or school closings. However, Colorado has an 80% vaccination rate, three times that of Alabama. His real point, and mine, is that we can keep schools and businesses functioning through Omicron, and the variants that will follow. The real point of Alabama is it will be the culling of the heard.

Immunoglobulin treatments, given early in the course of the illness, reduce death, and hospitalization time by 50%. Merck and Pfizer are introducing oral medications that have similar statistics.

Home antigen tests, in combination with uniform triple vaccination can make gatherings of unrelated people secure. More important, using group antigen testing, we can keep our schools open.

We have reached the point where lockdowns should not be necessary. The exception to this is nursing homes and chronic care facilities. Protecting these individuals is how we protect the healthcare system. Let’s be selective, rather than fearful.

In the previous surges of Covid, mortality was concentrated mainly the extreme elderly. Many people who hesitated to get vaccinated wondered if these deaths were influenza, the inevitability of aging, or mismanagement on the part of certain states.

One very disturbing trend in data from the UK is a spike in hospitalizations among children under the age of five. The first principle of all societies has always been the protection of their children. I do not know that omicron will precipitate mass death among the 5-year-olds.  But if it does, then I would ask the vaccine hesitant how they would let this evil triumph while, considering themselves of good character, they stand idly by.

Author: James Katz, MD, MPH

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