Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

On December 17, 2021 New York set a new daily record for COVID-19 infections. An early epicenter of the pandemic, the state broke its own record the next day, and the next. By the end of the month, it was recording nearly 75,000 positives a day. Meanwhile U.S. Senators Cory Booker and Elizabeth Warren –– both vaccinated, boosted, and conscientious about masking –– announced they’d tested positive for the coronavirus. Across professional sports leagues, hundreds of healthy, asymptomatic, vaccinated players tested positive –– jeopardizing games and even seasons in the NFL, NBA, and NHL. The next week, as holiday travel approached pre-pandemic levels, thousands of flights were abruptly canceled as dozens of infected crew members were unable to fly. 

In early 2020, these headlines would have prompted panic. In late 2021, as we approach the pandemic’s second anniversary, they elicited measured responses from some–and bored sighs from many. Even as a new variant spread from South Africa to Europe and the United States, studies involving hundreds of thousands of patients suggest that while wilier, this variation is also far less deadly than Delta. Which brings up the question, is the Omicron variant the “vaccine” we’ve been waiting for?

Risk Assessment 

On New Year’s Eve, as the clock ticked toward 2022, John Trowbridge faced an increasingly common challenge. The man who had spent a quarter-century overseeing tech systems for the Times Square ball drop limited his social contacts throughout December. He walked on the street instead of risking Manhattan’s crowded sidewalks. He wore KN95 masks. His socially distanced Christmas party included only vaccinated, boosted friends. He hugged his mother just twice. Yet despite the raft of precautions, he tested positive 24 hours before his biggest day of the year. Irreplaceable, Trowbridge, like many Americans, will do his job remotely.

While many of us need the sense of control delivered by mask wearing and social distancing, it seems to have had limited success with Omicron. While complacency isn’t the answer, neither is panic. Because for many people the risk of serious issues from this latest variant is small. It’s a normal, human response to feel sad or even fearful while reading accounts of the young father or child who died of COVID-19. Yet it’s also worth noting that news by definition is focused on the uncommon. After 24 months, the “novel” coronavirus is becoming decidedly less so. While comparisons to seasonal influenza are controversial, not only did some 52,000 people die in just a few months during the 2017-2018 flu season but nearly 10,000 were under age 65. Nearly 40,000 children were hospitalized. During the Spanish Flu of 1918, peak mortality was at the exact age of 28.

Throughout the COVID-19 pandemic, the patient profile has remained remarkably consistent. Whether in March of 2020 or late 2021, vaccinated or unvaccinated, rural or urban, the vast majority of patients who die or are hospitalized are over the age of 65. In 2020, this group accounted for 81% of the fatalities in the U.S. By 2021, this had dropped slightly to 69%. While there is considerable overlap between age and risk factors, it’s reasonable to assume that a fair number of fatalities and hospitalizations among those under age 65 are concentrated among people with risk factors including being overweight or obese, having cancer, heart disease, or diabetes.

Risk isn’t about anecdotes or headlines. It’s about numbers. An actuary wouldn’t calculate the higher risk of operating a motorcycle versus a car based on total U.S. population but would rather focus on motorcyclists. The risk of a healthy person under the age of 65 having a bad outcome from COVID-19 is low. Analyzing current data for New York magazine, David Wallace-Wells wrote in September of 2021 that, “All else being equal, an unvaccinated 66-year-old is about 30 times more likely to die, given a confirmed case, than an unvaccinated 36-year-old, and someone over 85 is over 10,000 times more at risk of dying than a child under 10.” Drawing on research from the UK’s Financial Times, he noted that a vaccinated 80-year-old has about the same mortality risk as an unvaccinated 50-year-old, and an unvaccinated 30-year-old has a lower risk than a vaccinated 45-year-old. 

The Centers for Disease Control and Prevention recently published estimates on the COVID-19 toll from the first U.S. infections in February of 2020 through September of 2021 (which includes Delta’s peak). Estimating deaths at over 900,000 (considerably higher than headline figures), the CDC put the total number of fatalities for people under age 50 at slightly over 60,000 during some 20 months of the pandemic. Even for those between the ages of 50-64, the death rate was around 253 per 100,000 versus nearly 1,300 per 100,000 for those over 65. 

Yes, every death is a tragedy but it’s worth noting that the increase in opioid deaths during the same period exceeded the number of people under the age of 50 who died from COVID-19. These deaths are concentrated among the young –– as are the thousands more people who died in car accidents and in homicides in 2021 than did in 2019. Doctors are also reporting increases in deaths among their patients of all ages from conditions like mental illness and kidney and heart disease as many of them were unable or unwilling to access non-emergency medical services. It’s also worth noting that since the COVID-19 deaths are a running total, around 1.3 million Americans died of heart disease during the same period. Around the same number died of cancer.

Another very important and unfortunately unknown number is how many people have already been infected by COVID-19 in the U.S. While it’s possible to quibble over data, the headline number of 50 million is almost certainly wrong. Early tests were wildly inaccurate. Plus, seeing how many asymptomatic sports stars test positive suggest that there are many millions of Americans who walked around last year oblivious to their own COVID-19 infections. So what does the CDC say? Well, their estimates put the total number of infections in the U.S. through September at over 146 million. One-hundred-forty-six million –– nearly half the population. With Omicron that number is almost surely over 50% of the country. When you are considering risk, this number of infections is vital. If the CDC’s estimates are accurate, it cuts the risk of a bad result by nearly two-thirds compared to the headline number.

Further, stories that focus on percentages rather than numbers do readers a disservice in favor of clicks and page views. If six patients are hospitalized with COVID in March, while one dozen are hospitalized in April it may be accurate to say the number of patients had doubled or increased by 100%, but most people would be less panicked to read that it was 12 –– so long as the doubling isn’t a trend. For example, in Los Angeles County hospitalizations peaked at over 8,000 in early 2021. As the year drew to a close that number, which had approached 2,000 during the Delta variant, was just over 1,250.

The Vaccination Question

Arriving less than one year after SARS-CoV-2 (the virus that causes COVID-19) was first identified in Wuhan, China, the mRNA vaccines are a modern miracle. Produced by Moderna and Pfizer, the two-dose shots led to a dramatic plunge of both hospitalizations and deaths –– particularly among the elderly. To date over 200 million Americans are fully vaccinated –– over 60% of the total population. Yet resistance has hardened among the 30% of adults who haven’t yet had a shot. Mandates have motivated some, but in a tight labor market many are willing to quit. Industries with staffing shortages are reluctant to require vaccines especially in the face of ongoing and unpredictable court challenges.

Beyond the colorful conspiracy theories, many opposed to the COVID-19 vaccines have questioned their safety because they arrived so quickly. The coherent counter argument is that speed was facilitated by funding rather than relaxed standards and that side effects like allergic reactions show up quickly. Unfortunately this narrative, consistent across most media outlets and among medical professionals, has been challenged by the Johnson & Johnson vaccine’s ongoing and mounting problems. Linked early on to myocarditis –– particularly acute among males under age 30 –– the one-shot vaccine that most closely resembled traditional inoculations has been paused multiple times in the U.S. and Europe.

The one-shot shot is not the only area of concern. Vaccines and even boosters for those under 18 has become a driving force in the U.S. Yet across Europe –– hardly a caldron of government-supported anti-vax sentiment–vaccines for children have been rolled out more slowly while boosters are not currently recommended.

The risk to a young person from the vaccine seems roughly equivalent to the risk from COVID-19. While some children have become ill from the virus, including a slight uptick with the Omicron variant, the number who were hospitalized has not only been low but some research suggests it was overcounted. Children also offer compelling evidence that, despite having never encountered the virus before, the human immune system is a remarkable engine. For while it’s easier to quantify antibody response, the T-cell reaction in children has consistently offered them outsized protection. This means that one question must be asked. How much risk should a 7 year old be expected to shoulder in order to protect a 70 year old? While there may be logical or even compassionate reasons for a wide variety of answers, surely “none” is acceptable as well.

The unvaccinated have been painted with a wide anti-vax brush, but being skeptical of something new is not the same as refusing shots against polio and measles –– two diseases which threaten young people and have vaccines with decades of research behind them. Further, no matter how much folks can casually dismiss breakthrough infections, no one would be pleased to get a touch of polio or a spot of measles after those vaccines. 

Indeed, a significant percentage of people who don’t want to take the vaccine are young –– the lowest risk cohort for this disease. The known and widely reported vaccine side effects are flu-like symptoms which can persist for days and hit the youngest hardest. Boosters seem to be even worse. The oft-repeated homily that getting vaccine-related side effects beats getting COVID-19 ignores the fact that at least 40% of all infections have no symptoms whatsoever –– a percentage that is likely far higher among the young and seems even higher with this newest variant. 

The evidence of the variant’s mild symptoms is clear cut. For those worried about the high numbers of unvaccinated, it’s worth noting that the regions with the highest number also have the highest rate of community spread. That means many if not most of the unvaccinated have had COVID-19. The symptoms with Omicron are equally mild for those with prior infections. But the best news is that this variant with its 50 spikes and dozens of mutations overwhelms Delta and all pre-existing variants. So getting sick with this version isn’t just less dangerous but will likely offer immunity against everything currently circulating. 

Yes, it’s possible that later variants will be more dangerous. However, it is not in a virus’s “best interest” to be deadly. No, every virus aspires to the ubiquity of the common cold: easily spread, easily replicated, and hardly ever serious. Mutations and time almost always lead to less dangerous versions. Further, as with many things, exposure may ultimately be preferable. Children started getting very sick with polio after infants were no longer exposed to it. Peanut allergies increased dramatically when parents stopped giving babies peanuts (pediatricians now generally recommend modest amounts early on). It’s too early to recommend getting this variant. Still, it seems increasingly likely that unlike the vaccines, Omicron could be the thing that leads the country back to a non-mask-wearing, frequent-flying, live-music festival normal.

References

• Estimated Flu-Related Illnesses, Medical Visits, Hospitalizations, and Deaths in the United States — 2017–2018 Flu Season
• Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality
• COVID-19: People with Certain Medical Conditions
• Estimated COVID-19 Burden
• Heart Disease Facts
• Cancer Facts & Figures 2021
• COVID-19 hospitalizations among children likely overcounted, researchers find
• How kids’ immune systems can evade COVID
• What to Expect after Getting a COVID-19 Vaccine