theatlantic | Here’s the upshot: Each fully vaccinated person might still be at minimal risk of getting seriously ill or dying from COVID this winter, but the vestiges of normalcy around them could start to buckle or even break. In the worst-case scenario, highly vaccinated areas could also see “the kind of overwhelmed hospital systems that we saw back in 2020 with the early phase in Boston and New York City,” Samuel Scarpino, a network scientist at the Rockefeller Foundation’s Pandemic Prevention Institute, told me. If only a small percentage of Omicron infections lead to hospitalization, the variant is still spreading with such ferocity that millions of people could need a bed.
Such a scenario would be especially dangerous if those millions of people all needed a bed at the same time. Omicron is so transmissible that cases could peak across the country more or less in tandem, Schiffer and Scarpino both said, which would make it harder for the U.S. to shuffle personnel and ventilators to particularly hard-hit regions. ICU capacities in some states are already stretched thin and health-care workers are resigning en masse, so the harms could be even worse. “If we don’t get serious, if we don’t get the masks on, if we don’t get testing up, we’re going to be back into lockdown again because people will be dying in the hallways of hospitals,” Scarpino said. The prospect of such a surge in hospitalizations is “keeping me up nights, to be honest,” Schiffer told me.
This all would be mitigated if Omicron turns out to cause significantly milder disease than Delta—still a possibility, but far from confirmed—and if the vaccines’ protection against severe disease holds strong. But even in that sunnier version of the future, cases are almost certain to increase in highly vaccinated areas and undervaccinated ones alike, and bring with them a host of disruptions to daily life. Schiffer suggested that in areas with sufficient political will—mostly highly vaccinated ones—high case rates could spur local leaders to institute new shutdowns. In any event, fully vaccinated people are still required to isolate for at least 10 days after a positive test, and anyone they’ve been in contact with might have to stay home from school or work. A positive test in a classroom could send dozens of kids into quarantine, and keep their parents out of work to care for them. Jon Zelner, an epidemiologist at the University of Michigan, told me that massive disruptions caused by surging Omicron cases this winter could force Americans to reconsider these sorts of procedures.
Whatever the effects on vaccinated Americans, the Omicron fallout is going to be much more severe for everyone else. In places with low vaccine coverage and strong anti-shutdown politics, inconvenience could be replaced by mass death and even greater grief. And the devastation will almost certainly be greater, on average, in rural communities, poor communities, and communities of color. “It’s unvaccinated people who are going to be at the worst risk for the worst outcomes. And it’s also going to be the folks who don’t have the ability or the luxury to quarantine or just kind of hide out when it looks like the numbers are getting too high,” Zelner said. People working multiple jobs might not have time to get a booster or sick days to use while recovering from side effects. People who live in areas that are underserved by hospital systems will have more trouble finding a bed and receive worse care if they do get sick.
None of these futures are yet written in stone. The scope of the coming hardship will depend on how capable Omicron is of causing severe disease and death. And though Omicron seems likely to overtake Delta, “cases are still low enough with Omicron that we can have a big effect if [we] act early,” Scarpino said—though “acting early was last week.” A month ago, one could still pretend that burden fell on those who lived in some other place, far away from vaccinated people in vaccinated communities. Now that delusion looks shakier than ever.
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