Predictive infectious disease outbreak interpretation and management is a wickedly problematic endeavor. Walking along a high wire over quicksand during a howling wind with no safety net starts to approximate the reality. But it is not just your life that is at stake, but those of friends, family, the public and society at large. The only thing that seems constant is change. Having done this for decades now, through far too many outbreaks, one conclusion that I am confident in is that (at a minimum) it requires humility and flexibility. Bear with me as I set this essay up with an example. As the South African data began to come in on Omicron, one of the fundamental “truths” of SARS-CoV-2 started to shift. Until recently, the data were quite strong that natural immunity (immunity obtained after infection and recovery) is quite effective in preventing infection, disease and death. As previously reviewed on this substack, the many mutations which characterize the Omicron variant result in a viral genotype with remarkable ability to circumvent both genetic spike protein vaccine-induced immunity AND (apparently to a lesser extent) natural immunity.
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