Former White House physician William Lang believes Omicron could continue to spread and become dominant across the globe. But he thinks that could be a good thing.

Lang said he tells people who fear Omicron may be a killer virus like Delta that it is highly probable "that Omicron is the beginning of the end because it is morphing into one of the other coronaviruses.”

He explained that there are about four common coronaviruses that cause about 20% of colds in the world. They were at one point in their existence likely causing bad disease, but humanity developed resistance to them, and now they cause colds. “That’s maybe what is happening with Omicron. I believe it’s more likely that it’s a Delta-plus killer,” he said.

Lang, chief medical officer for medical consultant WorldClinic, served as deputy physician under Presidents Bill Clinton and George W. Bush, at which time he dealt with the SARS epidemic and the Anthrax attacks. He also was an associate chief medical officer of the Department of Homeland Security.  

As an expert in medical contingency planning and public health response to biological incidents, Lang said he focuses on three things when it comes to infectious diseases: infectivity, seriousness, and mitigation.

In terms of infectivity, he said, Omicron looks to be somewhere between two and three times more infectious than Delta, which was already more infectious than some of the earlier variants. But the caveat, he said, is that early reports of infections are usually a bit higher.

“But even if you want to be a little bit skeptical, the data that we are seeing does tend to indicate that Omicron is more infectious,” he said, pointing to the outbreak at a company Christmas party in Oslo, Norway, on November 26 where 120 people were in attendance. Lang noted that a handful of the partygoers had recently returned from South Africa, where the Omicron variant was first detected.

Lang said there may have been 64 people infected. If everybody at the party was either vaccinated or tested beforehand, that implies that the variant is fairly infectious, he said. “When you follow the case counts and you have something with more infectious cases going up, well, what is there to do than be afraid.”

But indications are that the severity of illness associated with Omicron is significantly less. It is not known for sure how much less severe, but there are fewer relative number of hospitalizations, Lang noted. He said heavily overcrowded areas are not seeing significant increases in hospitalizations, and, anecdotally, doctors in South Africa are saying Omicron is causing mild symptoms.

But Lang wonders whether Omicron will escape the mitigation tools in place, which he categorizes as antiviral medications, monoclonal antibodies, vaccines and social distancing and masking.

For one, he questions whether social distancing and wearing a mask, which has been touted throughout the pandemic as foolproof ways to stay safe, will continue to provide the protection as they did with the earlier variants.

It is going to take “hard-heeled epidemiology public health data” to get a good idea on that, he said, explaining that Delta was more about how many people you have sharing a space. “Social distancing and masking was not as important as ventilation and density,” he said. 

But he said wearing a mask is better than not wearing one. “But is the increase in safe protection that you have significant? It’s hard to say with Delta, but with the earlier variant, yes, it was significant.” Still, Lang said he wears a mask if he is going into a crowded environment, but he doesn’t have as much confidence wearing one as he used to.

On the other mitigating tools, Lang said he is optimistic because a lot of good data is starting to come in. He noted that both Pfizer and Merck have developed the antiviral pills paxlovid and molnupiravir, respectively, that could be promising. Pfizer has said its pill reduces Covid-19 hospitalization rates by 89%, which Lang said is “a huge deal.” Both companies, he said, have indicated that their medications should remain effective against Omicron.

Pfizer also has indicated that its antiviral pill could be available by the end of the month. “I hate to use the term gamechanger, but they do have the potential to be a gamechanger,” he said.

Vaccines, he said, should also continue to prove effective against the new variant. He noted that Pfizer’s CEO Albert Bourla has indicated that research “Is showing that if you have the booster, you have enough antibodies and you have enough cellular immune response that it may not prevent infection, but it will significantly prevent intensive hospitalization and deaths,” he said. “And that’s a big deal.”

Additionally, both Moderna and Pfizer have said roughly within 100 days they plan to have modified vaccines that specifically address the Omicron variant. “[It could] can bring us back to the high-level of prevention we have had with Delta,” he said. “I wouldn’t bet the farm, but I am very optimistic right now.”

Lang said he is not recommending that people change doing what they are comfortable with doing during the holidays. But he said they should think twice about close crowds. Gatherings should be in a well-ventilated area, and at a minimum, people should wear masks. But he said outdoor Christmas events are much lower risk. “We have not seen things spread from huge football stadiums where everybody is yelling and screaming,” he said.

Lang said people also should think twice about  international travel during this time. 

“If you go someplace in the world and you just happen to be the unlucky one who gets Omicron, are you going to be put into some isolation for a couple of weeks? I have a high sense of things like that, so I am a little uncomfortable right now with international travel,” he said. 

Founded in 1998, WorldClinic is a private, concierge telemedicine practice that handles health issues affecting organizations, senior executives and individuals and their families.