Dare we feel a note of optimism about the end of the pandemic at a moment when pessimism has never been more oppressive?

Maybe. Over the weekend scientists noticed that cases on Gauteng province, the epicenter of South Africa’s Omicron outbreak, seemed to be leveling off. If the worst is already behind them with relatively few hospitalizations and zero deaths then maybe the new variant won’t be a beast after all.

A researcher in Johannesburg is speculating that no country will see its hospitals overrun due to an Omicron surge:

2 of 6:

Mild, milder, extremely mild.

As disease severity increases, the gap with Delta widens.

Keep in mind that SA is extremely vulnerable to C-19 with an average IFR of 0.5%, and 230,000 excess deaths attributable to the virus.

The IFR of #Omicron is estimated at 0.053%. pic.twitter.com/DWGAUbmSwb

— pieterstreicher (@pieterstreicher) December 11, 2021

Despite cases exploding there over the past month, South Africa’s case fatality rate is *falling,* which is what you’d expect from a new variant that’s super transmissible but rarely lethal.

South Africa's case fatality rate falls again to 0.5%. The theory that Omicron causes milder symptoms is becoming very hard to ignore… pic.twitter.com/rYxZDTOoGw

— Tom Calver (@tomhcalver) December 13, 2021

Is the pandemic over? Well, hold on.

Experts were watching to see what today’s new case numbers would be. Would the downward drift in Gauteng continue? According to South Africa’s top agency, new cases clock in at under 6,800, the lowest level in a week. Maybe the province really has peaked.:

#COVID19 UPDATE: A total of 45,101 tests were conducted in the last 24hrs, with 13,992 new cases, representing a 31.0% positivity rate. A further 11 #COVID19 related deaths have been reported, bringing total fatalities to 90,148 to date. See more here: https://t.co/7Q6qMuUvCe pic.twitter.com/IVIVCFQc6k

— NICD (@nicd_sa) December 13, 2021

Cases nationally have also declined over the past few days, a hopeful sign — but one that comes with a catch. The NICD is still working through a backlog of reporting so the recent numbers may undercount the true number of cases. We’ll have to wait a few more days to see if they’re adjusted upward retrospectively.

Meanwhile in Europe, though, scientists are shocked by the speed at which Omicron is spreading. All eyes are on Denmark and the UK, both of which are aggressively sequence the genome of their domestic cases to identify which strains of the virus are circulating. Yeesh:

Extremely worrisome #omicron news.
DK is sequencing more than nearly anyone else.

So —> this 𝙚𝙭𝙖𝙘𝙩 𝙨𝙖𝙢𝙚 𝙨𝙘𝙚𝙣𝙖𝙧𝙞𝙤 is unfolding 𝙧𝙞𝙜𝙝𝙩 𝙩𝙝𝙞𝙨 𝙢𝙞𝙣𝙪𝙩𝙚 across many parts of the 🇪🇺

▶️▶️ 𝙗𝙪𝙩 𝙬𝙚 𝙟𝙪𝙨𝙩 𝙙𝙤𝙣'𝙩 𝙠𝙣𝙤𝙬 𝙞𝙩 𝙮𝙚𝙩.

🚨🚨 https://t.co/DMl1BEyKo5

— Andrew Lover (@AndrewALover) December 12, 2021

Denmark’s @SSI_dk just released a new risk assessment on #omicron.
It estimates that #omicron will become the dominant variant in Copenhagen this week with more than 10,000 cases per day expected – an all-time pandemic high.https://t.co/onqFOsSShV pic.twitter.com/7w8RIlTzjM

— Kai Kupferschmidt (@kakape) December 13, 2021

If Omicron is as mild as Streicher surmises then super-exponential growth isn’t necessarily a disaster. But even a small fraction of a very big number will be a big number; if Omicron hospitalizes a smaller share of infected people than Delta does but ends up infecting half the population, that’ll mean many hospitalizations. And in fact, South Africa is already seeing its numbers climb:

BREAKING Hospitalizations South Africa
Hospitalizations ⬆️76% week over week
Gauteng Province⬆️61% week over week
GP ⬆️3.5% from yesterday
ICU⬆️8 from yesterday

Neither the worst that people were worried about NOR so mild. Expect deaths to ⬆️ this week. https://t.co/M6gGuky4n3 pic.twitter.com/eDjM52gAzR

— (((Howard Forman))) (@thehowie) December 13, 2021

The big worry with Streicher’s confident conclusion that the variant is mild is that hospitalizations always lag cases. Maybe the Omicron wave is still recent enough in Gauteng that a wave of very sick people is on the way but hasn’t arrived yet because the disease hasn’t reached that stage in the newly infected yet.

Scott Gottlieb is concerned that the Brits seem so concerned by what their data is telling them. There are already studies showing that people with three doses are solidly protected from Omicron, but people with two doses or natural immunity may be at risk:

"It's deeply concerning to see the British take this stance…if they are seeing a very significant threat from Omicron I think the world should take notice of that," says @ScottGottliebMD. pic.twitter.com/kbJ1WT476N

— Squawk Box (@SquawkCNBC) December 13, 2021

Boris Johnson didn’t mince words in addressing the British population last night. The tone here, based on the considered opinion of British scientists who are studying Omicron, is the opposite of Streicher’s tone:

"There is a tidal wave of omicron coming"

Boris Johnson says the U.K. will now offer all over-18s a coronavirus booster shot by the end of December, warning "we are now facing an emergency in our battle with the new variant"

Latest: https://t.co/692E8XIRzg pic.twitter.com/BUhbGeEwPM

— Bloomberg UK (@BloombergUK) December 12, 2021

There’s another complication. Virologist Trevor Bedford explained this morning that it’s not a sure thing that infection by Omicron will grant you natural immunity that protects you from all other variants. Some (including me) have theorized that if the new variant is super-transmissible but extremely mild then it might operate as a sort of “contagious vaccine,” generating immunity in people without any of the nasty symptoms that you experience when you catch Delta. Bedford’s point, though, is that since Omicron seems more capable of puncturing the immunity of people than previous variants were, it may function to some degree as a distinct virus that produces a distinct illness. You don’t gain immunity from COVID if you catch the flu or vice versa, right? Well, the same may be true of Delta and Omicron:

Intuitively, the more immune escape Omicron has from Delta-specific immunity the more the two variants have distinct ecological niches and so are able to co-exist without stepping on each other's toes. 3/15

— Trevor Bedford (@trvrb) December 13, 2021

Omicron might not outcompete Delta. It might just operate alongside it, potentially leaving people open to infection by different strains and maybe requiring an updated vaccine aimed at both. Still, if cases really are falling in Gauteng province then it must be that infection from previous variants provides *some* meaningful level of protection against Omicron. Only a quarter or so of South Africans are vaccinated but something like 75 percent or more are estimated to have recovered from COVID. If Omicron is running out of room to run, one would think it’s because those with natural immunity are blocking its path. Let’s hope so, because the last thing we need is two variants spreading instead of one.