Thankfully, the Omicron surge, which escalated so quickly, is now declining rapidly. On graphs of COVID cases, Omicron dwarfed previous surges. How did this happen, and what can we learn from it?

To me, the crux of the problem is this. As individuals, we make decisions based on our personal risk. For a young, healthy person who is vaccinated and boosted, the individual risk of COVID is low. This has been reinforced by news, public health announcements, and anecdotes that Omicron is milder. As our communities emerged from the Delta wave and struggled with the mental health effects of the last two years, we took this news as permission to do more. Individuals resumed pre-pandemic activities, feeling their own personal risk to be small relative to the benefits.

Unfortunately, the risk borne by Omicron is not at the individual level, but at the societal or systems level. As an example, the incredible contagiousness of the variant meant the community spread outstripped our testing capabilities. Individuals who developed mild symptoms couldn't find testing and ended up in our emergency department just to check for COVID. They probably would not have come to the ER otherwise; their disease was mild, and after they got confirmation, they were given instructions and sent home. But all of a sudden, our ERs took on the role of primary care provider and urgent care as well as an emergency room. This meant that when a real emergency happened - a stroke, heart attack, car accident - the ER was occupied with patients who would not ordinarily be there. Although young, healthy, immunized individuals with COVID may not need hospitalization or advanced treatments, they indirectly impact the health care system by absorbing attention, resources, time, and energy. 

The effect of individuals doing more snowballs. As more people venture into riskier and riskier activities, others feel "FOMO" or feel enabled to do more themselves. We have seen this time and again during the pandemic as the world attempts to return to pre-COVID activities and behaviors. These are normal goals and desires, but in the setting of a highly contagious variant, they lead to a dichotomy of rising cases along with rising numbers of people traveling, congregating, and socializing. For us in health care struggling with staffing shortages, overwhelmed hospitals, emotional trauma, and physical exhaustion, this generates resentment. Hospitals face a crisis, but the rest of the world doesn't seem to care. I feel this, and it is crushing.

Finally, the activities of low-risk people increase the risks for vulnerable people. I know people with cancer and transplants who have been meticulous these past two years, avoiding unnecessary activities, adhering to guidelines, and successfully avoiding COVID. They are terrified that catching the virus may put them at risk for dying. However, if COVID starts increasing in the community because people at low risk are doing more, then the odds worsen even for people taking all the precautions. There are everyday necessities that cannot be avoided: work, grocery shopping, school and childcare, doctors visits. As COVID infiltrates these areas of life, the immunosuppressed, elderly, and unvaccinated face a real threat to their health.

Now that we're leaving Omicron behind us, how do we proceed? Although much of this blog cautions against resuming pre-pandemic life, that's not what I'm advocating. I think it is reasonable and rational for each of us to evaluate our risk tolerance and adjust our activities accordingly. But we also live in an interconnected society, and our decisions impact others directly and indirectly. We need to be cognizant of what's happening at a macroscopic level and take responsibility for how our actions fit into the bigger picture.