Lurking among the swaying palm trees, sugary sands and azure waters of the Florida Keys is the most dangerous animal on earth: the mosquito.
While there are thousands of varieties of mosquitoes, only a small percentage of them are responsible for causing disease. One of the leading culprits is Aedes aegypti, which thrives in the warm standing waters of South Florida, Central America and other tropical climes, and carries the viruses that cause yellow fever, dengue, chikungunya and Zika.
Dengue, a leading cause of death in many Asian and Latin American countries, causes bleeding and pain so severe that it's referred to as "breakbone fever." Chikungunya and yellow fever can both be fatal, and Zika, when contracted by a pregnant woman, can infect her fetus and cause devastating birth defects, including a condition called microcephaly. Babies born with this condition have abnormally small heads and lack proper brain development, which leads to profound, lifelong disabilities.
Decades of efforts to eradicate the disease-carrying Aedes aegypti mosquito from the Keys and other tropical locales have had limited impact. Since the advent of pesticides, homes and neighborhoods have been drenched with them, but after each spraying, the mosquito population quickly bounces back, and the pesticides have to be sprayed over and over. But thanks to genetic engineering, new approaches are underway that could possibly prove safer, cheaper and more effective than any pesticide.
One of those approaches involves, ironically, releasing more mosquitoes in the Florida Keys.
The kill-switch will ensure that the female offspring die before they reach maturity and thus, be unable to reproduce.
British biotech company Oxitec has engineered male mosquitoes to have a genetic "kill-switch" that could potentially crash the local population of Aedes aegypti, at least in the short-term. The modified males that are being released are intended to mate with wild females.
Males don't bite; it's the female that's deadly, always seeking out blood to gorge on to help mature her eggs. After settling her filament-thin legs on her prey, she sinks a needlelike proboscis into the skin and sucks the blood until her translucent belly is bloated and glowing red.
The kill-switch will ensure that the female offspring die before they reach maturity and thus, be unable to reproduce. In some experiments using genetically modified mosquitoes, the small number of females that survived were rendered unable to bite. The modification prevented the proboscis, the sickle-like needle that pierces the skin, from forming properly. But this isn't the case with Oxitec's mosquitoes; in the Oxitec release, the females simply die off before they can mate.
The modified mosquitoes are the second genetically engineered insect to be released in the U.S. by Oxitec. The first was a modified diamondback moth, an agricultural pest that doesn't bite humans. But with the mosquitoes, there are many questions about the long-term effects on wild ecosystems, other species in the food chain, and human health. With the Keys initiative, there has been vociferous opposition from environmental groups and some local residents, but some scientists and public health experts say that genetically modified insects pose less of a risk than the diseases they carry and the powerful, indiscriminant pesticides used to combat them.
Oxitec spent a decade developing the technology and engaging in a massive public education campaign before beginning the field test in April. Eventually, the company will release 750,000 of the insects from six locations on three islands of the Florida Keys. Although the release has been approved by the Environmental Protection Agency, the Florida Department of Agriculture and Consumer Services, and the Florida Keys Mosquito Control District, the company was never able to obtain unanimous approval among local residents, some of whom worry that the experiment could cause irreversible damage to the ecosystem.
The company has already begun distributing multiple blue and white boxes containing the eggs of thousands of the mosquitoes which, when water is added, will hatch legions of modified males.
There are a number of techniques available to genetically engineer animals and plants to minimize disease and maximize crop yields. According to Kevin Gorman, chief development officer for Oxitec, the company's mosquitoes were altered by injecting genetic material into the eggs, testing them, then re-injecting them if not enough of the new genes were incorporated into the developing embryos. "We insert genes, but take nothing away," he says.
Gorman points out that the Oxitec mosquitoes will only pass the kill-switch genes on to some of their offspring, and that they will die out fairly quickly. They should temporarily lessen diseases by reducing the local population of Aedes aegypti, but to have a long-term effect, repeated introductions of the altered mosquitoes would have to take place.
Critics say the Oxitec experiment is a precursor to a far more consequential, and more troubling development: the introduction of gene drives in modified species that aggressively tilt inheritance factors in a decided direction.
Gene drives coupled with the recent development of the gene-editing technique, CRISPR-Cas9, promise to be far more targeted and powerful than previous gene altering efforts. Gene drives override the normal laws of inheritance by harnessing natural processes involved in reproduction. The technique targets small sections of the animal's DNA and replaces it with an altered allele, or trait-determining snippet. Normally, when two members of a species mate, the offspring have a 50 percent chance of receiving an allele because they will receive one from each parent. But in a gene drive, each offspring ends up getting two copies of a desired allele from a single parent—the modified parent. The method "drives" the modified DNA into up to 100 percent of the animals' offspring.
In the case of gene drive mosquitoes, the modified males will mate with wild females. Upon fertilization of the egg, the offspring will start off with one copy of the targeted allele from each parent. But an enzyme, called Cas9, is introduced and acts as a kind of molecular scissors to cut, or damage, the "wild" allele. Then the developing embryo's genetic repair mechanisms kick in and, to repair the damage, copy the undamaged allele from the modified parent. In this way, the offspring ends up with two copies of the modified allele, and it will pass the modification on to virtually all of its progeny.
There is some debate among researchers and others about what constitutes a gene drive, but leaders in the nascent field, such as Andrea Crisanti, generally agree that the defining factor is the heritability of a change introduced into a species. A gene drive is not a particular gene or suite of genes, but a program that proliferates in a species because it is inherited by virtually all offspring.
An illustration of how gene drives spread an altered gene through a population.
Mariuswalter, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
Of the experts who spoke with Leaps.org for this article, there was disagreement on whether the Oxitec mosquitoes carry a gene drive, but Gorman says they don't because they carry no inheritance advantage. The mosquitoes have baked-in limitations on their potential impact on the tropical ecosystem because the kill-switch should only temporarily affect the local population of Aedes aegypti. The modified mosquitoes will die pretty quickly. But modified organisms that do carry gene drives have the potential to spread widely and persist for an unknown period of time.
Since it has such a reproductive advantage, animals modified by CRISPR and carrying gene drives can quickly replace wild species that compete with them. On the other hand, if the gene drive carries a kill-switch, it can theoretically cause a whole species to collapse.
This makes many people uneasy in an age of mass extinctions, when animals and ecosystems are already under extreme stress due to climate change and the ceaseless destruction of their habitats. Ecosystems are intricate, delicately balanced mosaics where one animal's competitor is another animal's food. The interconnectedness of nature is only partially understood and still contains many mysteries as to what effects human intervention could eventually cause.
But there's a compelling case to be made for the use of gene drives in general. Economies throughout the world are often based on the ecosystem and its animals, which rely on a natural food chain that was evolved over billions of years. But diseases carried by mosquitoes and other animals cause massive damage, both economically and in terms of human suffering.
Malaria alone is a case in point. In 2019, the World Health Organization reported 229 million cases of malaria, which led to 449,000 deaths worldwide. Over 70 percent of those deaths were in children under the age of 12. Efforts to combat malaria-carrying mosquitoes rely on fogging the home with chemical pesticides and sleeping under pesticide-soaked nets, and while this has reduced the occurrence of malaria in recent years, the result is nowhere near as effective as eradicating the Anopheles gambiae mosquito that carries the disease.
Pesticides, a known carcinogen for animals and humans, are a blunt instrument, says Anthony Shelton, a biologist and entomologist at Cornell University. "There are no pesticides so specific that they just get the animal you want to target. They get pollinators. They get predators and parasites. They negatively affect the ecosystem, and they get into our bodies." And it's not uncommon for insects to develop resistance to pesticides, necessitating the continuous development of new, more powerful chemicals to control them.
"The harm of insecticides is not debatable," says Shelton. With gene drives, the potential harm is less clear.
Shelton also points out that although genetic modification sounds radical, people have been altering the genes of animals since before recorded history, through the selective breeding of farm and domesticated animals. While critics of genetic modification decry the possibility of changing the trajectory of evolution in animals, "We've been doing it for centuries," says Shelton. "Gene drives are just a much faster way to do what we've been doing all along."
Still, one might argue that farms are closed experiments, because animals enclosed within farms don't mate with wild animals. This limits the impact of human changes on the larger ecosystem. And getting new genes to work their way through multiple generations in longer-lived animals through breeding can take centuries, which imposes the element of time to ascertain the relative benefits of any introduced change. Gene drives fast-forward change in ways that have never been harnessed before.
The unique thing about gene drives, Shelton says, is that they only affect the targeted species, because those animals will only breed with their own species. Although the Oxitec mosquitoes are modified but not imbued with a gene drive, they illustrate the point. Aedes aegypti will only mate with its own species, and not with any of the other 3,000 varieties of mosquito. According to Shelton, "If they were to disappear, it would have no effect on the fish, bats and birds that feed on them." But should gene drives become widely used, this won't always be true of animals that play a larger part in the food chain. This will be especially true if gene drives are used in mammals.
One factor, cited by both proponents of gene drives and those who want a complete moratorium on them, is that once a gene drive is released into the wild, animals tend to evolve strategies to resist them. In a 2017 article in Nature, Philip Messer, a population geneticist at Cornell, says that gene drives create "the ideal conditions for resistant organisms to flourish."
Sometimes, when CRISPR is used and the Cas9 enzyme cuts an allele soon after egg fertilization, the animal's repair mechanism, rather than creating a straight copy of the desired allele, inserts random DNA letters. The gene drive won't recognize the new sequence, and the change will slip through. In this way, nature has a way of overriding gene drives.
In caged experiments using CRISPR-modified mosquitoes, while the gene drive initially worked, resistance has developed fairly rapidly. Scientists working for Target Malaria, the massive anti-malaria enterprise funded by the Bill and Melinda Gates Foundation, are now working on developing a new version of a gene drive that is not so vulnerable to genetic resistance. But cage conditions are not representative of complex natural ecosystems, and to figure out how a modified species is going to affect the big picture, ultimately they will have to be tested in the wild.
Because there are so many unknowns, such testing is just too dangerous to undertake, according to environmentalists such as Dana Perls of the Friends of the Earth, an international consortium of environmental organizations headquartered in Amsterdam. "There's no safe way to experiment in the wild," she says. "Extinction is permanent, and to drive any species to extinction could have major environmental problems. At a time when we're seeing species disappearing at a high rate, we need to focus on safe processes and a slow approach rather than assume there's a silver bullet."
She cites a number of possible harmful outcomes from genetic modification, including the possible creation of dangerous hybrids that could be more effective at spreading disease and more resistant to pesticides. She points to a 2019 paper in Scientific Reports in which Yale researchers suggested there's evidence that genetically modified species can interbreed with organisms outside their own species. The researchers claimed that when Oxitec tested its modified Aedes aegypti mosquitoes in Brazil, the release resulted in a dangerous hybrid due to the altered animals breeding with two other varieties of mosquito. They suggested that the hybrid mosquito was more robust than the original gene drive mosquitoes.
The paper contributed to breathless headlines in the media and made a big splash with the anti-GMO community. However, it turned out that when other scientists reviewed the data, they found it didn't support the authors' claims. In a short time, the editors of Nature ran an Editorial Expression of Concern for the article, noting that of the insects examined by the researchers, none of them contained the transgenes of the released mosquitoes. Among multiple concerns, Nature found that the researchers didn't follow the released population for more than a short time, and that previous work from the same authors had shown that after a short time, transgenes would have faded from the population.
Of course, unintended consequences are always a concern any time we interfere with nature, says Michael Montague, a senior scholar at Johns Hopkins University's Center for Health Security. "Unpredictability is part of living in the world," he says. Still, he's relatively comfortable with the limited Florida Keys release.
"Even if one type of mosquito was eliminated in the Keys, the ecosystem wouldn't notice," he says. This is because of the thousands of other species of mosquito. He says that while the Keys initiative is ultimately a test, "Oxitec has done their due diligence."
Montague addressed another concern voiced by Perls. The Oxitec mosquitoes were developed so that the female larvae will only hatch in water containing the antibiotic tetracycline. Perls and others caution that, because of the widespread use of antibiotics, the drug inevitably makes its way into the water system, and could be present in the standing pools of water that mosquitoes mate and lay their eggs in.
It's highly unlikely that tetracycline would exist in concentrations high enough to make any difference, says Montague. "But even if it did happen, and the modified females hatched out and mated with wild males, many of their offspring would inherit the modification and only be able to hatch in tetracycline-laced water. The worst-case scenario would be that the pest control didn't work. Net effect: Zero," he says.
As for comparing GMO mosquitoes with insecticides, Montague says, "We 100 percent know insecticides have a harmful effect on human health, whereas modified [male] mosquitoes don't bite humans. They're essentially a chemical-free insecticide, and if there were to be some harmful effect on human health, it would have to be some complicated, convoluted effect" that no one has predicted.
It's not clear, though, given the transitory nature of self-limiting genetically modified insects, whether any effects on the ecosystem would be long-lasting. Certainly in the case of the Oxitec mosquitoes, any effect on the environment would likely be subtle. However, there are other species that are far more important to the food chain, and humans have been greatly impacting them for centuries, sometimes with disastrous effects.
The world's oceans are particularly vulnerable to the effects of human actions. "Codfish used to dominate the North Atlantic ecosystem," says Montague, but due to overfishing, there were huge changes to that ecosystem, including the expansion of their prey—lobsters, crabs and shrimp. The whole system got out of balance." The fish illustrate the international nature of the issues related to gene drives, because wild species have few boundaries and a change in one region can easily spread far and wide.
On the other hand, gene drives can be used for beneficial purposes beyond eliminating disease-carrying species. They could also be used to combat invasive species, fight crop-destroying insects, promote biodiversity, and give a leg up to endangered species that would otherwise die out.
Today nearly 90 percent of the world's islands have been invaded by disease-carrying rodents that have over-multiplied and are driving other island species to extinction. Common rodents such as rats and mice normally encounter a large number of predators in mainland territories, and this controls their numbers. Once they are introduced into island ecosystems, however, they have few predators and often become invasive. Because of this, they are a prevalent cause of the extinction of both animals and plants globally. The primary way to combat them has been to spread powerful toxicants that, when ingested, cause death. Not only has this inhumane practice had limited impact, the toxicants can be eaten by untargeted species and are toxic to humans.
The Genetic Biocontrol of Invasive Rodents program (GBIRd), an international consortium of scientists, ethicists, regulatory experts, sociologists, conservationists and others, is exploring the possible development of a genetically modified mouse that could be introduced to islands where rodents are invasive. Similar to the Oxitec mosquitoes, the mice would carry a modification that results in the appearance of only one sex, and they would also carry a gene drive. Theoretically, once they mate with the wild mice, all of the surviving offspring would be either male or female, and the species would disappear from the islands, giving other, threatened species an opportunity to revive.
GBIRd is moving slowly by design and is currently focused on asking if a genetically engineered mouse should be developed. The program is a potential model for how gene drives can be ethically developed with maximum foresight and the least impact on complex ecosystems. By first releasing a genetically engineered mouse on an island — likely years from now — the impact would naturally be contained within a limited locale.
Regulating GM Insects
While multiple agencies in the U.S. were involved in approving the release of the Oxitec mosquitoes, most experts agree that there is not a straightforward path to regulating genetically modified organisms released into the environment. Clearly, international regulation is needed as genetically modified organisms are released into open environments like the air and the ocean.
The United Nations' Convention on Biological Diversity, which oversees environmental issues at an international level, recently met to continue a process of hammering out voluntary protocols concerning gene drives. Multiple nations have already signed on to already-established protocols, but the United States has not and, according to Montague, is not expected to. "The U.S. will never be signatory to CBD agreements because agricultural companies are huge businesses" that may not see them as in their best interests, he says. Bans or limitations on the release of genetically modified organisms could limit crop yields, for example, thereby limiting profits.
Even if every nation signed on to international regulations of gene drives, cooperation is voluntary. The regulations wouldn't prevent bad actors from using the technology in nefarious ways, such as developing gene drives that can be used as weapons, according to Perls. An example would be unleashing a genetically modified invasive insect to destroy the crops of enemy nations. Or the releasing of a swarm of disease-carrying insects. But in this scenario, it would be very hard to limit the genetically modified species to a specific environment, and the bad actors could be unleashing disaster on themselves.
Because of the risks of misuse, scientists disagree on whether to openly share their gene drive research with others. But Montague believes that there should be a universal registry of gene drives, because "one gene drive can mess up another one. Two groups using the same species should know about each other," he says.
Ultimately, the decision of whether and when to release gene drives into nature rests with not one group, but with society as a whole. This includes not only diverse experts and regulatory bodies, but the general public, a group Oxitec spent considerable time and resources interacting with for their Florida Keys project. In the end, they gained approval for the initiative by a majority of Keys residents, but never gained a total consensus.
There's no escaping the fact that the use of gene drives is a nascent field, and even geneticists and regulators are still grapping with the best ways to develop, oversee, regulate, and control them. Much more data is needed to fully ascertain its risks and benefits.
Experts agree that the Oxitec venture isn't likely to have a noticeable effect on the larger ecosystem unless something truly catastrophic goes wrong. But following the GMO mosquitoes over time will give scientists more real-world data about the long-term effects of genetically altered species. If the release doesn't work, nothing about the ecosystem will change and Aedes aegypti will continue to be a menace to human health. But if something goes horribly wrong, it could hinder the field for years, if not forever.
On the other hand, if the Oxitec mosquitoes and other early initiatives achieve their goals of reducing disease, increasing crop yields, and protecting biodiversity, in the words of Anthony Shelton, "Maybe, 25 to 50 years from now, people will wonder what all the fuss was about."
Correction: The original version of this article mistakenly stated that the modified Oxitec mosquitoes would not be able to form a proper proboscis to bite humans. That is true for some modified mosquitoes but not the Oxitec ones, whose female offspring die off before they reach maturity. Additionally, the Oxitec release was not approved by the FDA and CDC, as originally stated. The FDA and CDC withdrew their role and passed the oversight to other regulatory entities.
Astronauts at the International Space Station today depend on pre-packaged, freeze-dried food, plus some fresh produce thanks to regular resupply missions. This supply chain, however, will not be available on trips further out, such as the moon or Mars. So what are astronauts on long missions going to eat?
Going by the options available now, says Christel Paille, an engineer at the European Space Agency, a lunar expedition is likely to have only dehydrated foods. “So no more fresh product, and a limited amount of already hydrated product in cans.”
For the Mars mission, the situation is a bit more complex, she says. Prepackaged food could still constitute most of their food, “but combined with [on site] production of certain food products…to get them fresh.” A Mars mission isn’t right around the corner, but scientists are currently working on solutions for how to feed those astronauts. A number of boundary-pushing efforts are now underway.
The logistics of growing plants in space, of course, are very different from Earth. There is no gravity, sunlight, or atmosphere. High levels of ionizing radiation stunt plant growth. Plus, plants take up a lot of space, something that is, ironically, at a premium up there. These and special nutritional requirements of spacefarers have given scientists some specific and challenging problems.
To study fresh food production systems, NASA runs the Vegetable Production System (Veggie) on the ISS. Deployed in 2014, Veggie has been growing salad-type plants on “plant pillows” filled with growth media, including a special clay and controlled-release fertilizer, and a passive wicking watering system. They have had some success growing leafy greens and even flowers.
"Ideally, we would like a system which has zero waste and, therefore, needs zero input, zero additional resources."
A larger farming facility run by NASA on the ISS is the Advanced Plant Habitat to study how plants grow in space. This fully-automated, closed-loop system has an environmentally controlled growth chamber and is equipped with sensors that relay real-time information about temperature, oxygen content, and moisture levels back to the ground team at Kennedy Space Center in Florida. In December 2020, the ISS crew feasted on radishes grown in the APH.
“But salad doesn’t give you any calories,” says Erik Seedhouse, a researcher at the Applied Aviation Sciences Department at Embry-Riddle Aeronautical University in Florida. “It gives you some minerals, but it doesn’t give you a lot of carbohydrates.” Seedhouse also noted in his 2020 book Life Support Systems for Humans in Space: “Integrating the growing of plants into a life support system is a fiendishly difficult enterprise.” As a case point, he referred to the ESA’s Micro-Ecological Life Support System Alternative (MELiSSA) program that has been running since 1989 to integrate growing of plants in a closed life support system such as a spacecraft.
Paille, one of the scientists running MELiSSA, says that the system aims to recycle the metabolic waste produced by crew members back into the metabolic resources required by them: “The aim is…to come [up with] a closed, sustainable system which does not [need] any logistics resupply.” MELiSSA uses microorganisms to process human excretions in order to harvest carbon dioxide and nitrate to grow plants. “Ideally, we would like a system which has zero waste and, therefore, needs zero input, zero additional resources,” Paille adds.
Microorganisms play a big role as “fuel” in food production in extreme places, including in space. Last year, researchers discovered Methylobacterium strains on the ISS, including some never-seen-before species. Kasthuri Venkateswaran of NASA’s Jet Propulsion Laboratory, one of the researchers involved in the study, says, “[The] isolation of novel microbes that help to promote the plant growth under stressful conditions is very essential… Certain bacteria can decompose complex matter into a simple nutrient [that] the plants can absorb.” These microbes, which have already adapted to space conditions—such as the absence of gravity and increased radiation—boost various plant growth processes and help withstand the harsh physical environment.
MELiSSA, says Paille, has demonstrated that it is possible to grow plants in space. “This is important information because…we didn’t know whether the space environment was affecting the biological cycle of the plant…[and of] cyanobacteria.” With the scientific and engineering aspects of a closed, self-sustaining life support system becoming clearer, she says, the next stage is to find out if it works in space. They plan to run tests recycling human urine into useful components, including those that promote plant growth.
The MELiSSA pilot plant uses rats currently, and needs to be translated for human subjects for further studies. “Demonstrating the process and well-being of a rat in terms of providing water, sufficient oxygen, and recycling sufficient carbon dioxide, in a non-stressful manner, is one thing,” Paille says, “but then, having a human in the loop [means] you also need to integrate user interfaces from the operational point of view.”
Growing food in space comes with an additional caveat that underscores its high stakes. Barbara Demmig-Adams from the Department of Ecology and Evolutionary Biology at the University of Colorado Boulder explains, “There are conditions that actually will hurt your health more than just living here on earth. And so the need for nutritious food and micronutrients is even greater for an astronaut than for [you and] me.”
Demmig-Adams, who has worked on increasing the nutritional quality of plants for long-duration spaceflight missions, also adds that there is no need to reinvent the wheel. Her work has focused on duckweed, a rather unappealingly named aquatic plant. “It is 100 percent edible, grows very fast, it’s very small, and like some other floating aquatic plants, also produces a lot of protein,” she says. “And here on Earth, studies have shown that the amount of protein you get from the same area of these floating aquatic plants is 20 times higher compared to soybeans.”
Aquatic plants also tend to grow well in microgravity: “Plants that float on water, they don’t respond to gravity, they just hug the water film… They don’t need to know what’s up and what’s down.” On top of that, she adds, “They also produce higher concentrations of really important micronutrients, antioxidants that humans need, especially under space radiation.” In fact, duckweed, when subjected to high amounts of radiation, makes nutrients called carotenoids that are crucial for fighting radiation damage. “We’ve looked at dozens and dozens of plants, and the duckweed makes more of this radiation fighter…than anything I’ve seen before.”
Despite all the scientific advances and promising leads, no one really knows what the conditions so far out in space will be and what new challenges they will bring. As Paille says, “There are known unknowns and unknown unknowns.”
One definite “known” for astronauts is that growing their food is the ideal scenario for space travel in the long term since “[taking] all your food along with you, for best part of two years, that’s a lot of space and a lot of weight,” as Seedhouse says. That said, once they land on Mars, they’d have to think about what to eat all over again. “Then you probably want to start building a greenhouse and growing food there [as well],” he adds.
And that is a whole different challenge altogether.
We are sticking our heads into the sand of reality on Omicron, and the results may be catastrophic.
Omicron is over 4 times more infectious than Delta. The Pfizer two-shot vaccine offers only 33% protection from infection. A Pfizer booster vaccine does raises protection to about 75%, but wanes to around 30-40 percent 10 weeks after the booster.
That’s because the much faster disease transmission and vaccine escape undercut the less severe overall nature of Omicron. That’s why hospitals have a large probability of being overwhelmed, as the Center for Disease Control warned, in this major Omicron wave.
Yet despite this very serious threat, we see the lack of real action. The federal government tightened international travel guidelines and is promoting boosters. Certainly, it’s crucial to get as many people to get their booster – and initial vaccine doses – as soon as possible. But the government is not taking the steps that would be the real game-changers.
Pfizer’s anti-viral drug Paxlovid decreases the risk of hospitalization and death from COVID by 89%. Due to this effectiveness, the FDA approved Pfizer ending the trial early, because it would be unethical to withhold the drug from people in the control group. Yet the FDA chose not to hasten the approval process along with the emergence of Omicron in late November, only getting around to emergency authorization in late December once Omicron took over. That delay meant the lack of Paxlovid for the height of the Omicron wave, since it takes many weeks to ramp up production, resulting in an unknown number of unnecessary deaths.
We humans are prone to falling for dangerous judgment errors called cognitive biases.
Widely available at-home testing would enable people to test themselves quickly, so that those with mild symptoms can quarantine instead of infecting others. Yet the federal government did not make tests available to patients when Omicron emerged in late November. That’s despite the obviousness of the coming wave based on the precedent of South Africa, UK, and Denmark and despite the fact that the government made vaccines freely available. Its best effort was to mandate that insurance cover reimbursements for these kits, which is way too much of a barrier for most people. By the time Omicron took over, the federal government recognized its mistake and ordered 500 million tests to be made available in January. However, that’s far too late. And the FDA also played a harmful role here, with its excessive focus on accuracy going back to mid-2020, blocking the widespread availability of cheap at-home tests. By contrast, Europe has a much better supply of tests, due to its approval of quick and slightly less accurate tests.
Neither do we see meaningful leadership at the level of employers. Some are bringing out the tired old “delay the office reopening” play. For example, Google, Uber, and Ford, along with many others, have delayed the return to the office for several months. Those that already returned are calling for stricter pandemic measures, such as more masks and social distancing, but not changing their work arrangements or adding sufficient ventilation to address the spread of COVID.
Despite plenty of warnings from risk management and cognitive bias experts, leaders are repeating the same mistakes we fell into with Delta. And so are regular people. For example, surveys show that Omicron has had very little impact on the willingness of unvaccinated Americans to get a first vaccine dose, or of vaccinated Americans to get a booster. That’s despite Omicron having taken over from Delta in late December.
What explains this puzzling behavior on both the individual and society level? We humans are prone to falling for dangerous judgment errors called cognitive biases. Rooted in wishful thinking and gut reactions, these mental blindspots lead to poor strategic and financial decisions when evaluating choices.
These cognitive biases stem from the more primitive, emotional, and intuitive part of our brains that ensured survival in our ancestral environment. This quick, automatic reaction of our emotions represents the autopilot system of thinking, one of the two systems of thinking in our brains. It makes good decisions most of the time but also regularly makes certain systematic thinking errors, since it’s optimized to help us survive. In modern society, our survival is much less at risk, and our gut is more likely to compel us to focus on the wrong information to make decisions.
One of the biggest challenges relevant to Omicron is the cognitive bias known as the ostrich effect. Named after the myth that ostriches stick their heads into the sand when they fear danger, the ostrich effect refers to people denying negative reality. Delta illustrated the high likelihood of additional dangerous variants, yet we failed to pay attention to and prepare for such a threat.
We want the future to be normal. We’re tired of the pandemic and just want to get back to pre-pandemic times. Thus, we greatly underestimate the probability and impact of major disruptors, like new COVID variants. That cognitive bias is called the normalcy bias.
When we learn one way of functioning in any area, we tend to stick to that way of functioning. You might have heard of this as the hammer-nail syndrome: when you have a hammer, everything looks like a nail. That syndrome is called functional fixedness. This cognitive bias causes those used to their old ways of action to reject any alternatives, including to prepare for a new variant.
Our minds naturally prioritize the present. We want what we want now, and downplay the long-term consequences of our current desires. That fallacious mental pattern is called hyperbolic discounting, where we excessively discount the benefits of orienting toward the future and focus on the present. A clear example is focusing on the short-term perceived gains of trying to return to normal over managing the risks of future variants.
The way forward into the future is to defeat cognitive biases and avoid denying reality by rethinking our approach to the future.
The FDA requires a serious overhaul. It’s designed for a non-pandemic environment, where the goal is to have a highly conservative, slow-going, and risk-averse approach so that the public feels confident trusting whatever it approved. That’s simply unacceptable in a fast-moving pandemic, and we are bound to face future pandemics in the future.
The federal government needs to have cognitive bias experts weigh in on federal policy. Putting all of its eggs in one basket – vaccinations – is not a wise move when we face the risks of a vaccine-escaping variant. Its focus should also be on expediting and prioritizing anti-virals, scaling up cheap rapid testing, and subsidizing high-filtration masks.
For employers, instead of dictating a top-down approach to how employees collaborate, companies need to adopt a decentralized team-led approach. Each individual team leader of a rank-and-file employee team should determine what works best for their team. After all, team leaders tend to know much more of what their teams need, after all. Moreover, they can respond to local emergencies like COVID surges.
At the same time, team leaders need to be trained to integrate best practices for hybrid and remote team leadership. Companies transitioned to telework abruptly as part of the March 2020 lockdowns. They fell into the cognitive bias of functional fixedness and transposed their pre-existing, in-office methods of collaboration on remote work. Zoom happy hours are a clear example: The large majority of employees dislike them, and research shows they are disconnecting, rather than connecting.
Yet supervisors continue to use them, despite the existence of much better methods of facilitating colalboration, which have been shown to work, such as virtual water cooler discussions, virtual coworking, and virtual mentoring. Leaders also need to facilitate innovation in hybrid and remote teams through techniques such as virtual asynchronous brainstorming. Finally, team leaders need to adjust performance evaluation to adapt to the needs of hybrid and remote teams.
On an individual level, people built up certain expectations during the first two years of the pandemic, and they don't apply with Omicron. For example, most people still think that a cloth mask is a fine source of protection. In reality, you really need an N-95 mask, since Omicron is so much more infectious. Another example is that many people don’t realize that symptom onset is much quicker with Omicron, and they aren’t prepared for the consequences.
Remember that we have a huge number of people who are asymptomatic, often without knowing it, due to the much higher mildness of Omicron. About 8% of people admitted to hospitals for other reasons in San Francisco test positive for COVID without symptoms, which we can assume translates for other cities. That means many may think they're fine and they're actually infectious. The result is a much higher chance of someone getting many other people sick.
During this time of record-breaking cases, you need to be mindful about your internalized assumptions and adjust your risk calculus accordingly. So if you can delay higher-risk activities, January and February might be the time to do it. Prepare for waves of disruptions to continue over time, at least through the end of February.
Of course, you might also choose to not worry about getting infected. If you are vaccinated and boosted, and do not have any additional health risks, you are very unlikely to have a serious illness due to Omicron. You can just take the small risk of a serious illness – which can happen – and go about your daily life. If doing so, watch out for those you care about who do have health concerns, since if you infect them, they might not have a mild case even with Omicron.
In short, instead of trying to turn back the clock to the lost world of January 2020, consider how we might create a competitive advantage in our new future. COVID will never go away: we need to learn to live with it. That means reacting appropriately and thoughtfully to new variants and being intentional about our trade-offs.