Well, Omicron continues to show its colors across the globe with case rates surging far beyond what we've seen with any previous waves, like in Denmark and the UK.
I think a lot of people are underestimating the effect of Omicron even if it is mild on staffing at hospitals and the resulting horrific effects on the public health system. If, on any given day, a significant % of health care workers are out for a week say with a mild case of Omicron....
A local physician was on TV this week saying that "there is no slack in the system" in regard to local health systems. They're calling in national guard doctors and nurses...many of whom are likely doctors and nurses in their civilian lives. This seems like it could create an entirely new form of staffing issues.
It looks like they are reviewing the quarantine guidelines and considering decreasing them for vaccinated and boosted individuals who test positive. I think the UK did this - I believe only 5 days if vaccinated and boosted? Or to possibly be able to test out of quarantine - for example produce 2 negative tests within x period of time. But, with hospitals at/near capacity and suffering staffing shortages, 5 days is still extremely impactful and unmanageable.
There is so much talk about having a booster being so important to being fully protected, but what about the kids 5-11 who only recently got their shots? Or kids 12-15 who got shots months ago and are not approved for boosters? Are they considered protected? For how long, 2 months? 6 months? I feel like their level of protection will drop before they are approved for a booster. Is this concerning or not since they don't tend to get as sick?
we got evidence from the UK showing that those that got their second shot within the past 9 weeks is the same protective level as those that just got their booster. i'm confident that 5-11 year olds will be fully protected against omicron. i have more of a question for 12-15 year olds, and haven't seen any data on this recently.
This seems a bit concerning since it suggests that we will need very frequent boosters (quarterly??) without a lot of real progress. Am I missing something?
Actually, that's not what I'd expect at all. Quarterly would raise issues with development of humoral AND cellular immunity because the timeframe isn't long enough.
Probably not. I expect a 3rd dose to provide elevated humoral immunity and better recruited cellular immunity than we saw with the original series for a bunch of reasons that the literature has explored thoroughly.
There's been chatter that their immune response remains significant and they are protected. I've not seen anything published to that effect, just heard the chatter.
Thank you for asking this, too. I asked it as well! This has been my resounding question since the talk of having a booster intensified over the past month. Hopefully we can get an answer!
On a daily basis, I am awed by the quality of the writing and amount of actionable insight in your posts. Its a model for modern analytics where experts collaborate across many public available datasets to distill real knowledge. I've been building analytics teams for 25+ years and this is some of the best work, maybe THE best, work I've ever seen.
I was curious about this line "By next week Omicron could easily account for 100% of cases". Does that imply Alpha and Delta will be gone? Or should I read that as "approaching 100%"?
Alpha and Delta will be at least displaced as Omicron will predominate. Its increased ability to produce more replicatable virus particles will cause the infection rate to overwhel, at least transiently, Alpha and Delta. They won't be gone and may reemerge when Omicron's done overwhelming the population.
I'm leaning toward basing our expectations more on the UK experience than the S. Africa experience. Part of this could be cultural bias, but I also think our healthcare systems are more similar to UK than SA. Thus, I'm leaning toward Omicron not being significantly less serious than Delta, and when coupled to its increased transmission rate will pose a significant loading problem to the healthcare system.
A recent article from CDC, based on a study in Iowa strongly indicates the benefit of masks in preventing or reducing spread; it's time for us to bite the bullet and mandate masks for all, and to define a minimum standard for what an adequate mask is (I'm leaning toward good-quality KN95, KN94 [Korean standard], or N95, as approved by NIOSH and OSHA; and, well-fitted, without leaks).
Looks like American N95 and European FFP2 are roughly comparable, but there's an interesting note that says that as much as 70% of Chinese KN95 masks may not meet the American N95 standard. Not sure if that's just due to the differences in the certifying standard or if it's due to other shenanigans going on.
A number of the imported KN95s did not meet standards and have had their FDA EUAs revoked. The KN94 standard is similar to the N95 standard, and originates from Korea.
THANK YOU! I finally paid you today for this good work as a yearly subscriber. I appreciate you more than you know to give timely reliable guidance for my young children!
I’m so exhausted. I just canceled Christmas with family and I feel like I’m the only person in the world who has done this. I’m vaccinated and boosted and family is vaccinated but not boosted but the infection numbers are just so high that I’m still scared. Just saw a WaPo article where docs said we need to just move on if we are vaccinated but I just can’t get my head in that space. There’s no one to ask for advice and the experts are all over the place with recommendations.
Hang in there, Sharon. There are a lot of us that are cancelling Christmas plans, travel plans, wearing masks, and not dining in restaurants. Don't let the media and social media squeaky wheels make you think that you're alone in protecting yourself and your family. We'll get through this together, just stay the course.
Nope, ur not alone, I did it too. Shouting matches ensued. Grandparents are pissed and I’ve retained a family lawyer if my wife continues to prioritize nostalgia over health.
I am boosted, but only on top of J and J.
My wife is boosted, but pregnant.
My toddler son is a toddler, gulp.
The powers that be are using language such as “this will be a disease of the unvaccinated” and “it will find the unvaccinated”.
I am diagnosed OCD.
My symptoms are contamination of my family.
What a profoundly beautiful opportunity we have to immediately save lives just by staying home. Still people want to go out.
I know lots of people doing this. The way I figure it is that even if it ends up that it was relatively safe to visit relatives, there is so much unknown right now. If your visit is full of anxiety, it's not going to be much fun anyway. My mother always said, "Christmas is just a day," and we would have celebrations whenever we could get together, even if just a random weekend in the year.
Sharon, you're not alone. We'd cancelled Christmas with the kids but for other reasons. Tonight, we cancelled going out to dinner for the foreseeable future. My wife and I are vaccinated, boosted, but we live in a state where too many people think the virus and vaccines are hoaxes. Add self-testing to your protocol. That will give you some peace of mind, and will also make sure you can seek care immediately if you do happen to get a breakthrough case. Consider that most of the hospital and ICU admissions are unvaccinated, either with or without prior COVID infection. Omicron doesn't care much about prior infection but does respect, at least to some extent, vaccination because of the larger spectrum of antigens presented to the immune system for sensitivity.
Overall, the real experts are pretty much talking the same lines: The variance is all minor.
Be well and consider you made an informed decision, and go ahead. I can tell you I understand not spending the holidays with family: I did that all too many times in my training. It isn't much fun, but I made sure someone with wife and kids was home since I was single. And most holidays in this season, our hospital was slow, so I could take call from home. Still wasn't the same, and I think I've got some sense of how you're going to feel this weekend.
Take care of yourself, and know your decision was the right one, because you did it for the right reasons.
Thank you...I rely on your emails for all my decision-making. You are amazing -- not only an exceptional science writer, but you are also so on top of the news. I cannot tell you how grateful I am for your work. Question: I am totally lost about how to respond. Totally hunker down like it was March 2020 because my vaccine and booster are not enough? Or scale back on non-essential things and up the mask game to N95s, but allow my kids to continue with their indoor rock climbing team and school in 2 weeks? I can't figure out how to balance the impact on my kids' mental health of isolation with the risk of Omicron. I don't want to get sick and I live in Florida where it is "business as usual" and "every man for himself."
A very grateful, long-time reader here, Katelyn. I so appreciate your solid, scientific insight and empowering recommendations for how we can live safely and stay healthy in this unprecedented time.
I have one question: if someone received their first Pfizer mRNA vaccine in early July and their second Pfizer mRNA vaccine three weeks later in late July, are they eligible to be boosted now? From what I read on the CDC site, a booster is recommended 6 months after the second vaccine, which would mean this person needs a booster in late January?
The messaging in the media and in some medical sources is very confusing because they're giving a blanket statement to "Go get boosted." But there are millions of people who did not get their initial round of vaccines until later in summer or the fall. What does this mean for those folks?
Thank you again so much for your consistency, care and generosity here.
There's a line of thinking that we should have delayed 2nd doses of the mRNA vaccines to 3-6 months for maximum effectiveness. That said, the 6-month interval after full vaccination is based on a population statistic of waning circulating IgG antibodies, and a decrease in efficacy in prevention. That said, the original and stated intent of the vaccines was not to prevent disease but to moderate it and prevent SERIOUS disease and death. A booster well after completion of the original vaccine regimen reactivates the generation of IgG and IgM (with questionable action on IgA). This will create a circulating antibody pool that can moderate or prevent acute infection. In effect, our 3rd dose is about when we could have had our second, and likely achieved more'r'less the same effect in the long term. Another consideration, however, was that at the time, we NEEDED a heightened immune response to neutralize a virus in an active surge, so from that perspective, maybe we didn't do so bad with a 3 or 4 week interval. As with a lot of things, the tradeoffs have to be considered.
Our son received J & J and just received an MRNa booster. Am I reading this right that what may be needed is not a booster dose but a full series with an MRNa vaccine, i.e. he could now need two full shots? With you on the need for clarity re J & J. There are 14 million people out there and CDC needs to be much clearer about what they should do. Thank you!
A single booster of mRNA, probably preferring Moderna (but, how old is your son?) will provide sufficient humeral immunity and will help sensitize the cellular immune system. He should not need a full course of an mRNA vaccine.
My son also got the J&J. I read it as "we don't know." Antibodies may be low, but looks like T cell protection is quite strong. I haven't even convinced my son to get the booster yet, so your son is in a good place!
Mine too. I continue to watch, but we haven't seen/heard anything yet for that age group. Definitely looking forward to it! No sooner did we get her little brother's vaccinated, than our young teen hit that 6 month mark, and I don't know what to think. Add Omicron and my decision making is messy at best.
One of the consequences of having all the exposure and connectivity today is the potential for myocarditis is now much more visible than it would have been before. Incidence remains very low, but higher than baseline. Virtually all who contract it resolve in several days, and most go to the ICU because the ER doc draws a troponin level and it's high, and (s)he goes, "Wow, this guy's awfully young to be having a heart attack," not having put 2+2 together. Cardiologist starts following them, does a coupe days of serial labs, discharges them from the ICU direct to home.
Thank you so much for keeping us up to date. With so many people now testing and getting positive results for asymptomatic infections, I’d love to see a future post on how those people — and those who have been in close contact with them — should change their behavior. I recently learned, after being notified of a close contact exposure, that the CDC is *still* recommending people like me quarantine for 10 days, even though I’m boosted, have no symptoms, have had a negative PCR and multiple negative at-home Binax test results, and did not even spend much time with the infected person (who is also vaccinated and asymptomatic). I’m not going to quarantine for 10 days, but I also can’t get any guidance on what I *should* be doing. I’d love a future post on advice on this topic!
Unless I am misunderstanding (did you test positive?), that is not correct. “People who are fully vaccinated do NOT need to quarantine after contact with someone who had COVID-19 unless they have symptoms. However, fully vaccinated people should get tested 5-7 days after their exposure, even if they don’t have symptoms and wear a mask indoors in public for 14 days following exposure or until their test result is negative.” Via https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
On the other hand, if you tested positive, you need to isolate, not quarantine. Vaccination status doesn’t matter if you test positive. The protocol is the same.
You may be well-protected, but the person next to you may not be. If you tested positive after being exposed to a vaccinated, asymptomatic person for a short time, why do you think *you* (also vaccinated and asymptomatic) can’t transmit? Omicron is highly contagious. Asymptomatic spread is real. Please isolate.
I've seen this a lot: isolate versus quarantine. Reality is that there is no difference. The action is the same, the description changes once the isolated person is confirmed to be infected, at that point he is quarantined. The other concern is that few average Americans have the facilities or resources to effectively do either.
No. Let’s get these terms straight. If someone is positive, they isolate. If someone is exposed to a positive case, they quarantine to see if symptoms develop and/or they test positive—at which point quarantine transitions to isolation.
No, it does not, and that is not what you said. You are mixing them up. Please re-read your comment.
For example, students can quarantine at home if exposed to a positive classmate but do not need to isolate from their families. That’s completely unrealistic. Isolation needed if test positive or develop symptoms. This is a science page, let’s be accurate.
In this example the student who tested positive did not isolate,
and quarantine will have no effect because the family members are free to leave the quarantine area... You are correct both are unrealistic for the average person.
Denmark: 89.6% of Omicron cases are double or triple vaccinated with the unvaxed being 8.5%, contrast that to other all other variants 73% double or triple vaxxed, unvaxed 23.8%. It would seem that Omicron prefers the vaccinated by a wide margin, why?
And isn’t it important to look at severity of cases not just rate of infection? I’d rather not get infected at all but if I do I’d darn well prefer my vaccinated self have a much more mild case than your typical case for an unvaccinated patient?
Denmark has administered at least 11,402,735 doses of COVID vaccines so far. Assuming every person needs 2 doses, that’s enough to have vaccinated about 98% of the country’s population.
Without knowing the vaccination rate of the general population, the percent infected is meaningless. If 100% of the country had been vaccinated then *every* omicron case would be among the vaccinated.
but lets say we have 1000 people in Denmark infected. you'd expect 980 vaccinated people and 20 unvaxxed. Instead, according to those percentages, you have 730 vaccinated and 238 unvaxxed. From those numbers is clear that it prefers unvaxxed people by a huge margin.
Again... all meaningless unless you know the percent of population that is vaxxed.
I also think something else could be at play. This is the holidays, and the vaxxed would (on average) tend to probably want to get tested before going home to families on holidays. Whereas the unvaxxed would tend to not get tested. How many are sick?
I guess I'm not seeing the same data you're seeing. Went to the official site. If omicron were actually preferring unvaxxed, since it now accounts for more than 1/2 the cases, you'd expect to see at *least* the same numbers for vaxxed and unvaxxed, but I don't see that.
I do see an interesting preference for partially vaxxed though.
I'm a mediocre analyst at best but I think the ratio change we are seeing between Omicron and other variants reflects its ability to break through vaccination in some cases. So its not that it prefers the vaccinated. Its that is more effective against the vaccinated than other variants are.
I’m also curious why you would include a model that assumes Omicron is more severe than Delta when there is no evidence to that effect. It feels like disaster porn.
I've had that discussion with the lay public in several areas of modeling. My wife and I have it on a regular basis about weather forecasts. Perhaps the best line I know of, and one I subscribe to completely: All models are wrong, but some are useful.
I was puzzled by how CDC determined that 73% of US cases were Omicron it turns out that is a model-based estimate with a wide CI. I hope you point that out to readers if you haven't done so.
Love, love, love your newsletter. Thank you. Please comment on the use of Evusheld monoclonal antibody treatment for immunocompromised people who can’t develop antibodies with the vaccine or booster. Is there any indication of when it might become available? It is very hard to be vaccinated and boostered, yet still have 0 antibodies. I feel like a ticking time bomb.
I think a lot of people are underestimating the effect of Omicron even if it is mild on staffing at hospitals and the resulting horrific effects on the public health system. If, on any given day, a significant % of health care workers are out for a week say with a mild case of Omicron....
i completely agree. a small percentage will have a big effect
A local physician was on TV this week saying that "there is no slack in the system" in regard to local health systems. They're calling in national guard doctors and nurses...many of whom are likely doctors and nurses in their civilian lives. This seems like it could create an entirely new form of staffing issues.
It looks like they are reviewing the quarantine guidelines and considering decreasing them for vaccinated and boosted individuals who test positive. I think the UK did this - I believe only 5 days if vaccinated and boosted? Or to possibly be able to test out of quarantine - for example produce 2 negative tests within x period of time. But, with hospitals at/near capacity and suffering staffing shortages, 5 days is still extremely impactful and unmanageable.
There is so much talk about having a booster being so important to being fully protected, but what about the kids 5-11 who only recently got their shots? Or kids 12-15 who got shots months ago and are not approved for boosters? Are they considered protected? For how long, 2 months? 6 months? I feel like their level of protection will drop before they are approved for a booster. Is this concerning or not since they don't tend to get as sick?
we got evidence from the UK showing that those that got their second shot within the past 9 weeks is the same protective level as those that just got their booster. i'm confident that 5-11 year olds will be fully protected against omicron. i have more of a question for 12-15 year olds, and haven't seen any data on this recently.
This seems a bit concerning since it suggests that we will need very frequent boosters (quarterly??) without a lot of real progress. Am I missing something?
Actually, that's not what I'd expect at all. Quarterly would raise issues with development of humoral AND cellular immunity because the timeframe isn't long enough.
So should we be choreographing our vaccination with anticipated seasonal waves?
Probably not. I expect a 3rd dose to provide elevated humoral immunity and better recruited cellular immunity than we saw with the original series for a bunch of reasons that the literature has explored thoroughly.
So you think Dose 3 is inherently more durable?
There's been chatter that their immune response remains significant and they are protected. I've not seen anything published to that effect, just heard the chatter.
I like that chatter.
Thank you for this. That helps to know about my youngest. Now those older two…
Thank you for asking this, too. I asked it as well! This has been my resounding question since the talk of having a booster intensified over the past month. Hopefully we can get an answer!
On a daily basis, I am awed by the quality of the writing and amount of actionable insight in your posts. Its a model for modern analytics where experts collaborate across many public available datasets to distill real knowledge. I've been building analytics teams for 25+ years and this is some of the best work, maybe THE best, work I've ever seen.
I was curious about this line "By next week Omicron could easily account for 100% of cases". Does that imply Alpha and Delta will be gone? Or should I read that as "approaching 100%"?
Alpha and Delta will be at least displaced as Omicron will predominate. Its increased ability to produce more replicatable virus particles will cause the infection rate to overwhel, at least transiently, Alpha and Delta. They won't be gone and may reemerge when Omicron's done overwhelming the population.
I don’t understand this either.
I'm leaning toward basing our expectations more on the UK experience than the S. Africa experience. Part of this could be cultural bias, but I also think our healthcare systems are more similar to UK than SA. Thus, I'm leaning toward Omicron not being significantly less serious than Delta, and when coupled to its increased transmission rate will pose a significant loading problem to the healthcare system.
A recent article from CDC, based on a study in Iowa strongly indicates the benefit of masks in preventing or reducing spread; it's time for us to bite the bullet and mandate masks for all, and to define a minimum standard for what an adequate mask is (I'm leaning toward good-quality KN95, KN94 [Korean standard], or N95, as approved by NIOSH and OSHA; and, well-fitted, without leaks).
I've been doing some digging on mask standards in different countries recently and found the following article: https://www.medtecs.com/ffp2-vs-kn95-vs-n95-vs-kf94/
Looks like American N95 and European FFP2 are roughly comparable, but there's an interesting note that says that as much as 70% of Chinese KN95 masks may not meet the American N95 standard. Not sure if that's just due to the differences in the certifying standard or if it's due to other shenanigans going on.
Look here: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-protective-equipment-euas
A number of the imported KN95s did not meet standards and have had their FDA EUAs revoked. The KN94 standard is similar to the N95 standard, and originates from Korea.
THANK YOU! I finally paid you today for this good work as a yearly subscriber. I appreciate you more than you know to give timely reliable guidance for my young children!
I’m so exhausted. I just canceled Christmas with family and I feel like I’m the only person in the world who has done this. I’m vaccinated and boosted and family is vaccinated but not boosted but the infection numbers are just so high that I’m still scared. Just saw a WaPo article where docs said we need to just move on if we are vaccinated but I just can’t get my head in that space. There’s no one to ask for advice and the experts are all over the place with recommendations.
Hang in there, Sharon. There are a lot of us that are cancelling Christmas plans, travel plans, wearing masks, and not dining in restaurants. Don't let the media and social media squeaky wheels make you think that you're alone in protecting yourself and your family. We'll get through this together, just stay the course.
Agreed. I'm very tired of the voices preaching that covid safety is no big deal anymore.
Nope, ur not alone, I did it too. Shouting matches ensued. Grandparents are pissed and I’ve retained a family lawyer if my wife continues to prioritize nostalgia over health.
I am boosted, but only on top of J and J.
My wife is boosted, but pregnant.
My toddler son is a toddler, gulp.
The powers that be are using language such as “this will be a disease of the unvaccinated” and “it will find the unvaccinated”.
I am diagnosed OCD.
My symptoms are contamination of my family.
What a profoundly beautiful opportunity we have to immediately save lives just by staying home. Still people want to go out.
I know lots of people doing this. The way I figure it is that even if it ends up that it was relatively safe to visit relatives, there is so much unknown right now. If your visit is full of anxiety, it's not going to be much fun anyway. My mother always said, "Christmas is just a day," and we would have celebrations whenever we could get together, even if just a random weekend in the year.
Sharon, you're not alone. We'd cancelled Christmas with the kids but for other reasons. Tonight, we cancelled going out to dinner for the foreseeable future. My wife and I are vaccinated, boosted, but we live in a state where too many people think the virus and vaccines are hoaxes. Add self-testing to your protocol. That will give you some peace of mind, and will also make sure you can seek care immediately if you do happen to get a breakthrough case. Consider that most of the hospital and ICU admissions are unvaccinated, either with or without prior COVID infection. Omicron doesn't care much about prior infection but does respect, at least to some extent, vaccination because of the larger spectrum of antigens presented to the immune system for sensitivity.
Overall, the real experts are pretty much talking the same lines: The variance is all minor.
Be well and consider you made an informed decision, and go ahead. I can tell you I understand not spending the holidays with family: I did that all too many times in my training. It isn't much fun, but I made sure someone with wife and kids was home since I was single. And most holidays in this season, our hospital was slow, so I could take call from home. Still wasn't the same, and I think I've got some sense of how you're going to feel this weekend.
Take care of yourself, and know your decision was the right one, because you did it for the right reasons.
Brilliant as always. Thank you.
Thank you...I rely on your emails for all my decision-making. You are amazing -- not only an exceptional science writer, but you are also so on top of the news. I cannot tell you how grateful I am for your work. Question: I am totally lost about how to respond. Totally hunker down like it was March 2020 because my vaccine and booster are not enough? Or scale back on non-essential things and up the mask game to N95s, but allow my kids to continue with their indoor rock climbing team and school in 2 weeks? I can't figure out how to balance the impact on my kids' mental health of isolation with the risk of Omicron. I don't want to get sick and I live in Florida where it is "business as usual" and "every man for himself."
A very grateful, long-time reader here, Katelyn. I so appreciate your solid, scientific insight and empowering recommendations for how we can live safely and stay healthy in this unprecedented time.
I have one question: if someone received their first Pfizer mRNA vaccine in early July and their second Pfizer mRNA vaccine three weeks later in late July, are they eligible to be boosted now? From what I read on the CDC site, a booster is recommended 6 months after the second vaccine, which would mean this person needs a booster in late January?
The messaging in the media and in some medical sources is very confusing because they're giving a blanket statement to "Go get boosted." But there are millions of people who did not get their initial round of vaccines until later in summer or the fall. What does this mean for those folks?
Thank you again so much for your consistency, care and generosity here.
There's a line of thinking that we should have delayed 2nd doses of the mRNA vaccines to 3-6 months for maximum effectiveness. That said, the 6-month interval after full vaccination is based on a population statistic of waning circulating IgG antibodies, and a decrease in efficacy in prevention. That said, the original and stated intent of the vaccines was not to prevent disease but to moderate it and prevent SERIOUS disease and death. A booster well after completion of the original vaccine regimen reactivates the generation of IgG and IgM (with questionable action on IgA). This will create a circulating antibody pool that can moderate or prevent acute infection. In effect, our 3rd dose is about when we could have had our second, and likely achieved more'r'less the same effect in the long term. Another consideration, however, was that at the time, we NEEDED a heightened immune response to neutralize a virus in an active surge, so from that perspective, maybe we didn't do so bad with a 3 or 4 week interval. As with a lot of things, the tradeoffs have to be considered.
Our son received J & J and just received an MRNa booster. Am I reading this right that what may be needed is not a booster dose but a full series with an MRNa vaccine, i.e. he could now need two full shots? With you on the need for clarity re J & J. There are 14 million people out there and CDC needs to be much clearer about what they should do. Thank you!
A single booster of mRNA, probably preferring Moderna (but, how old is your son?) will provide sufficient humeral immunity and will help sensitize the cellular immune system. He should not need a full course of an mRNA vaccine.
My son also got the J&J. I read it as "we don't know." Antibodies may be low, but looks like T cell protection is quite strong. I haven't even convinced my son to get the booster yet, so your son is in a good place!
Any word on boosters for 12-15 year olds? It has been 6 months for mine.
Mine too. I continue to watch, but we haven't seen/heard anything yet for that age group. Definitely looking forward to it! No sooner did we get her little brother's vaccinated, than our young teen hit that 6 month mark, and I don't know what to think. Add Omicron and my decision making is messy at best.
One of the consequences of having all the exposure and connectivity today is the potential for myocarditis is now much more visible than it would have been before. Incidence remains very low, but higher than baseline. Virtually all who contract it resolve in several days, and most go to the ICU because the ER doc draws a troponin level and it's high, and (s)he goes, "Wow, this guy's awfully young to be having a heart attack," not having put 2+2 together. Cardiologist starts following them, does a coupe days of serial labs, discharges them from the ICU direct to home.
Messy at best is exactly it.
Thank you so much for keeping us up to date. With so many people now testing and getting positive results for asymptomatic infections, I’d love to see a future post on how those people — and those who have been in close contact with them — should change their behavior. I recently learned, after being notified of a close contact exposure, that the CDC is *still* recommending people like me quarantine for 10 days, even though I’m boosted, have no symptoms, have had a negative PCR and multiple negative at-home Binax test results, and did not even spend much time with the infected person (who is also vaccinated and asymptomatic). I’m not going to quarantine for 10 days, but I also can’t get any guidance on what I *should* be doing. I’d love a future post on advice on this topic!
Unless I am misunderstanding (did you test positive?), that is not correct. “People who are fully vaccinated do NOT need to quarantine after contact with someone who had COVID-19 unless they have symptoms. However, fully vaccinated people should get tested 5-7 days after their exposure, even if they don’t have symptoms and wear a mask indoors in public for 14 days following exposure or until their test result is negative.” Via https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
Thanks for the citation. This is what we have been doing in NY, so was surprised to read the original comment.
On the other hand, if you tested positive, you need to isolate, not quarantine. Vaccination status doesn’t matter if you test positive. The protocol is the same.
You may be well-protected, but the person next to you may not be. If you tested positive after being exposed to a vaccinated, asymptomatic person for a short time, why do you think *you* (also vaccinated and asymptomatic) can’t transmit? Omicron is highly contagious. Asymptomatic spread is real. Please isolate.
I've seen this a lot: isolate versus quarantine. Reality is that there is no difference. The action is the same, the description changes once the isolated person is confirmed to be infected, at that point he is quarantined. The other concern is that few average Americans have the facilities or resources to effectively do either.
No. Let’s get these terms straight. If someone is positive, they isolate. If someone is exposed to a positive case, they quarantine to see if symptoms develop and/or they test positive—at which point quarantine transitions to isolation.
Yep, exactly what I said. each term still means to "Stay apart - alone".
No, it does not, and that is not what you said. You are mixing them up. Please re-read your comment.
For example, students can quarantine at home if exposed to a positive classmate but do not need to isolate from their families. That’s completely unrealistic. Isolation needed if test positive or develop symptoms. This is a science page, let’s be accurate.
In this example the student who tested positive did not isolate,
and quarantine will have no effect because the family members are free to leave the quarantine area... You are correct both are unrealistic for the average person.
Wow, I didn't know this. This isn't even the advice in New York, where we have been more careful than many states.
In the early days household size was a pretty big risk factor.
Denmark: 89.6% of Omicron cases are double or triple vaccinated with the unvaxed being 8.5%, contrast that to other all other variants 73% double or triple vaxxed, unvaxed 23.8%. It would seem that Omicron prefers the vaccinated by a wide margin, why?
it may be base rate bias (see previous post here: https://yourlocalepidemiologist.substack.com/p/israel-50-of-infected-are-vaccinated). OR omicron prefers immune evasion.
And isn’t it important to look at severity of cases not just rate of infection? I’d rather not get infected at all but if I do I’d darn well prefer my vaccinated self have a much more mild case than your typical case for an unvaccinated patient?
South Africa reports the unvaccinated are showing zero or mild symptoms.
Unvaccinated or vaccinated? Given the charts posted in this article, it seems like it would be the vaccinated who are showing zero or mild symptoms.
Unvaccinated!
In Denmark according to a quick google.
Vaccination
Denmark has administered at least 11,402,735 doses of COVID vaccines so far. Assuming every person needs 2 doses, that’s enough to have vaccinated about 98% of the country’s population.
Without knowing the vaccination rate of the general population, the percent infected is meaningless. If 100% of the country had been vaccinated then *every* omicron case would be among the vaccinated.
but lets say we have 1000 people in Denmark infected. you'd expect 980 vaccinated people and 20 unvaxxed. Instead, according to those percentages, you have 730 vaccinated and 238 unvaxxed. From those numbers is clear that it prefers unvaxxed people by a huge margin.
Again... all meaningless unless you know the percent of population that is vaxxed.
The base rate is not applicable for relative comparison. Look at my post again and contrast the "omicron" versus "all other variants" percentages!
I also think something else could be at play. This is the holidays, and the vaxxed would (on average) tend to probably want to get tested before going home to families on holidays. Whereas the unvaxxed would tend to not get tested. How many are sick?
With Delta, triple vaxed 95% effective. Omicron, 70%. Unvaxxed, 0% for both. Plug and chug and your example is explained.
100 people. 80% vaxxed. Delta. 4 vaxxed and 20 unvaxxed. Omicron 24 vaxxed and 20 unvaxxed.
By percentage. Delta 4/24 = 17% vaxxed, 83% unvaxxed.
Omicron 24/44 = 55% vaxxed, 45% unvaxxed.
I guess I'm not seeing the same data you're seeing. Went to the official site. If omicron were actually preferring unvaxxed, since it now accounts for more than 1/2 the cases, you'd expect to see at *least* the same numbers for vaxxed and unvaxxed, but I don't see that.
I do see an interesting preference for partially vaxxed though.
https://experience.arcgis.com/experience/aa41b29149f24e20a4007a0c4e13db1d/page/page_5/
https://files.ssi.dk/covid19/omikron/statusrapport/rapport-omikronvarianten-21122021-14tk Table 4, page 7
I'm a mediocre analyst at best but I think the ratio change we are seeing between Omicron and other variants reflects its ability to break through vaccination in some cases. So its not that it prefers the vaccinated. Its that is more effective against the vaccinated than other variants are.
Exactly.
And... Denmark has a more robust surveillance testing system than we do here.
I’m also curious why you would include a model that assumes Omicron is more severe than Delta when there is no evidence to that effect. It feels like disaster porn.
to provide an upper and lower bound?
I agree, and uncertainty in modeling is something that I constantly struggle to explain to laypeople in my role, too.
I've had that discussion with the lay public in several areas of modeling. My wife and I have it on a regular basis about weather forecasts. Perhaps the best line I know of, and one I subscribe to completely: All models are wrong, but some are useful.
This is a good sound bite and one I need to remember.
I can only claim that, in the meteorology world it's taken as a truism.
I was puzzled by how CDC determined that 73% of US cases were Omicron it turns out that is a model-based estimate with a wide CI. I hope you point that out to readers if you haven't done so.
It's also an estimate with a much narrower CI based on reports from state labs. I'm fairly confident this number is solid.
Love, love, love your newsletter. Thank you. Please comment on the use of Evusheld monoclonal antibody treatment for immunocompromised people who can’t develop antibodies with the vaccine or booster. Is there any indication of when it might become available? It is very hard to be vaccinated and boostered, yet still have 0 antibodies. I feel like a ticking time bomb.