First, thank you for your work. You have become an essential info source for me. Please don't take what I'm about to say too badly. From where you are, you can't see what's happening the UK. You can only see what gets published about it.
I live in England adjacent to Wales. Some of my view of the NHS is from family and friends who work in it.
From across the Pond, it may look to you like our NHS is not close to capacity because our case rate isn't as high as it got last year. You may not be aware that the NHS does not have the resources it had in earlier waves. Notice I said resources, not funding. We do not have all our health care workers (HCWs) any more. Many are ill or have been left disabled (and unable to do their work) by the remarkably high incidence of Long COVID or have been exhausted to the point of taking early retirement or resigning or committing suicide. Remaining HCWs seldom have access to the higher grade face masks now being recommended by many experts to fend of Omicron.
Our government said to carry on, dropped nearly all COVID measures 19 July, even told us this month to go ahead with holiday parties. But children under age 12 are unvaccinated. Schools are open with no masks in classrooms, no ventilation improvements (our ventilation is often poor), fully packed classes, no remote teaching any more, and prosecution of parents who try to keep their children out (as some clinically extremely vulnerable friends are trying to do in self-defense). So children get it (often half or more of a classroom at a time), an entire household gets it from each of them, and then everyone they interact with gets it.
People often take lateral flow tests before events and only attend if their result is negative. The false negative rate for those tests is relatively high. With previous variants, one false negative might result in a few people at the event getting COVID. Now, it is common for one false negative to result in all or nearly all attendees getting COVID from an event of just a couple of hours. Our prevalence rate is so high that if you have a gathering of, say, 40 people, statistically you must expect at least one attendee to have the virus.
Some examples of impact on the NHS? The entire Appointments team for a certain hospital was taken out by COVID from their holiday party, despite everyone's LFT being negative beforehand. A hospital tried to force admin staff to feed patients with no one properly trained available to turn to if something goes wrong such as a patient choking. Admin staff are as overworked as clinical staff, so that didn't fly. They're now using untrained volunteers. Even with non-urgent care cancelled, there aren't enough trained HCWs.
Hospitals are not the only part of the system at an extreme. The average wait for an ambulance for a heart attack or stroke was 55 minutes just before the distortions of Christmas break. That's supposed to be just a few minutes. For other critical health matters, it is now common to wait 4 or 5 hours for an ambulance, and then for the ambulance to wait as much as half a day before being able to transfer the patient into A&E (Accident & Emergency). For those who do get hospital care, there aren't enough home health care workers, partly due to COVID and partly due to Brexit. As a result, patients often cannot be discharged when they are ready because they can't be provided with enough support to get by outside the hospital. That blocks beds, which has ripple effects all the way through to ambulance availability.
The NHS is held together by the sheer willpower of those who remain able to work in it. The bit of help from the military is nowhere near enough. Outside the government, the surge of workload shaping up for January after holiday gatherings looks like it will be disastrous.
Thanks for adding the additional layer behind the case and hospitalization numbers. I'm in British Columbia, and while my Health Authority is in reasonable shape, I know of many parts of the Canadian healthcare system that are struggling with staffing issues as you mention. The case numbers may not be as high as last year, but the system capacity is also not as high.
Dr. Jetelina, thank you. Thank you for digesting all of this information into bites for everyone to understand. I am a Registered Nurse with nearly 20 years critical care and flight nursing and having undergone the H1N1 epidemic and now COVID 19. Your work is important and valuable. As I live in a rural part of Idaho, the pandemic has not "hit here" yet. No masks, vaccination rates are horrendous, it's all a hoax, etc., despite the medical community begging people to heed their advice. The devil is always in the details and for me that is stats, but meaningful and understandable stats - which you provide. While I'm feeding the resident cow, myriad roaming sheep and goats, a flock of pigs, I think about the items you post and the relevance to our community. I wish there is a way to harness your knowledge and expertise to convince the reluctant many to heed the advice. Thanks for all you do and know you impact our medical world.
I wish you would have discussed the CDC recommendations for healthcare workers. Hospitals in staffing crisis can bring back employees with “mild symptoms”..? The CDC lost me on these new guidance recommendations. Their lack of transparency is quite frankly disgusting and negligent. They may not have planted the seeds of doubt that keep so many from getting vaccinated, but they have certainly thrown a lot of water on those seeds. All these reactive changes and very little public education. Clearly some people don’t understand how science works and they have done nothing to solve this problem.
I can tell you the nurses at the hospital where I work are nearing a breaking point and giving permission to the management to make Covid related call offs punitive will backfire in a very messy way. We should be paying attention to the AACN that speaks of 60% of critical care nurses are thinking about leaving… it’s more like 80% in my ICU. This situation is untenable and will end up costing lives.
thanks all for your concern!! we are doing well. just low grade fevers, lots of snot, and a very tired mama. thankful for getting through slowly but surely
Also, does anyone else feel that the our vaccinated 12-15 year olds are being penalized for doing the right thing and getting vaccinated as soon as possible? Many are more than 6 months out but not eligible for a booster. They’re going to have to quarantine constantly at this rate.
Steve and I send our best for your family and hope that all heal easily and rapidly.
While you care for others, please, remember to care for yourself. Let yourself have breaks when you can with something that relaxes you and removes tension whether it be a mystery, punching the air while visualizing the illness, taking a walk, or whatever else may help you.
thank you SO much for this update. The CDC guideline change confuses me too. I hope they show us data that supports this change soon.
I am sorry to hear that SARS-COV-2 has finally found it’s way into your home. It has in mine too, despite our best efforts. Reading your updates gives me such validation, I can’t thank you enough. I’ve been the protocol enforcer for so long both at home and at work (I’m a veterinarian); it’s exhausting. To know that covid has finally made it into my own home makes me feel like a failure. Your newsletter makes me feel like I’m not fighting this alone. Thank you so much for your support and I hope your family feels better soon! <3
Omicron is making everywhere a hot mess. Hit me on Christmas. Luckily rapid testing seems to have stopped the chain with me.
Was very mildly symptomatic for a couple of days with neg tests. Got two consecutive pos by adding a throat swab before nose. So far, like mild cold. Fingers crossed. Will retest tomorrow.
Take care of your family and take a break from this! Proirities!
Dr. Jetelina, I want to offer thanks for your newsletter. I help to lead the COVID response for a university, and your material is key for us. It is objective, written incredibly well, and balances detail and complexity, all while remaining easily intelligible. It is truly a great blessing. Thank you.
I’m looking at the data you are showing on the uncoupling of cases and hospitalization. Is it too early to really tell or do you think there has been enough time to asses initial patterns? Thank you!!
yeah looking at cases and hospitalizations right now is a bit of a mess. cases today are probably largely Omicron (but Delta is definitely mixed in there). the hospitalizations are still due to Delta though. so we *should* see even more de-coupling in the coming weeks
Have any of the studies on pediatric cases looked at whether adults in the family are vaccinated? In other words, since my kids are too young to be vaccinated, have I (& my husband) reduced their risk at all by being vaccinated myself?
'Dr. Amy Edwards, a pediatric infectious disease doctor at UH Rainbow Babies and Children’s, said this kind of uptick in hospitalized children due to COVID is new..
“We worry about school and we worry about that sort of stuff, and certainly with omicron and even with delta, we did see a lot more school transmission than we used to see with COVID, and with omicron that’s only going to get worse,” Dr. Edwards said. “But it’s still true that the vast majority of pediatric COVID comes from adult or teenage family members. So if those adults and teenagers are vaccinated, that helps protect those unvaccinated one and two and three and four-year-olds.”
I think it is also important to look at who is being check in "with covid" or the test came up for it. Everyone that gets admitted gets a test. In DFW, the check in "with covid" is in the older kids eligible for the vaccine, pre-dom. Also, I encourage you to look at raw numbers and not percent. If you had 5 kids yesterday and then 10 today a % is scary. To your other question, all of us are at risk for COVID at this point, it is just how your body will handle it. Plenty of my friends and their family have COVID right now and the parents are boosters and the kids are vaxx as recently as Dec 1
I don’t think that “decoupling” between cases and hospitalizations will hold. There just hasn’t been enough time since the case spike hit for the hospitalizations to hit. Maryland is now 2 weeks in to cases spiking and our hospitalizations are taking off. Our hospitals are shifting to crisis standards of care and our Covid admits are about to hit an all time high - and the cases are nowhere near peaking. We are in trouble and our state is fairly well vaccinated.
I think I'd prefer it if you would give us the links directly. The link that you're providing is a substack blog with what appears to be a fair amount of bias
(Danish study) The negative estimates in the final period arguably suggest different behaviour and/or exposure patterns in the vaccinated and unvaccinated cohorts causing underestimation of the VE. This was likely the result of Omicron spreading rapidly initially through single (super-spreading) events causing many infections among young, vaccinated individuals.
A recent study from England (in preprint) found higher effectiveness against symptomatic Omicron initially after BNT162b2 vaccination followed by a rapid decline in protection, and that VE increased to 75.5% (56.1 to 86.3%) two weeks after booster vaccination using unvaccinated individuals as comparison.
Our study contributes to emerging evidence that BNT162b2 or mRNA-1273 primary vaccine protection against Omicron decreases quickly over time with booster vaccination offering a significant increase in protection.
The quote is from Danish study that you used as evidence of negative vaccine efficiency. The authors of study wrote in the discussion section that severeal early superspreader events is most likely responsible.
Last I heard Indiana is down to around 250 icu beds out of about 2100. In the hospital were I work a vast majority are unvaccinated. And none in the icu but a few very immunocomprimised patients.
First, thank you for your work. You have become an essential info source for me. Please don't take what I'm about to say too badly. From where you are, you can't see what's happening the UK. You can only see what gets published about it.
I live in England adjacent to Wales. Some of my view of the NHS is from family and friends who work in it.
From across the Pond, it may look to you like our NHS is not close to capacity because our case rate isn't as high as it got last year. You may not be aware that the NHS does not have the resources it had in earlier waves. Notice I said resources, not funding. We do not have all our health care workers (HCWs) any more. Many are ill or have been left disabled (and unable to do their work) by the remarkably high incidence of Long COVID or have been exhausted to the point of taking early retirement or resigning or committing suicide. Remaining HCWs seldom have access to the higher grade face masks now being recommended by many experts to fend of Omicron.
Our government said to carry on, dropped nearly all COVID measures 19 July, even told us this month to go ahead with holiday parties. But children under age 12 are unvaccinated. Schools are open with no masks in classrooms, no ventilation improvements (our ventilation is often poor), fully packed classes, no remote teaching any more, and prosecution of parents who try to keep their children out (as some clinically extremely vulnerable friends are trying to do in self-defense). So children get it (often half or more of a classroom at a time), an entire household gets it from each of them, and then everyone they interact with gets it.
People often take lateral flow tests before events and only attend if their result is negative. The false negative rate for those tests is relatively high. With previous variants, one false negative might result in a few people at the event getting COVID. Now, it is common for one false negative to result in all or nearly all attendees getting COVID from an event of just a couple of hours. Our prevalence rate is so high that if you have a gathering of, say, 40 people, statistically you must expect at least one attendee to have the virus.
Some examples of impact on the NHS? The entire Appointments team for a certain hospital was taken out by COVID from their holiday party, despite everyone's LFT being negative beforehand. A hospital tried to force admin staff to feed patients with no one properly trained available to turn to if something goes wrong such as a patient choking. Admin staff are as overworked as clinical staff, so that didn't fly. They're now using untrained volunteers. Even with non-urgent care cancelled, there aren't enough trained HCWs.
Hospitals are not the only part of the system at an extreme. The average wait for an ambulance for a heart attack or stroke was 55 minutes just before the distortions of Christmas break. That's supposed to be just a few minutes. For other critical health matters, it is now common to wait 4 or 5 hours for an ambulance, and then for the ambulance to wait as much as half a day before being able to transfer the patient into A&E (Accident & Emergency). For those who do get hospital care, there aren't enough home health care workers, partly due to COVID and partly due to Brexit. As a result, patients often cannot be discharged when they are ready because they can't be provided with enough support to get by outside the hospital. That blocks beds, which has ripple effects all the way through to ambulance availability.
The NHS is held together by the sheer willpower of those who remain able to work in it. The bit of help from the military is nowhere near enough. Outside the government, the surge of workload shaping up for January after holiday gatherings looks like it will be disastrous.
Thanks for adding the additional layer behind the case and hospitalization numbers. I'm in British Columbia, and while my Health Authority is in reasonable shape, I know of many parts of the Canadian healthcare system that are struggling with staffing issues as you mention. The case numbers may not be as high as last year, but the system capacity is also not as high.
Dr. Jetelina, thank you. Thank you for digesting all of this information into bites for everyone to understand. I am a Registered Nurse with nearly 20 years critical care and flight nursing and having undergone the H1N1 epidemic and now COVID 19. Your work is important and valuable. As I live in a rural part of Idaho, the pandemic has not "hit here" yet. No masks, vaccination rates are horrendous, it's all a hoax, etc., despite the medical community begging people to heed their advice. The devil is always in the details and for me that is stats, but meaningful and understandable stats - which you provide. While I'm feeding the resident cow, myriad roaming sheep and goats, a flock of pigs, I think about the items you post and the relevance to our community. I wish there is a way to harness your knowledge and expertise to convince the reluctant many to heed the advice. Thanks for all you do and know you impact our medical world.
I wish you would have discussed the CDC recommendations for healthcare workers. Hospitals in staffing crisis can bring back employees with “mild symptoms”..? The CDC lost me on these new guidance recommendations. Their lack of transparency is quite frankly disgusting and negligent. They may not have planted the seeds of doubt that keep so many from getting vaccinated, but they have certainly thrown a lot of water on those seeds. All these reactive changes and very little public education. Clearly some people don’t understand how science works and they have done nothing to solve this problem.
I can tell you the nurses at the hospital where I work are nearing a breaking point and giving permission to the management to make Covid related call offs punitive will backfire in a very messy way. We should be paying attention to the AACN that speaks of 60% of critical care nurses are thinking about leaving… it’s more like 80% in my ICU. This situation is untenable and will end up costing lives.
Hospital employees can come back with "mild symptoms" but can't come back if they are not vaccinated, but test negative?
I’m crisis mode there are no restrictions on either population
Wait… am I reading this correctly? Did Covid infiltrate your family? Are you all ok?
thanks all for your concern!! we are doing well. just low grade fevers, lots of snot, and a very tired mama. thankful for getting through slowly but surely
Do you think you picked it up due to holiday travel or other exposure?
Also, does anyone else feel that the our vaccinated 12-15 year olds are being penalized for doing the right thing and getting vaccinated as soon as possible? Many are more than 6 months out but not eligible for a booster. They’re going to have to quarantine constantly at this rate.
It’s in the news today. Coming very soon. Check out Washington Post if you can.
Reuters is reporting the Delta airlines CEO pushed to have the CDC change the quarantine guidelines. So it seems less a scientific decision, and more a political decision. https://www.reuters.com/business/aerospace-defense/delta-ceo-asks-cdc-cut-quarantine-time-breakthrough-covid-cases-2021-12-21/
Steve and I send our best for your family and hope that all heal easily and rapidly.
While you care for others, please, remember to care for yourself. Let yourself have breaks when you can with something that relaxes you and removes tension whether it be a mystery, punching the air while visualizing the illness, taking a walk, or whatever else may help you.
thank you SO much for this update. The CDC guideline change confuses me too. I hope they show us data that supports this change soon.
I am sorry to hear that SARS-COV-2 has finally found it’s way into your home. It has in mine too, despite our best efforts. Reading your updates gives me such validation, I can’t thank you enough. I’ve been the protocol enforcer for so long both at home and at work (I’m a veterinarian); it’s exhausting. To know that covid has finally made it into my own home makes me feel like a failure. Your newsletter makes me feel like I’m not fighting this alone. Thank you so much for your support and I hope your family feels better soon! <3
Omicron is making everywhere a hot mess. Hit me on Christmas. Luckily rapid testing seems to have stopped the chain with me.
Was very mildly symptomatic for a couple of days with neg tests. Got two consecutive pos by adding a throat swab before nose. So far, like mild cold. Fingers crossed. Will retest tomorrow.
Take care of your family and take a break from this! Proirities!
So sorry to hear you and your family are under the weather with COVID.. Hope its all mild cases and you guys have a fast recovery..
Dr. Jetelina, I want to offer thanks for your newsletter. I help to lead the COVID response for a university, and your material is key for us. It is objective, written incredibly well, and balances detail and complexity, all while remaining easily intelligible. It is truly a great blessing. Thank you.
I’m looking at the data you are showing on the uncoupling of cases and hospitalization. Is it too early to really tell or do you think there has been enough time to asses initial patterns? Thank you!!
yeah looking at cases and hospitalizations right now is a bit of a mess. cases today are probably largely Omicron (but Delta is definitely mixed in there). the hospitalizations are still due to Delta though. so we *should* see even more de-coupling in the coming weeks
Has the CDC shared the evidence to back up these changes yet?
Um, no.
Have any of the studies on pediatric cases looked at whether adults in the family are vaccinated? In other words, since my kids are too young to be vaccinated, have I (& my husband) reduced their risk at all by being vaccinated myself?
Anecdotal (not studies)
'Dr. Amy Edwards, a pediatric infectious disease doctor at UH Rainbow Babies and Children’s, said this kind of uptick in hospitalized children due to COVID is new..
“We worry about school and we worry about that sort of stuff, and certainly with omicron and even with delta, we did see a lot more school transmission than we used to see with COVID, and with omicron that’s only going to get worse,” Dr. Edwards said. “But it’s still true that the vast majority of pediatric COVID comes from adult or teenage family members. So if those adults and teenagers are vaccinated, that helps protect those unvaccinated one and two and three and four-year-olds.”
Dr. Edwards said one of the patterns they’ve noticed is the vast majority of kids who are hospitalized with COVID have parents who are unvaccinated.' https://www.wkyc.com/article/news/health/coronavirus/coronavirus-numbers/northeast-ohio-doctors-report-more-kids-hospitalized-for-covid-19/95-9e49d724-9ab7-449f-8a95-02d8f47804ac?fbclid=IwAR0ds9wdRVqnX3bk5E1iB65mf7zbPQNJ9_z1AJ9HMNUZKX0GWp9IcK4G2I0
I think it is also important to look at who is being check in "with covid" or the test came up for it. Everyone that gets admitted gets a test. In DFW, the check in "with covid" is in the older kids eligible for the vaccine, pre-dom. Also, I encourage you to look at raw numbers and not percent. If you had 5 kids yesterday and then 10 today a % is scary. To your other question, all of us are at risk for COVID at this point, it is just how your body will handle it. Plenty of my friends and their family have COVID right now and the parents are boosters and the kids are vaxx as recently as Dec 1
Katelyn...just subscribed. Cannot thank you enough for what you do! My best to you & yours.
I don’t think that “decoupling” between cases and hospitalizations will hold. There just hasn’t been enough time since the case spike hit for the hospitalizations to hit. Maryland is now 2 weeks in to cases spiking and our hospitalizations are taking off. Our hospitals are shifting to crisis standards of care and our Covid admits are about to hit an all time high - and the cases are nowhere near peaking. We are in trouble and our state is fairly well vaccinated.
Your state may be well vaccinated, as is ours, but early data is indicating that the vaccine has *negative* efficacy vs. omicron for cases:
https://boriquagato.substack.com/p/more-evidence-on-omicron-vaccine
Time will tell how this relates to hospitalizations.
Not for hospitalizations, where T cells are protective. In South Africa, prior infection was also protective for hospitalization.
Do you have any reputable sources for this claim? My (lay) understanding was that OAS isn't really a big deal for Covid compares to other illnesses
The studies are linked in the article, as well as this one. Look for the blue text linking to the data sources. https://boriquagato.substack.com/p/vaccine-evasion-and-and-oas-signal
I think I'd prefer it if you would give us the links directly. The link that you're providing is a substack blog with what appears to be a fair amount of bias
(Danish study) The negative estimates in the final period arguably suggest different behaviour and/or exposure patterns in the vaccinated and unvaccinated cohorts causing underestimation of the VE. This was likely the result of Omicron spreading rapidly initially through single (super-spreading) events causing many infections among young, vaccinated individuals.
A recent study from England (in preprint) found higher effectiveness against symptomatic Omicron initially after BNT162b2 vaccination followed by a rapid decline in protection, and that VE increased to 75.5% (56.1 to 86.3%) two weeks after booster vaccination using unvaccinated individuals as comparison.
Our study contributes to emerging evidence that BNT162b2 or mRNA-1273 primary vaccine protection against Omicron decreases quickly over time with booster vaccination offering a significant increase in protection.
Thank you. Let me know when your study comes out.
It looks like those super-spreading events among the young, vaccinated have now also occurred in Germany and Canada too!
https://boriquagato.substack.com/p/vaccine-evasion-and-and-oas-signal
The quote is from Danish study that you used as evidence of negative vaccine efficiency. The authors of study wrote in the discussion section that severeal early superspreader events is most likely responsible.
https://www.medrxiv.org/content/10.1101/2021.12.20.21267966v2.full.pdf
so sorry to hear this.. may i ask if the majority of hospitalizations are unvaccinated or both? thank you
Last I heard Indiana is down to around 250 icu beds out of about 2100. In the hospital were I work a vast majority are unvaccinated. And none in the icu but a few very immunocomprimised patients.
Majority (definitely not all) of Covid hospitalizations in Maryland are unvaccinated
Wishing your family a quick recovery. Thank you for all that you do.