Last week the World Health Organization reported more than 15 million cases of COVID19, which is so high that they had to change the y-axis scale of their epi curve. During the WHO press conference, one advisor said, “
From an epidemiological standpoint, this information is fascinating. From a nursing standpoint, it is moderately terrifying. Here, in Virginia, our new governor has removed mask mandates for K-12 public schools, flaunting CDC recommendations, and opposes vaccine mandates for healthcare workers. I'd be interested in policy change impacts on our state but am not confident in his newly appointed cabinet members overseeing VHHS and VDH to adequately report. Time will tell.
Fellow Virginian here. I agree, it will be interesting (and terrifying) to watch. I am expecting that we will re-spike in feb after the school mask “choice” has been in effect for a few weeks. I am also hoping that the complete shut down for a week in the Fredericksburg region from the snow storm helped slow our local peak. I haven’t watched case numbers closely but the positivity rate is hovering around 45% for my health district and our total hospitalizations for the health system I work in have seemed to level out a bit.
I am confused about Virginia being blue on the capacity map. We are in crisis standards of care. I’m having a hard time seeing the individual county lines, but it doesn’t look like anything in our area is represented as being in trouble and we definitely are (Fredericksburg region). I can’t imagine that field hospital beds puts us back in the “has capacity” range?
My sibling is running for Congress in her home state and believes that parents should decide whether or not their children wear masks in school. I just can't see the logic other than stubbornly refusing to cede control over to a government agency.
I love your optimism about Omicron peaking, but with our vaunted federalist fragmented approach, the many unvaccinated libertarians, and the Supreme Court taking the virus's side it seems reasonable that the Omicron surge will continue by spreading into the remaining vulnerable areas of the US.
In my opinion the USA omicron surge will likely be prolonged as it reaches other parts of USA where population density is less and vaccination rates are lower. In these areas the medical system will be overwhelmed and substantial hospitalizations (and ICU) use will occur, with increased deaths. Mercantile activity will be impaired, even if kept open against public health advice. Then it is possible, given the R(t) of omicron the virus may flow back into the rest of the USA. This will result in more deaths, more disability, more stress on the health care system than in the leading countries we are watching, such as Denmark, South Africa, and Israel.
You state: "there will be the same number of new infections on the way down as there were on the way up." That would be true is the curve were symmetric, yet since the "down side" of South Africa's curve is fatter and taking longer (5+ weeks vs 3 for up), wouldn't there be *more* infections on the way down?
Also, when you state "African deaths are still increasing" - do you mean the *rate* of death is increasing (terrifying) or the *number* of deaths is increasing (which is sort of obvious, which is why I'm wondering if you mean *rate*)?
Again, thanks so much for helping all of us understand and know what to keep our eyes on.
I recently read a few posts from other people talking about how the down side of most covid curves have more cases than the upslope (approximate 40% before peak, 60% after peak of cases - and with a higher baseline after. Also several others talking about south african death *rates* still increasing and theorizing that omicron deaths happening later than earlier variants (more vascular damage causing heart attacks, strokes, kidney failure, fewer respiratory deaths). https://threadreaderapp.com/thread/1482847821397176325.html?fbclid=IwAR2-yjUR1R-UknI-m42SzSSzMKE13LxNMVB7CsDltERxT0tVDBP9lLQQX94
Would you be willing to accept $50 contributions so that the likes of the New York Times, Fox News, Bloomberg News, the Wall Street Journal, and Breitbart News can receive your emails?
I would love to see "absolute risk" of hospitalization expressed on a *per case* basis, with reasonable assumptions for true case counts. I loved your post last week on "denominator thinking" but the most important denominator - # of cases - is almost always left out of statements of risk. A key metric for "ending" the pandemic is when the risk of getting sick / dying is low assuming you catch the virus, instead of the risk assuming we're taking population-level steps (masks, isolation) to avoid it. In fact, expressions of absolute risk that implicitly include mitigation measures give people a false sense of security and lead to risky behavior / taking the pandemic too lightly.
Great summary - I agree that Omicron has torn through the US and collectively is on the decline but has laid waste on many health care systems ( and still is). Unequivocally this is a different disease ( for most) and the lack of anosmia and aguesia are telling re tissue tropism and diminished lower respiratory targeting as well.
THE REAL issue now is whether this massive wave of omicron ( primary and especially breakthrough) will be attended by Long COVID ({PASC) at a similar or hopefully diminished incidence as previous waves ( especially Delta) . No data as of yet because its too soon. IF ( a big IF) we knew that Omicron had a far less impacts chronically the justification of a'conservative' ( progressive?) proposed strategy of not taking vigorous NP efforts to risk mitigate ( no booster for all- Israel like program ... in young and low risk segments of the population ie not elderly or immunocompromised!) would be somewhat sensible. Since it can not be stopped
I think the unvaccinated are less likely to be tested because they generally don't think that covid is severe and they are less likely to interact with the health system. This can result in some strange results for example page 13 of https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1018416/Vaccine_surveillance_report_-_week_37_v2.pdf (may need to download, Safari doesn't like the mix of portrait and landscape) where for older ages the vaccinated have higher rates of covid. For hospitalisations and deaths everything makes sense because these are difficult to avoid.
Seems to me that we need to know fairly precisely the relationship between infectiousness and symptoms, particularly by immunity status (vaxxed, boosted, recovered, etc.) so that we can know how to proceed once this wave is down.
As I think about the "omicron wave" and people getting ready for "the next variant," I find myself thinking that the way omicron pushed out delta (and delta pushed out whatever was before delta) was by being more transmissible. Given the R(0) of omicron, the "next variant" would have to be REALLY, REALLY transmissible to push out omicron. Thus I see two scenarios: one where omicron and minor mutational variations becomes the ongoing, endemic variant for years to come; and another scarier one where a variant comes along that is even MORE transmissible and thus creates even more havoc in our civilization and society. Am I missing something?
It was really hard to imagine something could be more transmissible than Delta. It was a record setter for respiratory viruses. Then came Omicron, which looks like it doubled Delta's R(0). Given that this bug's been in billions of people at this point, I wonder how much evolutionary landscape it hasn't explored. With reconfigurable mRNA vax and good anti-virals and perhaps a pan-Corona vax, perhaps we'll do okay no matter what gets thrown our way...
It's about effective reproduction, not inherent transmissibility. Meaning, as more and more people are exposed to the Omicron spike, the ability for Omicron to spread goes down. The dominant strain is a combination of inherent properties of the virus strain and population factors, such as acquired immunity.
so then, if a new variant came out while "herd" immunity was still low and omicron's r(t) was still relatively high, it would 1) have to not be blocked by omicron immunity and 2) have an r(t) of its own, higher than that of omicron, in the moment - otherwise omi would continue to outcompete. There are a lot of moving parts but i think the biggest would be forward immunity, from omicron to the new variant. Absent that, you are correct, that if the new variant had an effective r(t) > omicron, secondary to omicron having infected everybody, its r(0) could be higher or lower than any previous variant.
Thank you for this update. When our local supermarket has to close 2 hours early for the last three weeks in highly boosted Ireland, Omicron is a lot more serious than I was hoping. The previous variants set the bar so low (with such serious illness) that the scale of what is happening now is beginning to sink in. It is sobering to read your and other trustworthy, data driven assessments.
The difference to last year is still there: I have yet to hear of anyone I know going to hospital in an ambulance because of covid this January. It was such a sad time. This time last year, the first Pfizer vaccines were given to the nursing home residents and hospital staff. I still hope that American citizens will have another look at American vaccines, that have the power to improve life for everyone.
Another solid update, thank you. Given how clearly the data is presented and diverse sources from which it originates, how can so many people continue to rely on conspiracy theories and conjecture for their health decisions? The vaccines work, they're incredibly low-risk, and widely available. US vaccination rates continue marching steadily upward, but what can be done to break the stranglehold of misinformation-guided decisions by the anti-vax crowd?
Thank you for the update. With so many kids/teens getting Omicron, I'm wondering if there's any data/guidance on getting a booster shot after you've had Omicron and qualify for a booster? My 15 year old son was vaccinated the moment he was eligible, but then got Covid over winter break while visiting his father (a mere week before boosters were approved for his age group). I'm curious if I should get him his booster now, later, or hold off. Thoughts?
What is your opinion of the qcovid.org risk assessment tool? The NYT published a link to it this morning claiming that it's broadly applicable outside of the UK, but a local epidemiologist in MI told me that the data was too old and the UK's medical environment too different for that to be applicable here in the US where the case rates are much higher than their tool permits.
Question- do we know how many times Covid -19 can pass from 1 person to another? More specifically, if A gives it to B and B gives it to C…. Is there a limited number of reinfections that can occur which might account for waves?
Is this explained by the idea that hospitalizations/deaths lag cases by a small duration (2-3 weeks)?
Also, is it plausible that cases are actually dropping here given they haven't yet started dropping significantly nationwide, and also that west-coast overall isn't showing the same trend? In other words, could this be bad data, or a regional anomaly that indicates a true-drop in cases?
From an epidemiological standpoint, this information is fascinating. From a nursing standpoint, it is moderately terrifying. Here, in Virginia, our new governor has removed mask mandates for K-12 public schools, flaunting CDC recommendations, and opposes vaccine mandates for healthcare workers. I'd be interested in policy change impacts on our state but am not confident in his newly appointed cabinet members overseeing VHHS and VDH to adequately report. Time will tell.
Fellow Virginian here. I agree, it will be interesting (and terrifying) to watch. I am expecting that we will re-spike in feb after the school mask “choice” has been in effect for a few weeks. I am also hoping that the complete shut down for a week in the Fredericksburg region from the snow storm helped slow our local peak. I haven’t watched case numbers closely but the positivity rate is hovering around 45% for my health district and our total hospitalizations for the health system I work in have seemed to level out a bit.
I am confused about Virginia being blue on the capacity map. We are in crisis standards of care. I’m having a hard time seeing the individual county lines, but it doesn’t look like anything in our area is represented as being in trouble and we definitely are (Fredericksburg region). I can’t imagine that field hospital beds puts us back in the “has capacity” range?
My sibling is running for Congress in her home state and believes that parents should decide whether or not their children wear masks in school. I just can't see the logic other than stubbornly refusing to cede control over to a government agency.
The best summary in a while. If one reads this and still doesn't get it, he is reading in the wrong language!!
I love your optimism about Omicron peaking, but with our vaunted federalist fragmented approach, the many unvaccinated libertarians, and the Supreme Court taking the virus's side it seems reasonable that the Omicron surge will continue by spreading into the remaining vulnerable areas of the US.
And then what will happen?
In my opinion the USA omicron surge will likely be prolonged as it reaches other parts of USA where population density is less and vaccination rates are lower. In these areas the medical system will be overwhelmed and substantial hospitalizations (and ICU) use will occur, with increased deaths. Mercantile activity will be impaired, even if kept open against public health advice. Then it is possible, given the R(t) of omicron the virus may flow back into the rest of the USA. This will result in more deaths, more disability, more stress on the health care system than in the leading countries we are watching, such as Denmark, South Africa, and Israel.
Thanks for your excellent summaries.
You state: "there will be the same number of new infections on the way down as there were on the way up." That would be true is the curve were symmetric, yet since the "down side" of South Africa's curve is fatter and taking longer (5+ weeks vs 3 for up), wouldn't there be *more* infections on the way down?
Also, when you state "African deaths are still increasing" - do you mean the *rate* of death is increasing (terrifying) or the *number* of deaths is increasing (which is sort of obvious, which is why I'm wondering if you mean *rate*)?
Again, thanks so much for helping all of us understand and know what to keep our eyes on.
I recently read a few posts from other people talking about how the down side of most covid curves have more cases than the upslope (approximate 40% before peak, 60% after peak of cases - and with a higher baseline after. Also several others talking about south african death *rates* still increasing and theorizing that omicron deaths happening later than earlier variants (more vascular damage causing heart attacks, strokes, kidney failure, fewer respiratory deaths). https://threadreaderapp.com/thread/1482847821397176325.html?fbclid=IwAR2-yjUR1R-UknI-m42SzSSzMKE13LxNMVB7CsDltERxT0tVDBP9lLQQX94
https://graphics.reuters.com/world-coronavirus-tracker-and-maps/countries-and-territories/south-africa/
https://www.facebook.com/dale.w.harrison/posts/5159417130744222
Dear Katelyn,
Would you be willing to accept $50 contributions so that the likes of the New York Times, Fox News, Bloomberg News, the Wall Street Journal, and Breitbart News can receive your emails?
I would love to see "absolute risk" of hospitalization expressed on a *per case* basis, with reasonable assumptions for true case counts. I loved your post last week on "denominator thinking" but the most important denominator - # of cases - is almost always left out of statements of risk. A key metric for "ending" the pandemic is when the risk of getting sick / dying is low assuming you catch the virus, instead of the risk assuming we're taking population-level steps (masks, isolation) to avoid it. In fact, expressions of absolute risk that implicitly include mitigation measures give people a false sense of security and lead to risky behavior / taking the pandemic too lightly.
THE QUESTION OF OMICRON AND PASC/Long COVID
Great summary - I agree that Omicron has torn through the US and collectively is on the decline but has laid waste on many health care systems ( and still is). Unequivocally this is a different disease ( for most) and the lack of anosmia and aguesia are telling re tissue tropism and diminished lower respiratory targeting as well.
THE REAL issue now is whether this massive wave of omicron ( primary and especially breakthrough) will be attended by Long COVID ({PASC) at a similar or hopefully diminished incidence as previous waves ( especially Delta) . No data as of yet because its too soon. IF ( a big IF) we knew that Omicron had a far less impacts chronically the justification of a'conservative' ( progressive?) proposed strategy of not taking vigorous NP efforts to risk mitigate ( no booster for all- Israel like program ... in young and low risk segments of the population ie not elderly or immunocompromised!) would be somewhat sensible. Since it can not be stopped
Love collective thoughts on this
I think the unvaccinated are less likely to be tested because they generally don't think that covid is severe and they are less likely to interact with the health system. This can result in some strange results for example page 13 of https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1018416/Vaccine_surveillance_report_-_week_37_v2.pdf (may need to download, Safari doesn't like the mix of portrait and landscape) where for older ages the vaccinated have higher rates of covid. For hospitalisations and deaths everything makes sense because these are difficult to avoid.
So, what's next?
Seems to me that we need to know fairly precisely the relationship between infectiousness and symptoms, particularly by immunity status (vaxxed, boosted, recovered, etc.) so that we can know how to proceed once this wave is down.
https://twitter.com/ScottGottliebMD/status/1483445587446018048?s=20
For the non-naïve immune, can we use symptoms as starting point for mitigation or will we miss too much transmission and be stuck with another cycle?
Also, has anyone done any research into what Omicron reinfection cycle might look like?
And, has anyone done any estimates or modelling on how many immune naïve will be left after this wave?
As I think about the "omicron wave" and people getting ready for "the next variant," I find myself thinking that the way omicron pushed out delta (and delta pushed out whatever was before delta) was by being more transmissible. Given the R(0) of omicron, the "next variant" would have to be REALLY, REALLY transmissible to push out omicron. Thus I see two scenarios: one where omicron and minor mutational variations becomes the ongoing, endemic variant for years to come; and another scarier one where a variant comes along that is even MORE transmissible and thus creates even more havoc in our civilization and society. Am I missing something?
It was really hard to imagine something could be more transmissible than Delta. It was a record setter for respiratory viruses. Then came Omicron, which looks like it doubled Delta's R(0). Given that this bug's been in billions of people at this point, I wonder how much evolutionary landscape it hasn't explored. With reconfigurable mRNA vax and good anti-virals and perhaps a pan-Corona vax, perhaps we'll do okay no matter what gets thrown our way...
It's about effective reproduction, not inherent transmissibility. Meaning, as more and more people are exposed to the Omicron spike, the ability for Omicron to spread goes down. The dominant strain is a combination of inherent properties of the virus strain and population factors, such as acquired immunity.
That's R(t) you're talking about. R(0) would be transmission in a completely naive population with no mitigation strategies....I think.
Yep - i think you have it correct. R(t) is a changing number, while r(0) is pretty fixed.
so then, if a new variant came out while "herd" immunity was still low and omicron's r(t) was still relatively high, it would 1) have to not be blocked by omicron immunity and 2) have an r(t) of its own, higher than that of omicron, in the moment - otherwise omi would continue to outcompete. There are a lot of moving parts but i think the biggest would be forward immunity, from omicron to the new variant. Absent that, you are correct, that if the new variant had an effective r(t) > omicron, secondary to omicron having infected everybody, its r(0) could be higher or lower than any previous variant.
Thank you for this update. When our local supermarket has to close 2 hours early for the last three weeks in highly boosted Ireland, Omicron is a lot more serious than I was hoping. The previous variants set the bar so low (with such serious illness) that the scale of what is happening now is beginning to sink in. It is sobering to read your and other trustworthy, data driven assessments.
The difference to last year is still there: I have yet to hear of anyone I know going to hospital in an ambulance because of covid this January. It was such a sad time. This time last year, the first Pfizer vaccines were given to the nursing home residents and hospital staff. I still hope that American citizens will have another look at American vaccines, that have the power to improve life for everyone.
Another solid update, thank you. Given how clearly the data is presented and diverse sources from which it originates, how can so many people continue to rely on conspiracy theories and conjecture for their health decisions? The vaccines work, they're incredibly low-risk, and widely available. US vaccination rates continue marching steadily upward, but what can be done to break the stranglehold of misinformation-guided decisions by the anti-vax crowd?
Thank you for the update. With so many kids/teens getting Omicron, I'm wondering if there's any data/guidance on getting a booster shot after you've had Omicron and qualify for a booster? My 15 year old son was vaccinated the moment he was eligible, but then got Covid over winter break while visiting his father (a mere week before boosters were approved for his age group). I'm curious if I should get him his booster now, later, or hold off. Thoughts?
What is your opinion of the qcovid.org risk assessment tool? The NYT published a link to it this morning claiming that it's broadly applicable outside of the UK, but a local epidemiologist in MI told me that the data was too old and the UK's medical environment too different for that to be applicable here in the US where the case rates are much higher than their tool permits.
I really can't see why it is left there, as it doesn't cover Delta or Omicron.
Question- do we know how many times Covid -19 can pass from 1 person to another? More specifically, if A gives it to B and B gives it to C…. Is there a limited number of reinfections that can occur which might account for waves?
King county (Seattle) is reporting a drop in cases, but hospitalizations and deaths are still going up.
https://kingcounty.gov/depts/health/covid-19/data/daily-summary.aspx.
Is this explained by the idea that hospitalizations/deaths lag cases by a small duration (2-3 weeks)?
Also, is it plausible that cases are actually dropping here given they haven't yet started dropping significantly nationwide, and also that west-coast overall isn't showing the same trend? In other words, could this be bad data, or a regional anomaly that indicates a true-drop in cases?