Thread by @ReportingHealth

THIS MORNING: Join us for our webinar featuring @celinegounder, who will brief us on the latest happening with the Omicron variant. Live tweets happening here at 10 a.m. PT. #Thread

https://twitter.com/ReportingHealth/status/1468665489668730884

@celinegounder @celinegounder is an infectious diseases specialist, internist and epidemiologist. She is a clinical assistant professor of medicine and infectious diseases at @nyugrossman and cares for patients at Bellevue Hospital Center. She also founded @justhuman501c3.

Public health officials are talking about a triple whammy -- Omicron, the Delta variant, plus the seasonal flu. Join us now for this talk.

Where do things stand with #Omicron? @celinegounder says we've seen Omicron numbers spiking. In NY, NJ, Puerto Rico and Virgin Islands surveillance area, 13% of COVID cases are the Omicron variant. "I suspect those numbers will shoot up dramatically."

Look for an Omicron wave peaking in January and coming down in February, @celinegounder says. We already saw delta spiking before Thanksgiving, w/ hospitalizations and deaths increasing. We'll see Delta continue to contribute to cases and deaths in coming weeks.

It's unclear whether Delta or Omicron will come to dominate cases in the United States or globally in the coming weeks, @celinegounder says. Vaccines and antibodies from prior infection provide some level of protection.

Omciron will lead to an increasing burden on the healthcare system in the coming months, Gounder says.

Omicron continues to be described as "mild." That's a result of lower case fatality rates, @celinegounder says. How virulent or severe a disease is an infected individual depends on the age and other demographics. It should be qualified by immune status, age, demographic.

What's the virulence across demographic groups? Ages? Immune status? Once you identify that and look beyond data based solely upon generalized population status, you can draw better conclusions.

Omicron data can also be misleading. You won't find Omicron cases if you don't test. No every specimen gets genomic sequencing. It wasn't surprising for CA to get the first Omicron case b/c they are testing a lot of cases and are a big state.

Antibodies are like strips of velcro @celinegounder says. One strip may be enough to recognize the virus before. Now you may need 20 or 40 strips with Omicron. A certain number of antibodies with a certain stickiness could recognize prior variants. They aren't as sticky w/omicron

You're trying to increase the range of variants that the immune system can recognize. The short term benefit of a vaccine booster shot is to override numbers, @celinegounder says.

There are some potential downsides to switching to an Omicron specific vaccine, @celinegounder says. We don't know how well such a vaccine would work in other variants, like Delta.

Our immune system makes guesses at how pathogens will evolve and stay ahead of the virus. A third dose of vaccine may give our immune system the hint to keep guessing and increase the range of other variants it needs to recognize. #omicron

The CDC released its forecast yesterday about fears of transmissibility coming true. What further analysis is being done here and abroad, and how do journalists stay on top of it? Read primary literature, preprints, science literature, @celinegounder says

#Protip: become friends with a scientist who can help you understand preprint studies -- somebody who understands virology, immunology, etc. Lots of preprints get spun by lay media w/o understanding or context and they've been used to promote disinformation about vaccines.

A study today reports you have relatively higher levels of omicron in the bronchi vs the lungs when compared to Delta and other variants. It could explain how omicron might be less virulent, @celinegounder says.

The White House and leading scientists are advising COVID boosters. Other scientists say they're not necessary, pointing to T-cells and B-cells. @celinegounder says it's less about science and more about what's being prevented. Long covid? Hospitalizations? Severe disease? Death?

The White House vaccine booster strategy was to stop all infections. That's not possible, @celinegounder says. It's a respiratory virus transmitted through mucosal surfaces. Immunity on those surfaces isn't good. 2nd: incubation period is 3-4 days or 2-3 days for Omicron

Measles has a much longer incubation period. It's a race between your immune system and the virus. Usually we give a vaccine series then antibodies wane. You're reliant then upon memory cells, which take 4-5 days to kick-in. Incubation periods of 2-3 days is less time

The point here? Your memory cells won't move fast enough to entirely prevent COVID infection unless you continually get boosted. Be clear on what we need to prevent and why, @celinegounder says. Setting goal posts on preventing all infections is unrealistic.

Vaccines prior to omicron had been holding up well in most populations in preventing severe disease, hospitalizations and deaths, @celinegounder says. Initial CDC guidance was for those at risk of those outcomes -- elderly, immunocompromised, etc.

With emergence of omicron, it makes sense to get a booster, @celinegounder says. But interest for that booster should be in limiting hospitalizations, severe disease and death.

"COVID is something we're going to be dealing with for decades to come. This is our new normal. This is our new life." -@celinegounder

There's a continued role of the media to hold us all accountable to continue public health efforts and address COVID. Loss of media coverage often = loss of public health efforts.

How do immunocompromised, elderly and other high-risk groups deal with Omicron? Get a booster, @celinegounder says, but understand that you're still at risk of a breakthrough infection. Layer your protections.

Other protective measures? Masks (up your game with N95 respirators, KN95 or KF94, surgical masks or cloth masks are OK, but way less effective.) Open doors and windows; use a HEPA air filtration unit; gather outdoors; test before gathering, etc.

Insurance companies will be reimbursing for rapid tests, @celinegounder says, and WH will be making rapid tests available for free through some community centers, food banks, etc. It's not enough, though, she says.

Testing really needs to be everyday now with 0-3 day incubation period of Omicron when spending time during the holidays, @celinegounder says.

What should local and state jurisdictions do to prepare for Omicron and Delta waves? For hospitals: plans around elective procedures to reallocate staffing for needed care. Look at staffing agencies to bring in outside staff. For PH: increase wastewater surveillance.

Increase genomic surveillance to understand what variants are present; and then continue to push for vaccination of unvaccinated people. Push community outreach and educate public about preferred masks, @celinegounder says.

How about long-covid and Omicron? We don't know a lot about it, @celinegounder says. You could have ongoing replication of the virus in the body, an autoimmune response where immune system turns against body, etc. We need to know how long covid forms to know how to prevent it.

Ideal scenario is to be vaccinated, then if you have a breakthrough infection your severity is reduced, and hopefully if you get Paxlovid or another anti-viral pill it could potentially reduce risk of long covid.

What determines frequency of testing? How quickly you turn positive from time of exposure. For Omicron, incubation period (time of exposure to time of symptoms) is 0-3 days.

With emergence of Omicron, we should be testing daily. For the holidays, you're using rapid testing as a way to decide whether to take off your masks ahead of a gathering. These are concentrated periods of exposure where you'll want to behave more freely, @celinegounder says.

The most important thing if you can't daily test is to mask and improve ventilation and air purification of rooms where gatherings take place, like classrooms, @celinegounder says.

For journalists, how do you suggest covering Omicron when some scientists and medical professionals disagree on health recommendations? Be careful to look at qualifications of those people, @celinegounder says. Ask straight up: what are your biases?

Lots of ER doctors are interviewed on these subjects related to COVID, but they aren't experts on public health, disparities, supply chain, infectious disease, epidemiology, immunology and so many other subjects, @celinegounder says. Be wary of interviews like that.

For some populations we may look at annual boosters for COVID-19, @celinegounder says. Nursing home residents are a good example. Same for certain occupations where you're at higher risk, like healthcare.

Rapid treatment requires rapid testing, @celinegounder says. Testing needs to be made more available and you need to get one-stop shopping - take a test. If you're positive, you walk out with anti-viral pills. That's how you make public health impact. It's unclear we'll do that.

Our healthcare system isn't set up for this kind of rapid care delivery, @celinegounder says. Even getting a primary care appointment takes 3 days or longer. Antiviral pills may not have intended effect if we can't deploy them early enough when somebody gets sick.

How much genomic sequencing should states do to get an accurate picture of new variants? Somewhere between 15-30% would be best, Gounder says.

That's it for today, folks! Thank you so much for your attendance. We'll be posting a video recording of this webinar a little later today on this thread.

Missed the webinar today? We have a recording for you right here: