Lets talk about why we'll soon see an uncoupling of infections and hospitalizations

No, its not because Omicron is "mild"

I'm not sure it is

Its because Omicron has so much immune evasion

That we'll see a change in who gets infected

How to think about it

We know among unvaccinated

About 5% of infected folks get hospitalized

Among vaccinated

About 0.5%

Throughout the pandemic (including delta wave), most infections were among unvaccinated

So hospitalization rates have been about 5% of cases
Omicron is different

It'll cause many more infections among 2-shot vaxxed folks

So we'll see large increases in infections in that crowd

So as cases spike

Rate of hospitalization will not spike to the same degree

Because many of the cases will be of vaccinated folks

But let's be clear on a few things:

1. We'll still see a rise in hospitalizations -- largely from unvaccinated but definitely some in un-boosted high-risk adults

2. Long COVID. Always a concern but appears far less common and less serious among vaccinated people

This is why we should pay less attention to case counts in Omicron wave

And pay close attention to hospitalizations, deaths

And best way to prevent those?

Get high risk folks boosted and using good public health measures (high quality masks, testing, ventilation, etc.)


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More from @ashishkjha

17 Dec
The conversation about the coming Omicron wave vacillates between

OMG -- Omicron will be cataclysmic


I'm done with this pandemic and have moved on

Neither is helpful

A middle course can help navigate this complex time without massive disruptions or a lot of deaths

First, lets get on the same page

We should expect a large wave of infections

Likely gathering steam in late December peaking sometime in mid January

And likely falling quickly to low numbers by end of February

This is about the next 2 months

What should our goal be?

Given how transmissibility of Omicron

It'll be hard to suppress infections without very large restrictions

There is neither appetite for big restrictions

Nor do I think needed

So what should our goal be?

Saving lives, keeping hospitals functional, schools open

as starters
Read 10 tweets
8 Dec
With early data rolling in, here’s where we currently stand with Omicron

First, we have plenty of evidence that Omicron will spread easily, quickly, and far

We should expect, globally, relatively large waves of infections

How will people fare?

Depends on who you are

I think of 3 groups of people

Immunologically naïve

Somewhat protected

Highly protected

Depending on which group you are in

Your risk of infection varies

As does your risk of bad outcomes

So let's talk about each of them

Group 1 Immunologically naïve:

Who are they?

Unvaccinated and not recently infected

How will they fare?

They are likely to get infected with Omicron at very, very high rates

Many of them will get sick. I hope...but doubt... that the virus will be mild for them

Read 6 tweets
30 Nov
While everyone is focused on #Omicron

Let's not forget Delta, our current scourge

And over past 5 days, we've seen a 25% drop in cases (see graph)

Good news, right?


Its what we see during every holiday: drops in cases due to drops in testing

And its a problem

Some of the drop off is lack of reporting

But a lot of it is sick people not getting tested

That's a problem because...with less testing

more infected people are spreading to others

And what we've seen?

Bigger the drop during the holiday

Bigger the bounce that follows

Which gets us to this Thanksgiving

We've seen a 25% drop in cases over Thanksgiving holiday

That's big -- much bigger than last Thanksgiving

Which means we should expect a sharp jump in reported infections later this week

Some of those will be reporting catchup


Read 4 tweets
26 Nov
A key question US policymakers are asking

Should they follow the EU and put in a travel ban to South Africa?

Is there any benefit of travel bans? Yes here is

Is there any cost of travel bans? Yes there is

So lets talk about what we know

Thread (1 of 4)
First, most of the evidence suggests that travel bans

If put in early, can slow spread of the new variant into a country by a week or two

Not keep it out -- but slow it

Why not keep it out? Because the variant is already in Asia (HK), Europe (Belgium) and other parts of Africa
And it is entirely possible its already here in the US

So travel bans help a little....and buys us a week or two

So what's the cost?

South Africa has done an extraordinary job identifying, sequencing and transparently sharing data on the variant

If we impose a travel ban...
Read 4 tweets
26 Nov
Every few months, we hear about anew variant

Most turn out to not be much

Well, unfortunately, there's a new variant B.1.1.529 that is concerning

What do we know so far? A few things but not a lot

Reminder: when it comes to variants, we focus on three things

Short thread
What are those three to pay attention to?

Is it more transmissible than current strain (Delta)?

Does it cause more severe disease?

And does have it more immune escape (will it render prior infections or vaccines less effective)?

So lets talk quickly about what we know

On transmissibility, data look worrisome

It has taken off quickly in South Africa

This graphs look concerning

But with case numbers in SA low right now, rapid takeover could be driven in part by other factors

So yes, am worried about transmissibility. But not sure

Read 7 tweets
7 Nov
Quick update on state of pandemic in the US

National picture has turned mixed

Bad news: rapid declines in cases has plateaued

Over past 2 weeks, new infections flat at about 75K per day

The good news?

Early in November, we're flat

Could be much worse. Could be 2020

If we compare same two months to last year, we see a very different picture

Last year at this time, infection numbers were taking off!

Doubling every 3 weeks

We were on a steep acceleration

This year, we have the FAR more contagious Delta

Schools are open

And we're flat!
You all know why

Nearly 60% of Americans now fully vaccinated

So as the air gets cold and dry

The virus, spreading more efficiently, keeps running into walls of vaccinated people

And can't accelerate

If you look at the state picture, this becomes clearer
Read 7 tweets

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