FINALLY, real data on Omicron's severity – from So. Africa & Australia, summarized in threads from @jburnmurdoch & @andrewlilley_au:


Bottom line from these preliminary studies: looks like Omi's per case hospitalization rate ...(1/4)
... is ⬇50-70% compared w/ Delta's. But once in hospital, studies find similar risk of "severe disease" (eg, ICU admit). Impact on death rates? Too soon to say.
Findings are good news overall (equal severity would be awful), though need more data to be sure – the stakes...(2/4)
are just too high. The studies don't tell us if the lower case-hospitalization rate is due to a ⬇in the inherent virulence of Omicron, vs. the impact of immunity from vaccines or past Covid.
Your friendly reminder that we'll likely see case rates that rise by more... (3/4)
... than 50-70%. If they do, overall risk to avg person wouldn't be ⬇, & could be ⬆.
For me, a 50-70% ⬇in severity doesn't cross my "let 'er rip" threshold. What would? If severity was ⬇90%, maybe, tho I'd still worry about Long Covid & transmission to vulnerables).(4/End)

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More from @Bob_Wachter

22 Dec
This thing has rapidly become the world’s exasperating good news/bad news story. If your head isn’t spinning, you’re not paying attention.

A 🧵on my take on both the good news & the bad, with an emphasis on the things that have changed in the past few days... or minutes.(1/25)
Bad news: Omicron has exploded in the U.S., weeks before we thought it would. As recently as 2 weeks ago, most experts thought this would be a January issue, not a December one. The rapid uptick nationally, particularly in cities like NYC, Miami, & Houston, is jaw-dropping.(2/25)
Even here in SF, the nation’s most vaccinated (and likely boosted) city – and a city where masking is still the norm – we’re now seeing the familiar northward-facing curve (Figure). It’s now clear that no place in the U.S. will be spared a direct hit from Omicron.(3/25) Image
Read 25 tweets
17 Dec
This is one of the most confusing times of the pandemic, w/ a firehose of new Omicron data (lots of fab work on #medtwitter putting it into context). In this (long) 🧵, I'll offer my take on how the new information is changing my thinking & behavior.(1/25)
I'll start with a few general principles & observations (to save space & time I’m largely going to omit primary data – it’s out there; follow @EricTopol to keep up):
1) Things are uber-dynamic. We have far more clarity now than we had 3 wks ago, but many unknowns remain...(2/25)
...More infectious: yes, not sure by how much. Immune evasion: definitely. Severity: conflicting data from UK & So. Africa, even today. Could mean it's same as Delta, could mean it's moderately less. Doubt it's more severe or massively less severe. We'll learn more soon.(3/25)
Read 25 tweets
12 Oct
Latest twist in "aspirin for primary prevention" story (rec: don't do it) hits home. nytimes.com/2021/10/12/hea… When I was in med school, I told my dad (age 52) to take an ASA daily. He was a stressed-out guy, heart attacks were common, & early evidence on ASA was supportive.(1/8)🧵
A few months later, I got a call that he had passed out on the train. The cause: a huge upper GI bleed. I felt terrible – I was pretty sure that my aspirin had caused his bleed. This was, in essence, my first prescription, and I'd nearly killed my father. I rushed home. (2/8)
The GI doc let me watch as he performed dad's endoscopy, expecting to find stomach inflammation or an ulcer. I heard the doc gasp when he found a large polyp at the stomach-esophagus junction – it was clearly not what he expected to see. Turns out it was a stomach cancer. (3/8)
Read 8 tweets
20 Aug
Covid (@UCSF) Chronicles,Day 521
I can't resist one more thread on boosters. I see lots of debate on data: about antibody levels, infections vs severe infctns, etc. I don't see much about the big issue: the tension between 2 perspectives – that of individuals vs. society.(1/25🧵)
It's particularly tricky when talking about a global pandemic since (as we've learned, painfully) no person is an island: individual behavior impacts the collective & vice versa. In pandemics, there's also the matter of who comprises the collective: just domestic or global?(2/25)
For those who don't follow healthcare closely, you've stumbled into a longstanding tension in health policy, one that maps pretty well to two different and (mostly) fraternal fields: clinical medicine and public health.

As a physician (though one with public health... (3/25)
Read 25 tweets
19 Aug
Lots of criticism of new booster plans, much of it re: how much of ⬇efficacy # s are due to confounding vs truly ⬇effectiveness. To me, it seems incontrovertible that vax effectiveness is ⬇significantly, though amount of drop – particularly vs severe cases – is unclear.(1/7🧵)
I'm in support of the new booster plans. This is anecdotal, but in past week I've heard of 2 fully vaxxed people in 70s who died of Covid. With Delta & waning vax effectiveness, this will happen. Even if failure to wear masks contributed to the cases, that'll happen too. (2/7)
We can make two types of errors here: acting too early and acting too late. Given that it'll take 4-6 months to roll out boosters to 200M people, I think we need to skate to where the puck is going. To my reading, the evidence we have regarding waning vax effectiveness... (3/7)
Read 7 tweets
4 Aug
Covid (@UCSF) Chronicles, Day 504

To me, the most confusing time in the pandemic was May 2020, as we exited lockdown and nobody quite knew what they should & shouldn’t do (clean the mail? touch the dog?).

But now is giving May 2020 a run for its money. (🧵1/25)
Today, a smorgasbord of some of the most confusing issues: Delta, masking, vaccine efficacy, vax mandates, boosters.

Bottom line is that my thinking has changed. Six months ago, I felt like I understood all of the key variables when it came to the virus & vaccines. And… (2/25)
…when I learned that a variable had changed w/ Delta, I assumed nothing else had.

But now I see that it’s best to assume that nearly every parameter is different – usually for the worse. That creates cognitive vertigo, but it matches the facts on the ground. (see below.)(3/25)
Read 25 tweets

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