Thread by @DrTomFrieden

What will happen with Covid in 2022?? There’s SO much we don’t know about Omicron and the future of Covid. I outline 12 questions and reveal how we can avoid Covid dominating our lives in 2022. Here we go… 1/thread

Question 1: How much severe illness will Omicron cause in different risk groups? People who were previously infected, those with or without vaccination, and people who have gotten boosted, by age group. Looks less severe, but only time will tell. Let’s dive into severity. 2/

15 months ago we compared Covid-19/flu. Best estimate Covid 5x deadlier than flu, now clear about 10x. (Flu, frankly, doesn’t get the respect it deserves for hospitalizing hundreds of thousands and killing tens of thousands in the US every year.) bit.ly/3FtTN7V 3/

Here are the 3 numbers to track:
- Cases. Peaked at 250k/day a year ago. Will exceed that within a week or two
-Hospitalizations. Peaked at 16k/day. No idea what will happen now
-Deaths. Peaked at 3,500/day. Will exceed 2K/day within weeks. By how much? No way to know.
4/

Omicron could cause 10x more deaths than flu in a regular flu season, or “only” half as many. Time will tell. Those who are vaccinated are definitely best prepared, especially if boosted. 5/

Question 2: Will Omicron protect against future variants? Best-case: Omicron infects most people, rarely causes severe disease, results in strong immunity against future variants. Quite possible but perhaps unlikely because mild illness doesn’t often result in robust immunity. 6/

Question 3: Are older people relatively spared by Omicron, and, if so, is that because of higher rates of vaccination or other factors? There have been relatively few hospitalizations among older people thus far. Will this change? Time will tell. 7/

Question 4: Why did cases fall so rapidly in South Africa? Did Omicron infect so many people that there were few susceptibles left? Possibly. 8/

Question 5: How feasible and important is it to prevent infections? New analysis from the UK suggests booster protection against Omicron infection wanes over time. South Africa is no longer quarantining contacts or isolating asymptomatic cases. 9/

We don’t want health care workers to infect patients & others, have reduced isolation time in face of a massive surge to preserve essential health care services. And we’re not yet confident of much lower virulence or less risk of long Covid with Omicron. Too soon to say. 10/

Question 6: What’s the optimal dosage schedule for COVID-19 vaccines? Safety and efficacy studies weren’t rushed, but the optimal primary series – doses and schedule – for different groups are difficult to determine. Not clear that preventing infection is a realistic goal. 11/

Question 7: Are mix-and-match vaccine regimens best? mRNA vaccines seem to boost antibodies the most and very rarely cause serious adverse events. But maybe some mix of vaccines will be best. Too soon to say. Financial interests of companies make this hard to study. 12/

Question 8: Has Biden administration been unwilling or unable to force Moderna to share its technology? Altho Moderna greatly increased production, it’s making about 1/4th the doses of Pfizer. If a tweaked vax is needed, Moderna’s failure to share tech could kill millions. 13/

Question 9: Will a tweaked vaccine be needed, and for what? If to prevent infection that may be a fool’s errand. To prevent severe disease from a future variant? Only time will tell. 14/

Question 10: Will a more deadly variant emerge? Maybe the 4 coronaviruses that circulate are soft echoes of pandemics past; maybe Covid will become another common cold. That’s cold comfort for nurses, doctors and other staff struggling as we enter Year 3 of the Covid Pandemic.15/

Question 11: Can we reach more of the unvaccinated, and how will the Supreme Court rule on mandates? Personal responsibility? Don’t we each have a responsibility not to endanger others? 16/

Question 12: Will we learn our lesson? Many predicted this pandemic. And we can greatly reduce the risk of a future pandemic this deadly and devastating, including through the 7-1-7 target. Will we? Only time will tell. preventepidemics.org/preparedness/7… 17/

Adaptation is how Covid stays ahead of us. Evading immunity. Moving fast. Sharing innovations (mutations) globally. Will WE adapt and share lessons around the world? Will we adopt and adapt innovations from elsewhere? If we don’t, this virus or the next will stay ahead of us.18/

The more we learn, the quicker we learn it, the faster we adapt to new knowledge, the safer we’ll be.

Our biggest gaps aren’t in learning what we need to do but doing what science has shown we must do.

Protect the elderly and vulnerable. Save lives. Protect livelihoods. 19/

It’s actually not that complicated:
1. Vaccinate and boost.
2. Mask up: N95 for elderly/immunosuppressed
3. Balance risk/benefit. Do what matters to you, safely.
20/

We must also invest heavily in getting better, faster information to answer the most important questions, strengthening basic data collection systems, starting with real-time public health tracking and more robust primary health care in the US and globally. 21/

Artificial intelligence, machine learning, genomics, predictive modeling are all potentially important. But without better systems to track what’s really happening on the front lines in real time, they are a house of cards, not a sound foundation for life-and-death decisions. 22/

Life can only be understood backwards, but it must be lived forwards.

Soren Kierkegaard

21/end