Thread by @DrJacobsRad

I've just finished up my afternoon, evening, and overnight call. Here are my observations.

My apologies, but this is going to be a long thread.

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#Omicron #OmicronVariant #COVID19

My heart dropped when I opened my 1st case yesterday. It was a covid pneumonia and I thought to myself, here we go again. The next case that I opened was completely normal, and the next one, and the next one, and so on. Occasionally another COVID pneumonia would pop up.

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In all, I tallied no more than four suspected covid pneumonias. At the worst of the Delta wave, I could tally as many as 60 a shift.

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In chatting with the ER Physicians on duty with me, I tried to get a sense of what they were seeing in terms of the impact of the Omicron wave on their department.

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The consistent comment was that they were flooded with patients with upper respiratory tract complaints, but they were far less sick than in the previous waves. Occasionally hidden among these dozens of peoplr was a really sick patient.

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Another common observation was that no one had recently admitted a patient to hospital who had been boosted or fully vaccinated. Those who have been sick enough to be admitted to hospital in the most recent wave have been unvaccinated patients.

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So what are the take-home points?

1. The Omicron wave will not come anywhere near the initially modeled worst case scenario in terms of hospitalization and ICU utilization.

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2. There is far more Omicron spreading through the population then is represented in the official case count.

This is good news as it means that the case fatality rate and the hospitalization rate are likely both significantly lower than reported.

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3. It is desperately important that people get vaccinated. The vaccines are protecting people from severe disease. Those who are the sickest, whether it be from Omicron or Delta are unvaccinated.

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#GetVaccinated #GetBoosted

4. If you believe that Omicron is a milder variant, that seems to be true only for the vaccinated. For the unvaccinated, let me tell you that from an imaging point of view, it still results in a severe pneumonia. Don't take any chances. Again, get vaccinated and get boosted.

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5. Omicron is highly contagious and case numbers are exploding. Given its low impact on the vaccinated population, we should stop focusing on case counts and use more relevant metrics such as hospitalizations and ICU numbers.

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6. There are immediate considerations around these real world findings that temper the modeling projections, not least of which are our decisions around school opening post winter holidays, return to youth athletics, and extracurricular activities for children.

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7. The last point that I want to make is the importance of both real world experience and modeling. Modeling allows us to prepare for what might happen, but real world clinical experience tells us what is actually happening.

Reality must trump theory when setting policy.

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