COVID Update: Tens of millions could get COVID in the US this winter omicron wave.

What are the chances of getting infected during this wave? How much different from “normal” pandemic times?

Let me try some basic math. This isn’t big math with log scales but the kind where the numbers are round enough because there are enough assumptions to make precision feel false. 2/
There are 250,000 recorded daily infections now. Actual estimates are that it’s actually about 4x higher counting for rising test positivity, test shortages & at home tests. IHME projects well over 1 million/day. 2/…
How many infectious people are there? Nationwide, if you assume 1 million new cases/day & if people were infectious for 5 days, that’s 5 million. (Yes I have those kind of math skills)

Some of those 5 mm will isolate— hopefully the 1.25 million who test positive. 3/
So say 3.5 to 4 million people (or just above 1% of the population) would likely be infectious & in public.

So that’s a national average and we are likely weeks away from peaking.

What about during the wave’s peak in a hot spot? 4/
In DC, the biggest hotspot in the US has 186 cases/100,000.

Instead of 1% of the population, using the same math, DC would be closer to 3%. And DC hasn’t peaked yet.
We can’t be sure how high it will climb but if you assumed 5% of people at peak could be walking around infectious, that doesn’t seem outrageous.

1 in 20 people you see might be infectious. This compares to 1 per 1,000 at a time of low prevalence. 6/
So compared to low prevalence times, the takeaway is that you could be 50x as likely to interact with someone with COVID.

If omicron is more contagious, it could also take less exposure to a person or a room to get infected. 7/
Reasonable people could come up with more sophisticated analysis.

But even so, risks of walking into a store or restaurant or school and getting g COVID are multiples higher.

And household spread is higher. 8/
So far hospitalization rates are much lower.

Hospitalizations used to follow cases very predictably. So far, in major hot spots this has changed. This is c/o @HealthIndAdv. 8/
While hospitalizations are up, with omicron so far the likelihood of a case leading to a hospitalization is lower. 9/
One explanation— vaccines strongly protect against hospitalizations but allow breakthrough omicron infections. And the vast majority of hospitalizations are unvaccinated people.

Viral replication differences with omicron in the lungs could also be part of the reason.10/
The RATE of hospitalizations matters to us individually. But the NUMBER of hospitalizations matters to hospitals.

And that increase is enough to cause many hospitals to fill over the next month or two. 11/
There are many more reasons to avoid getting infected besides risk of hospitalization. Missing work, not seeing family, infecting others & risking long-term symptoms are all reasons we don’t talk enough about. 12/
Many of us live with people at real risk if they get sick. This level of spread makes anyone with a compromised immune system more at risk & more isolated.

Service workers & commuters are also at greater risk & not by choice. 13/
What to do about all of this if you want to avoid infection?

-N95 or equivalent masks in public
-test 2 days post exposure
-boost if you haven’t
-gather more outdoors & in smaller crowds

None of these are individually foolproof. All are smart in combination. 14/
COVID is causing a lot of disruptions several years running.

The near term future may be marked by these waves & the rough numbers tell me that risks go up meaningfully during these times. 15/
Even as we have more tools to manage these disruptions & these waves, the burden continues to fall disproportionately on those most vulnerable & with the fewest choices.

The steps we take can improve everyone’s odds. /end

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More from @ASlavitt

31 Dec 21
Roller coasters give us fewer twists & turns than we’ve had in the last 2 years. 1/
Coming to grips with each new reality of the virus itself as we experience it— contagiousness, illness, symptomatic spread— is hard enough.

Yet each time we do, it seems to make new versions with different features an ever harder adjustment. 2/
We have seen a string of new news over 2 years that still manages to surprise as much as the first wave itself. It’s deadliness has been replaced by its fitness as perhaps its most enduring feature. 3/
Read 23 tweets
26 Dec 21
COVID Update: I’ve interviewed well over 100 experts now. With omicron, the graphs & opinions are many but the truths are muddled.

There are plenty of contradictions including 8 important ones. In that muddy world, 2022 will be shaped by differing circumstances & 3 attitudes. 1/
1. Some of the scientists I respect the most, like @DrTomFrieden & @Farzad_MD are expressing doubts that with omicron, efforts to prevent contagion are realistic.

Yet, there are many of us who have worked hard to avoid COVID & don’t want to stop now. 2/
2. Omicron, either because of our T cell response, vaccination rates, inherent challenges in spreading to the lungs, or some combination is less likely to put any one of us in the hospital.

Yet hospitals will be swamped because enough people will still get sick. 3/
Read 25 tweets
23 Dec 21
COVID Update: The marvels of science are slowly but surely taming this virus.

Vaccines are helping mute the effects of Omicron. And now Paxlovid, approved by FDA under EUA, ushers in a new era of the pandemic. Patience & caution still required. 1/
For almost everyone, vaccines make dying from COVID extremely unlikely. Delta increased the need for a booster. Omicron increases it further if you want to avoid even a mild infection.

But the main point is vaccinate the globe & the country & fewer will lose their lives. 2/
Still, in the US at least, this leaves 130 million people who aren’t vaccinated, the majority of whom are eligible.

This isn’t a failure of science. The vaccine is very well tolerated & production scales nicely. But it is a vulnerability nonetheless. 3/
Read 19 tweets
21 Dec 21
COVID Update: The good case for what’s happening with Omicron is getting signs of scientific support. 1/
What could be good about a new variant that blankets the population and has mutations that make it far easier to spread & harder for many vaccines to keep up with? 2/
Certainly it’s rapid spread will stress already stressed Hospital systems. That’s NOT good.

Very encouraging to see President Biden will announce today the military personnel & FEMA will be deployed to help. 3/
Read 21 tweets
18 Dec 21
COVID Update: A setback is a setback. And we’ve had 3 setbacks with vaccine testing this week.

But all of those setbacks remind me of how blessed we have been so far by science and the people who monitor safety.

One setback, announced yesterday, is the change of position from the CDC on Johnson & Johnson’s vaccine. 2/
J&J’s vaccine was flagged and pulled from the market temporarily in the Spring when reports of several blood clotting issues arose.

Many criticized the decision for causing doubt & disruption of vaccines at a critical moment after it was ultimately put back on the market. 3/
Read 23 tweets
16 Dec 21
COVID Update: Three groups of Americans will face Omicron in 3 very different ways.

Those who can
Those who can’t
And the biggest group— those who can but haven’t

17% of Americans have gotten boosted, a dangerously low number with a virus which doesn’t respect prior infection or those with 1 or 2 doses. 2/
23% of Americans either aren’t eligible for boosters (17%) or eligible for the vaccine (6%).

That’s 75 million Americans who are basically counting on the rest of us to stay safe through no choice of their own. 3/
Read 12 tweets

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