COVID Update: We now understand the difference between a wave and a tsunami.

What I’ve tried to understand is how big it gets & what things look like afterwards. 1/
When the scales of the graph have to change, things that look big begin to look small by comparison. But this graph is about to get outdated… 2/
A number of experts are writing that the actual number of cases in the US is now 4-5x the reported cases.

In the past the assumption was it was more like twice the reported cases.

Why? 3/
When we had a 100k cases/day w Delta, we had more people testing in hospitals, more tests available & fewer at-home tests (which don’t make their way into results). Test positives were lower.

A pharmacy chain told me they are selling 1 million at-home tests/day.None counted.4/
So 600,000 positive reported cases we are seeing is really more like 2.5 to 3 million.

How high it gets will depend on how many people an average person infects. And with Omicron this has remained 2-3x higher than Delta. 5/
Omicron is not more contagious. That’s not it’s super power. It infects more people because its many mutations avoid prior immunity until our body’s T-cells & B cells respond.

And also because it infects quickly. So short exposures create infections. 6/
These short exposures are a fundamental issue. Given the time it takes tests, particularly at home tests, to work, you can be contagious & infectious while still testing negative.

This is how this thing spreads quickly & within families. 7/
Now if we were a country completely compliant with N-95 mask wearing like Hong Kong, I would tell you Omicron wouldn’t have much of a chance to spread.

We’re not. Yesterday in a MN school board meeting, the board wouldn’t even entertain discussion about a mask requirement. 8/
Today at a Supreme Court hearing, lawyers for some states are arguing that the federal government doesn’t have a right to require people to test or vaccinate in workplaces or be vaccinated in hospitals.

They are wrong. 9/
As long as we choose to fight a culture war instead of the virus, the tsunami grows.

A Republican from the Bush Administration & I completely agree that the fed govt is well within its authorityand we write in @washingtonpost today. 10/…
This tidal wave will grow much bigger.

-We are without a culture of protecting one another
-with a virus that spreads more quickly than can be detected,
-& where prior immunity doesn’t protect against infection

How high? 11/
Now, I get sent a whole lot of analyses & newsletters sent to me. One national security analysis recently said that there could be as many as 10 million positive new cases/day at peak. 4x as high as today.

Whether we reach that has a lot to do with us.12/
In any case there are only so many days we can infect several million people people/day before we run out of people to infect.

By the end of January in most of the country, if we haven’t done anything to slow it down, it will run out of gas on its own. 13/
During January, the number of Americans that will get COVID could reach 100 million by some estimates.

With many out 5 days or more, it makes me think about airlines, schools, post offices, stores, dentists closed, short staffed & disrupted.14/
We live in a country without paid family leave, guaranteed sick leave & many who don’t show up don’t get paid.

This is a tsunami of economic issues leading to health consequences & health issues which leading to economic consequences. 15/
Many will get COVID & not even know it even as they spread it

Some will get colds & fevers as their body fights off the virus

Some will need to be hospitalized
The majority are people who haven’t been vaccinated. But a few who have & are old or sick will be too.16/
Hospitalizations are already setting records as this sweeps through this maskless & partway vaccinated country.

Only a small portion of the tens of millions who get COVID this January need be hospitalized for that to happen.

Imagine it getting worse.17/
Even with this, omicron goes easy on the lungs. We will surely have a rising death count but it should be far below last year’s pre-vaccination levels.

Higher or lower than if this were a delta winter wave is not an answer I can find. 18/
When the tsunami clears and the hospitals begin to empty & businesses reopen & people start to say that the pandemic is now over, the truth is no one knows what happens next.

There are a few scenarios to look at. 19/
In a sunny scenario omicron immunity protects against severe illness from another variant including Delta, tests come online, antivirals become plentiful, schools resume & we get a multi-variant booster in the fall.

Even in a sunny scenario we could lose 500 ppl/day.20/
In a cloudy scenario, random shit keeps happening: summer month Florida outbreaks, immunity wanes & few get boosted, omicron resurges in small waves. Here, we are are almost all protected against serious illness but face continual disruptions & uncertainty. 21/
In the stormy scenario, the unexpected disrupts us again. A new variant possibly from a different lineage emerges. It competes well against omicron, prior protection is light & it may be more severe. Our science requires updates in this scenario. 22/
Predicting clear skies is dangerous at any point and isn’t supported by the facts. But it’s at least equally plausible as any other weather pattern. 23/
What there isn’t is a scenario like Hong Kong where we take matters into our own hands and make our own weather. Masking up when cases rise so we can keep schools open. Overcoming election year politics to follow common sense. Thinking globally. 24/
We will take exactly what the weather gives & just hope it settles & gets more predictable and that more take advantage of the tools we have at our disposal.

We may not know what a normal year is until after we have had a couple of them in a row./end

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More from @ASlavitt

6 Jan
I am still doing my best to try to understand the meaning of the events January 6, 2021.

I think January 6 . . . .
was a day of martyrs, of heroes, of victims, of villains, and of clowns…and in votes taken soon after, many of the victims turned into clowns
was yet another reminder that the things we take for granted are not promised to us, they are earned
Read 12 tweets
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
30 Dec 21
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/…
Read 18 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

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