Thread by @ASlavitt

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 But this graph is about to get outdated… 2/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/

washingtonpost.com/opinions/2022/…

This tidal wave will grow much bigger.

Why?
-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