Thread by @ashishkjha

Watching national data

And being in the hospital this week

I see two things that appear contradictory

But both are true

1. Link between cases & hospitalizations is much weaker with Omicron than in the past

2. Our healthcare system is in trouble

Thread: the moment we are in

Let's talk about I'm seeing in the hospital first

In the hospital, seeing lots of COVID patients

Some admitted due to COVID

They are all either:

1. Unvaccinated

2. Very high risk folks not boosted

And some admitted "with" COVID as incidental

Almost all not boosted

2/n

Haven't seen a single boosted person admitted for COVID

And in the national data

Risk of hospitalizations is still those two groups

Unvaccinated
High risk not boosted

And that pool of people is still very, very large

And that is driving the surge of hospitalizations

3/

But first,

Let's look at the link between cases and hospitalizations

We're admitting 15K-20K COVID patients a day!

If you use NY data, may be half are incidental "with COVID"

So 7.5K-10K every day

That's still a lot

But... way less than what we'd have seen in prior waves

In prior waves, you could look at cases today

And reliably predict 6%-9% of them would be hospitalized a week later

Now, closer to 2%-3%

And since we're missing a LOT of cases now because folks testing + at home

Hospitalization rate is even lower

But we still have a problem

Because those getting hospitalized are from the "at risk for hospitalizations if infected" group

And there are a lot of Americans in that group

My estimate? At least 40 million

Though in reality, probably more

And I'm only focusing on adults

So let's do some math

6/9

There are about 6 million Americans >65 who are not yet even vaccinated

They are VERY high risk for getting severe disease

There are 20 million people >65 who are vaccinated but not boosted

They remain at risk of getting severe disease if infected

7/9

There are 60M adults (<65) who aren't vaccinated

And 30M adults 50-64 vaccinated but not boosted

If 25% have high risk conditions

And if 30% have some protection from prior infection

That's still at least 15M people <65 at risk for bad outcomes

Though likely more

8/

So at least 40M Americans vulnerable to severe disease if infected

A quarter could easily get infected in Omicron wave

And 10% of them hospitalized

That's 1M+ hospitalizations

There is no way our healthcare system can handle that in the next month or 6 weeks

9/12

So we have two things happening

Many "very low risk of bad outcomes" people are getting infected

The young/vaccinated/maybe boosted or older but boosted

Those cases are not turning into severe illness

Great!

That's the uncoupling of cases and hospitalizations

10/12

But we still have at least 40M Americans, likely more

Who are vulnerable

And when they get infected

Many are landing in the hospital

It may be a "milder" disease

But let me assure you

Omicron not milder enough to protect unvaccinated folks or un-boosted high risk folks

So how do we get through the next month or so?

We can still get more vulnerable people protected

First shot of vaccine begins to provide some protection within 10-14 days

Boosters begin to work within a week

That will help reduce number of vulnerable folks

But also..

12/14

We have to reduce the sheer volume of infections

Using public health approaches like more testing, avoiding indoor crowds, and more indoor mask wearing

I remain very worried about our hospitals' ability to care for everyone who needs care over next 6 weeks

13/14

So on the debate of whether cases matter or not?

Among protected people, they matter way less

Among vulnerable people, they matter a lot

But because we all live in one country

We have to reduce infections overall even as we protect more people via vaccines and boosters

End