Where we are now with vaccinations, therapeutic- and with the Omicron variant- is very different from March 2020, or December 2020, or even October 2021.
We were not wrong to urge NPIs when the population was spike naive, and R0 was 2.5
2/ in fact, these actions, painful as they were, bought us time for the vaccine rollout, and saved hundreds of thousands of lives.
But we can't insist on the same prescriptions when the disease has changed, for fear of being called "inconsistent", or "giving up"
3/ Omicron is less deadly than the Wuhan strain for unvaccinated, and 10x less deadly for the vaccinated
We have the vaccines and the boosters and the meds and the tests and the good masks to protect the elderly and the immunocompromised, - if we can just marshal them.
4/ at the same time, an increase in infectiousness of 2-3x for Delta, and ANOTHER 2-3x for Omicron, with more asymptomatic and pre-symptomatic spread means that even a shutdown would only slow, not extinguish the pandemic
Even if that were socially and politically feasible 🤷
5/ the shorter incubation period and massive numbers of undiagnosed infections means that contact tracing for disease control at this point is a farce.
It wasn't a year ago. I supported it. I was right to do so.
It's absurd now.
6/ so yes,
We shouldn't close schools now
We should focus on protecting elderly and immunocompromised
Case counts are meaningless
It's not clear if we need to test asymptomatics
We should stop contact tracing
None of these were true last year
They are true now
7/ what should define what "camp" you're in is not whether you are "pro-shutdown" or anti-,
1/ The biggest challenge with the Omicron surge is hospital and ICU capacity, w a lot of infections in a short period, and health care workers out with infection
Anecdotally, many hospitals aren't cancelling elective procedures yet-because of finances (Anyone have data on this?)
2/ Could the remaining relief funds from @CMSGov be conditioned on hospitals deferring elective surgeries? ie framed as compensating for foregone elective procedures?
3/ I'm mindful that deferring these procedures has real-life consequences for patients and their families, in addition to hospital finances
But the risk to everyone (including those getting elective procedures) of overwhelmed and burnt out medical staff is very real.
1/ A big part of understanding the relationship between COVID cases and mortality is understanding the age structure of the waves
I've been looking at NYC "Respiratory" syndrome for ED visits (I was a member of the group that pioneered its use for public health 20 years ago)
2/ During prior influenza seasons, NYC would have up to 1,000 extra emergency department visits a day, much of the increase driven by babies and children (low prior immunity). Their share of ED visits would increase from ~20% to 40%
COVID19 was a completely different story
3/ Every day the number of ED visits rose higher. I remember seeing the first break in the relentless increase, and barely daring to believe that we had reached a peak. It was March 28. There were an extra 3,000 ED visits that day.
1/ The rate of Omicron infections in NYC is unprecedented.
I'd estimate 100,000 infections occurred ... yesterday. Maybe 300,000 over the past 10 days.
1% hospitalization rate would mean 3,000 admits to come over the next few days
I hope it's much less than that (86 so far).
2/ Complicating matters, after driving down influenza (and RSV) to undetectable levels last year, we let up on social distancing, masking, and they have come back
So at least part of the increase in ED visits and hospitalizations will be due to influenza/RSV (especially in kids)
3/ On the other hand, using COVID-specific hospitalizations may be overcounting "incidental" cases among those admitted (or dying) for other reasons, especially if very high attack rate for Omicron
They looked at UK COVID cases with (n=208,947) and without (n=15,087) the dropout associated w Omicron, and perform regression analyses to see what factors could predict Omicron
Date, for one
3/ for example, to predict whether a case is Omicron, you could find a clue by whether they are a reinfection (breakthrough).
There were 4,100 reinfections, but 36% of them were in the dropout group, compared w only 7% of the total cases. (OR 6.55 after controlling for all else)
1/ Omicron is ripping through America right now, to an extent we won't fully realize until later
At this point, I think most people can hope to delay infection, but not to avoid it.
I don't think herd immunity is a realistic goal anymore
Here's what I think it means for us
2/ Even as the Delta wave continues to kill over a thousand people a day, Omicron is already here, and there is no reason to believe that the explosive growth we have seen in other countries, and in local outbreak (like Cornell University) isn't happening across the US already.
3/ an Intrinsic infectiousness that is perhaps 2-3 times higher than Delta, with a short incubation time, and at least some measure of immune escape- means that we are unlikely to get Rt below 1 (and the outbreak quenched) before it rips through a large proportion of susceptibles