1/ Tom captures well this reality.

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-,

#Hopium or #LerErRip

It's whether we try to make decisions based on the facts as best we understand them, with appropriate humility.

And a willingness to change.

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More from @Farzad_MD

8 Jan
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.
Read 4 tweets
24 Dec 21
1/ We are all seeing the massive wave of Omicron sweep through our communities

Severity will make the difference between a bad winter and a horrific one

We keep saying "hospitalizations are still low, but it's early"

When is it time?

In NYC, it should be showing now.
2/ If you look at the counts of COVID cases and subsequent hospitalizations, they tend to track each other quite closely, but with a lag of 5-6 days

Deaths follow hospitalizations, by about 12 days. (it's too soon for that)

[Big props to my alma mater @nycHealthy for #opendata]
3/ So how many hospital admissions should we be seeing right now?

First, let's look at what's happened to the hospitalization rate in NYC since the awful days of March 2020.

It's gotten a LOT better (in part because we're better at testing and diagnosing COVID)
Read 17 tweets
21 Dec 21
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.

But even worse, they were almost adults.
Read 9 tweets
21 Dec 21
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

(got to rerun excess mortality analysis, @WeinbergerDan)
jamanetwork.com/journals/jamai…
Read 6 tweets
18 Dec 21
1/ The wide range of predictions here is appropriate given how little we know about severity.

Many are pointing to the @imperialcollege @nfergus study as support for a belief that Omicron has similar severity than Delta.

I don't think it does.

Let's dig in
2/ the paper is here if you want to read it for yourself. imperial.ac.uk/media/imperial…

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)
Read 9 tweets
17 Dec 21
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
Read 17 tweets

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