Latest @WHO #TechnicalBrief on #Omicron
Overall risk remains very high & threat depends on

1⃣Transmissibility of #variant
2⃣How protective vaccines & prior infection are
3⃣Virulence of variant
4⃣Understanding of dynamics & uptake PHSM

Full 🧵👇 (1/)
who.int/publications/m…
Epidemiology (1)
-#Omicron has large growth advantage over #Delta - grows significantly more than Delta in countries with community transmission
- Evidence that immune evasion contributes to rapid spread
-Wk 52, global weekly #COVID19 incidence ⬆️ 71% compared to prior wk
(2/)
Epidemiology (2)
-Study from HK found #Omicron infects human bronchus tissue faster and better than #Delta
-#UK study found Omicron outcompetes Delta in experiments using cells derived from human nose, but not seen in lung derived cells
-Growth advantage in upper resp tract
(3/)
Epidemiology (3)
-Data from Korea - serial interval of #Omicron was 2.22 days (CI 1.48-2.97) compared to #Delta 3.26 days (CI 2.92-3.6)
-In #SouthAfrica a higher proportion (16%) routinely screened asymptomatic were infected with #Omicron vs 2.6% in #Beta and #Delta
(4/)
Transmission (1)
-#Omicron shows significant growth advantage, higher secondary attack rate, and higher observed reproduction number compared to #Delta
- #UK ⬆️risk of household transmission using routine testing data (adjusted OR from #Omicron compared to #Delta 2.9)
(5/)
Transmission (2)
-Household SAR in #UK 15.8% for #Omicron and 10.3% for #Delta
-Household SAR in #Denmark 31% for #Omicron and 21% for #Delta
- High growth rate due to immune evasion and increased transmissibility
(6/)
Disease severity (1)
-#SouthAfrica, #UK, #Canada, #Denmark suggest reduced hospitalization compared to Delta
-Severity ⬆️ with age, medical conditions, and among people not vaccinated
-Several sources suggest risk of hospitalization and requirement for ventilation lower
(7/)
Disease severity (2)
-#UK reported hospitalizations with #COVID19 continue to increase with 9,218 new admits in wk 51 (45% ⬆️ ) over prior week)
-#UKHSA showed 47% reduction in risk of presentation to emergency care or hospital w/ #Omicron vs #Delta
(8/)
Disease severity (3)
- #USA 7 day avg of 14, 776 admits btwn 27 Dec - 2 Jan (62.9% increase from prior week)
- #Denmark 0.9% of #Omicron cases have been hospitalized vs 1.1% of other variants
- #Canada shows ⬇️risk of hospitalization and death for Omicron vs Delta (HR 0.46)
(9/)
Diagnostics
-Diagnostic accuracy of routinely used #PCR and Ag-#RDT assays does not appear to be impacted by #Omicron
-Studies of comparative sensitivity of Ag-#RDT's are ongoing
(10/)
Immunity (1)
-Data suggest there is reduction of neutralizing titers against #Omicron in individuals who have received primary #vaccination or had prior #SARSCoV2 infection
-Increased risk of #reinfection has been reported
(11/)
Immunity (2)
-Early data suggests effectiveness of studied vaccines is lower against #Omicron and symptomatic disease than #Delta
-Two studies demonstrate #vaccine efficacy against hospitalization is higher than against symptomatic disease, but lower than against #Delta
(12/)
Tropsim
-Preliminary evidence suggest shift in tropism of #Omicron towards the upper respiratory tract as compared to #Delta and wild type virus
-There is evidence of less severe pathogenicity in syrian hamster model
(13/)
Therapeutics
-Preliminary data from non-peer reviewed publications suggests some of the mAbs may have impaired neutralization against #Omicron
-#mAbs will need to be individually tested against Omicron
(14/)
Re-infection risk (1)
-Risk of reinfection in #England with #Omicron was estimated to be 5.4 fold higher in comparison to #Delta.
- The relative risk was 6.36 and 5.02 for #unvaccinated and #vaccinated respectively
(15/)
Reinfection risk (2)
-Report by #UKHSA found that 5.9% of confirmed cases from 1 Nov to 14 Dec due to reinfection
-Relative risk of re-infection from #Omicron at 3.3
- Increased trend of reinfection observed in #Denmark, #Israel #SouthAfrica
(16/)
Finally, please read the @WHO #TechnicalBriefs on #Omicron - they have so much great information!

I tried to summarize the important scientific research coming out but it is hard give justice in a twitter thread.

who.int/publications/m…
(17/)

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More from @KrutikaKuppalli

1 Jan
This narrative is exactly what I was worried about👇

We still don’t know #Omicron causes less severe disease but has become so politicized leaders say it only causes a “sore throat” without thinking of the immediate & long term (post #COVID19 condition #LongCovid) effects
#COVID19 and #Omicron most certainly does not only cause a “sore throat” we are seeing ⬆️⬆️ numbers of ICU admits and hospitalizations.
Yes some may have mild disease (thank you #vaccines) but these people can still transmit and put others (ie immunecompromised) at high risk.
The strain this is putting on healthcare systems and workers is tremendous.

Procedures that are non-emergent like cardiac catheterizations, biopsies, & other important surgeries are being postponed. This may lead to delays in diagnosis of things like cancer & adverse outcomes.
Read 5 tweets
30 Dec 21
💯agree with @jabarocas - in the past 24 hours 5 healthcare worker friends in different parts of the #US have been diagnosed with #COVID19.
At this rate as hospitalizations ⬆️ there will be an ⬆️ shortage of HCW's- who will care for patients & what will it look like a🧵
1/
✅The provider: patient ratio ⬆️⬆️⬆️
✅Patients wait longer for things like water, ice, food, & meds as nurses are stretched caring for more patients
✅The lab is stretched thin so bloodwork takes longer to return
✅Radiology is busier so it takes longer for an X-ray
2/
✅Physicians have less time to spend with patients and families because they have more individuals to see
✅There is less time to critically think about patients as HCW's are in triage mode trying to meet patients needs (I understand this is concerning, but is reality)
3/
Read 5 tweets
30 Jul 21
Here is a link to the @MMWR with the data from the #Provincetown outbreak which led @CDCgov to change their recommendation on #Masks due to the #DeltaVariant

Here is a🧵highlighting the important points
1/

cdc.gov/mmwr/volumes/7…
-There were 469 cases of #COVID19 in Barnstable, MA in July 2021
- 346 (74%) cases in fully #vaccinated
- #Sequencing in 119/133 (89%) specimens confirmed #DeltaVariant
-274 (79%) with breakthrough infection were symptomatic
-4/5 hospitalized were fully #vaccinated

2/
-Ct value similar in fully vax'd (127) vs. those not (84) (22.7 vs 21.5)
-Most cases in males (85%); median age 40
-Time from vax completion -> infection 86 d (6-178 d)
- Vax as cause for breakthrough
#PfizerBiontech (159,46%)
#Moderna (131,38%)
#Janssen (56,16%)

3/
Read 6 tweets
30 Jul 21
Here is some of the @CDC data that was looked at and published by @washingtonpost to make the recommendations to re-implement #masks earlier this week

Note that the #DeltaVariant is MORE transmissible than
- MERS & SARS
- Ebola
- Seasonal Flu and the Flu of 1918
- Smallpox
1/
#DeltaVariant associated with lower Ct value in breakthrough cases, longer duration of Ct < 30, and higher risk of re-infecton
2/
Breakthrough cases of #DeltaVariant have ~ 10 fold increase in viral load compared to alpha or other lineages
3/
Read 7 tweets
14 Apr 21
1/
Information regarding the six patients who have developed CVST after the #JohnsonandJohnson #CovidVaccine
- All were white females
- Only one was on oral contraceptives
2/ Clinical features of the patients
3/ Location of CVST
Read 8 tweets
10 Jan 21
Thoughts on #CovidVaccine Rollout

I see a lot of suggestions/posts about #vaccine rollout and since I have been involved with this thought I would provide insight based on my experiences

See thread below 👇

1/
1. Expecting our hospitals/healthcare systems to absorb the #CovidVaccine rollout without support is unreasonable.

- Hospitals are running on empty and short staffed trying to manage caring for patients
- Rolling out this vaccine takes a lot of support and planning

2/
2. The lack of federal coordination is making this increasingly complex

- Each state has its own plan and within each state each hospital has its own plan
- There is no uniformity
- This leads to disparities between and within states

3/
Read 9 tweets

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