Omicron is causing a TSUNAMI, not a wave, of infections in the US. No one knows what will come next with Covid, but we can make a big difference now by taking simple actions to shield the vulnerable & protect health care. Here's where we are—and where we might be headed. 1/thread
We’ve learned a lot about Omicron in the past two months. It’s stunningly transmissible and has left Delta in the dust. Omicron is far less likely than Delta to cause severe disease, especially in people who are vaccinated and boosted. 2/
We’ll know more in a few more weeks, but it appears that the current spike in Covid cases driven by Omicron may subside nearly as quickly as it rose, as happened in South Africa. 3/
But we're far from out of the woods. Rapid increases in cases are leading to increases in hospitalizations, ICU admissions, and deaths, especially among the unvaccinated, and these may continue to increase for several weeks. 4/
The latest CDC data shows a stunningly high 29% test positivity rate. That means we’re missing a LOT of cases. There’s no doubt Omicron is making many people sick, but how concerned should we be? How do we square “less severe” with record-setting cases and hospitalizations? 5/
How many people have Omicron in the US today? A stunning number. We’re diagnosing ~1 million a day and likely missing 3-5 times that many. People are potentially infectious for around 5 days (1-2 days before diagnosis and a few days after)... 6/
...So nearly one in 10 people in the country today may have Covid. That’s why @CDCgov was right to adjust isolation and quarantine recommendations before the Omicron flash flood. 7/
Since Covid emerged, people have compared it with flu. There’s a lot people don’t understand about flu—including that it kills up to 50,000 people a year in the US and floods hospitals during many flu seasons. 8/
For the past 18 months, it’s been flatly wrong to compare the impacts of Covid with flu. With Omicron and vaccines, the calculation has changed, but we still need to look at the full picture. And we definitely shouldn’t dismiss the real problems we’re facing. 9/
On an INDIVIDUAL basis, the severity of Omicron is far less than Delta and roughly equivalent to flu, especially for people who have been vaccinated. 10/
That DOESN’T mean Omicron is “mild” or that it’s not a big problem right now, especially for the unvaccinated. Those who are hospitalized and test positive for Omicron are much more likely to be unvaccinated. 11/
What makes Omicron MORE devastating than flu is the pace. Instead of a 3-4 month flu season, Omicron could cause 2-3 times as many cases in 3-4 WEEKS—as much as 10 times the number of cases per week. 12/
What’s more, we’re experiencing the Omicron spike on top of rising flu cases. It will be crucial to monitor excess deaths (or deaths above baseline) in the coming weeks to parse the burden of both diseases. 13/
We’re facing a tsunami, not a wave. Many hospitals are getting overwhelmed. 14/
The big variable is the large number of people—about a quarter of Americans age 5 and older—who aren't fully vaccinated. Only 40% of those eligible for a booster have received one. In some places, including the South & Rocky Mountain regions, vaccination rates are far lower. 15/
Although most people requiring hospitalization from Covid are unvaccinated, some vaccinated people will get very sick, some will get long Covid, and anyone who’s infected can spread illness to those at higher risk for severe Covid. That’s why we must keep up our defenses. 16/
Age and underlying health status matter a lot in how people deal with illness, so all of us need to assess our own individual risk level and take steps to avoid infection—especially during the current surge, which isn’t likely to last long. 17/
Even if you don’t consider yourself at high risk, getting Covid may not be a walk in the park. It’s also not clear how much an Omicron infection protects you from getting it again. Generally, non-severe infections don’t cause strong immunity. 18/
Now is not the time to give up or “let it rip.” But that doesn’t mean Covid has to dominate our lives. We can make a big difference by taking simple actions to limit transmission, shield the most vulnerable from infection, and protect health care. 19/
That means vaccinating as many people as we can, wearing masks in public indoor spaces, quarantining appropriately and testing after exposure, isolating if we test positive or have symptoms, and ensuring universal availability of effective Covid treatments. 20/
A CDC report published today found that use of monoclonal antibody treatment among Black, Hispanic, and Asian patients is lower than among White and non-Hispanic patients. We must fix these disparities. 21/
Consider upgrading to more protective respirators such as N95 masks if they fit well and can be worn comfortably, per new guidance from CDC. 22/
We don’t know what’s coming next with Covid. Omicron could be the last big surge before it turns into a more manageable disease. Or Delta could re-emerge as Omicron wanes. Or there might be yet another variant that is both extremely transmissible AND highly virulent. 23/
Some people assume that Covid can only get weaker from here, but that’s not necessarily true. Only the future will tell what the future holds. 24/
Everyone is so tired of the pandemic. But the virus is adapting and the quicker we adapt the less Covid will dominate our lives. If we work together we can minimize the impact of Omicron and be in a better position to handle whatever Covid—or the next challenge—throws at us. 25/

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More from @DrTomFrieden

7 Jan
Some have criticized CDC’s guidance on isolation for people who test positive for Covid. I believe it’s basically correct, though they could roll it out better. 1/thread
Last night I explained what the new guidance means for you if you get Covid. Now I’m going to tackle why the guidance makes sense from a public health perspective. 2/
Isolation prevents people with Covid from spreading the infection, but it has negative effects, not only on the physical and mental health of the person isolated, but also on their family and their community's ability to continue important activities. 3/
Read 23 tweets
6 Jan
No one wants to spread an infection to someone who could get seriously ill or die from it. If you test positive for Covid or have symptoms, it’s important to stay home and isolate. I’ll try to clarify CDC’s guidance on what you should do if you get Covid. 1/thread
The reality is that Omicron is out of control in the US. Because of this, critical services are at risk of disruption, including our health system, schools, and transportation. We MUST save both lives and livelihoods. 2/
Based on what we know right now, Omicron is much more infectious than other variants and shortens the time between exposure and symptomatic illness. People are most infectious just before they develop symptoms and a day or two after. 3/
Read 13 tweets
24 Dec 21
What will happen with Covid in 2022?? There’s SO much we don’t know about Omicron and the future of Covid. I outline 12 questions and reveal how we can avoid Covid dominating our lives in 2022. Here we go… 1/thread
Question 1: How much severe illness will Omicron cause in different risk groups? People who were previously infected, those with or without vaccination, and people who have gotten boosted, by age group. Looks less severe, but only time will tell. Let’s dive into severity. 2/
15 months ago we compared Covid-19/flu. Best estimate Covid 5x deadlier than flu, now clear about 10x. (Flu, frankly, doesn’t get the respect it deserves for hospitalizing hundreds of thousands and killing tens of thousands in the US every year.) 3/
Read 23 tweets
18 Dec 21
A tidal wave of Omicron will hit the US and other countries at the worst possible time—holidays approaching, health systems strained from Delta, flu starting, many feeling pandemic fatigue. If we get our response right, Covid won't dominate our lives in 2022. Here’s how. 1/thread
It’s astonishing how quickly Omicron is spreading and leaving Delta in the dust. It may be one of the most contagious viruses we’ve ever seen. New case records have already been set in South Africa and the UK and are inevitable in the United States 2/
Omicron already made up ~3% of Covid in the US on December 11. The proportion is significantly higher now, doubling every 2-3 days. New York City, the original Covid epicenter in the US, is again at the forefront with Omicron. 3/
Read 21 tweets
11 Dec 21
What are the facts on Omicron? The picture is getting clearer: Omicron spreads faster and is better able to escape immunity than other variants. Severity is still unknown, although it's likely vaccination reduces severe disease. The virus has adapted; we must as well. 1/thread
Today’s technical briefing from @UKHSA has a wealth of info. Encouraging to see quick research and action from scientists and health agencies in South Africa, UK & other places, and CDC. Too little credit often given for great work under great pressure. 2/
Omicron will almost certainly overtake Delta and cause new waves of infection globally. This happened within weeks in South Africa. In the UK, Omicron cases are projected to reach parity with Delta by mid-December, according to the briefing, and are doubling every 2-3 days. 3/
Read 16 tweets
10 Dec 21
Covid vaccines are safe, effective and continue to be our best protection. Breakthrough infections are expected. We’ve learned a lot about who’s at risk for severe breakthrough, including from good CDC data. With this information we can protect people better. 1/thread
Studies show lower vaccine effectiveness against severe Covid among older adults, people with immunocompromising conditions, and people with certain comorbidities—groups already at higher risk of hospitalization and death from Covid. 2/
Age matters a lot when it comes to Covid. Although unvaccinated people of all ages are far likelier to die from Covid, according to CDC’s data tracker, there’s a hugely elevated risk for older vaccinated adults, especially those over 80. 3/
Read 8 tweets

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