Getting asked when will Omicron peak in the US?

My best guess?

I think we are there

We are seeing a little bumpiness in the data because of MLK day holiday

But evidence says as a nation, we have likely peaked

Big states: CA, FL, and NY have peaked. May be even Texas

Thread
Beyond peak, there are two surprises worth discussing

First, I said few days ago that I expected hospitalizations to rise a while longer

Turns out, not so much

Hospitalizations have flattened nationally and are declining in places like NY

Why? What did I get wrong?

2/4
The reason my guess on hospitalizations may have been too pessimistic?

In previous surges, cases caused hospitalizations and folks stayed in hospital for a while

With Omicron, fewer hospitalizations

And Omicron hospitalizations are, on average, much shorter

That's good!

3/6
And one more surprise? Lower than expected deaths

Cases increased nearly 400% from Dec 1 to Dec 31

By now, you might expect to see 3-4 fold increase in deaths from a month ago

So what are we seeing?

Small increases (see below)

Thank goodness

Why?

4/6
Why have we (thankfully) not seen massive spike in deaths?

1 Omicron is less virulent

2 We have lots of population immunity

Lets be clear: 2,000 deaths a day still awful

But had Omicron been Delta and had we had fewer vaccinations

We'd be seeing 8,000 deaths/day, may be more
So here's the bottom line:

Some places in the US still rising but others falling

And nationally, we have likely peaked

When this is surge is done, 30-40% of Americans likely will have been infected

That's a lot!

6/7
But there's hope

Hospitalizations should decline soon

Deaths may rise some but should turn down in next week or two

And as Omicron surge ebbs

And life returns back to more of a normal

Let's use that time to prepare to more effectively manage future variants and surges

End

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More from @ashishkjha

Jan 16
Quick update on the pandemic in US

We're averaging about 800K identified cases daily

Likely missing 75% - 80% of infections

If you do the math

At least 1 in 100 Americans getting infected every day

Everyone wants to know: when do we peak?

Here's the national picture

Thread
The national picture shows a slowing of the surge

But we're still rising

But if we dig a bit deeper, a few things emerge

First, let's start with the big 4

CA, TX, FL, NY

Why? Lots of people live there, geographically and politically diverse

What do we see?

a few things
There is no doubt NY has peaked, down a lot

FL looks like it has peaked, down some

California may be plateauing, likely

Texas is hard to tell, likely still rising, not sure

And that is the 2nd big point:

There is no single national experience

Local conditions vary, widely
Read 8 tweets
Jan 10
Given the immense value of in person schooling for America's kids,

Lets talk about how every school can be in person safely today

Not under ideal conditions

But under real-world conditions

First, let's start with "ideal", which LOTS of school districts have done

Thread
What is ideal?

1. Teachers vaxxed/boosted
2. Kids vaxxed
3. Everyone masked w/good masks
4. Ventilation
5. Testing

Billions of $ available for ventilation and testing
Vaccines free, widely available

I get it, some places chose not to do it

But $ is not the barrier

2/n
So lots of school districts chose not to do these things

What if a school doesn't have testing and systemic upgrades in ventilation?

Can schools still be safe?

Absolutely!

If folks vaxxed/boosted
And we have masking (compliance doesn't have to be 100%)

Still very safe
Read 7 tweets
Jan 8
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/
Read 14 tweets
Jan 4
Day 2 of hospital service

A few observations about the whole "hospitalized for COVID" versus "hospitalized with COVID"

This distinction matters

But may be not in the way people think

First, we have a few patients in the hospital for COVID

But not many, thank goodness

Thread
Not many because RI is highly vaccinated state

More common on our service is folks admitted with COVID

That is, they came to hospital for something else and found to have COVID

Its tempting to say that COVID here incidental and therefore, doesn't matter

Not quite right

2/n
There are two types of "with COVID" patients and they both have an impact on care, utilization, stress to the system

The first type is: had COVID -- was "mild" -- but now have complications

Example (changing details for confidentiality)

The 86 y.o. man with kidney disease

3/n
Read 7 tweets
Jan 3
We know how to keep people safe in schools during COVID

For an airborne virus

Masking and ventilation/filtration substantially slow spread

As does regular testing

And vaccines protect from bad outcomes

So I've been puzzling over why this isn't happening everywhere

Thread
If key strategies include masking, ventilation, testing, vaccines

Masks became widely available late 2020

By early 2021, there was lots of $ from Feds for improving vent/filtration as well as testing

By fall 2021, every adult & school-aged kid was eligible for vaccines

2/n
So barriers are now primarily not money or availability (though testing is currently a challenge)

So what are the main barriers?

First, misinformation

Like schools are always safe (you have to make them safe)

Or masks don't work (they do, some more than others)

3/n
Read 6 tweets
Dec 29, 2021
.@ezraklein asks a great question

What is the goal at this point?

I think it needs another element

What costs we are willing to pay to achieve that goal?

My goals?

Save lives, prevent hospitals getting overwhelmed, keep essential things (schools) open

In that order

And

🧵
Let's talk about other goals and costs we're willing to bear

Reduce infections? Yes!

Low cost things like encouraging indoor masks will help

But to really suppress infections? We likely need hard lockdowns

Which makes no sense at this point in pandemic

So the other goals...
Saving lives, keeping hospitals functional, schools open?

We know how to do that

1. Vaccines & boosters for all but especially high risk folks

2. Lots of rapid tests in key settings (nursing homes, schools, etc)

3. More ventilation/filtration

This all feels doable

3/4
Read 4 tweets

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