US COVID-19 deaths US >2000/day & continue to rise.
I can't help but wonder if focus on Omicron's mildness contributed to size of surge & deaths occurring now.
Difference in severity was small relative to higher infectiousness. Latter should have been singular focus of messaging.
Obviously it would have been far worse if omicron had been as severe as Delta. But focus on mildness of Omicron by scientists, media, government, CDC, etc. contributed to people being less safe than they should have & now thousands are dying/day & many more w/ long covid
Biggest failure, in my opinion, was lackluster efforts to roll out 3rd dose boosters, which played huge role in much smaller impact of Omicron on deaths in UK & elsewhere.
In US, many scientists argued against need for boosters, possibly b/c of global vaccine equity issues.
However, science was clear that protection was waning & boosters were needed to reduce transmission. Boosters could have saved >10,000s of lives in Omicron surge. Denial of this science by many who knew better still bothers me deeply. medrxiv.org/content/10.110…
Vaccine inequity bothers me even more. I'm saddened progress has been so slow in getting vaccines to people who need them. Supply is no longer the issue. It's now about $$, despite cost to vaccinate world being tiny compared to impact. I contributed here: gogiveone.org
Many people think Omicron surge is over (despite still having 400K cases/day in US!!!) & we can pretend pandemic is over, rather than redoubling our efforts to get people vaccinated & boosted. I wish there was more focus on a prospective approach.
For example, in Dec/Jan during Omicron surge US sent military doctors to help take care of patients. If US had sent military to vaccinate people in Oct/Nov, surge would have been smaller. Urgency to act is always too late.
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What is an "acceptable" # of COVID-19 deaths in US?
Lots of folks suggesting that post-omicron we can pretend we're post-pandemic.
But 1K deaths/d = 365K deaths/yr
Flu avg is ~35K/yr
We need avg ~100deaths/day to get near flu
We've never had daily avg <225 since Mar 2020
We'll need deaths to plummet post-Omicron & stay low (no new variants - wishful thinking!) to get even close. Otherwise we'll need higher vaccination coverage or other ways to keep transmission lower.
Or accept much higher deaths as "normal". Good to be explicit if that's it.
FYI I wasn't intentionally subtweeting article by @devisridhar (saw it after posting) but obvious question is if vaccines are refused by large frac of pop, then what? I don't have easy answers but ~365K deaths/yr seems like a lot to me. theguardian.com/commentisfree/…
Fundamental misunderstanding of what it means for Omicron to result in less severe illness. Still no studies compare hospitalization in naive people infected w/ Omicron & Delta. All studies simply measure effect of vaccination + previous infection which we know reduce severity.
Here's best attempt to control for vaccination status & prev infection (including undetected cases). It finds 0-30% reduction in risk of hospitalization. That's tiny & much smaller than other studies that don't account for this. imperial.ac.uk/media/imperial…
(cont)
If you read @jburnmurdoch & @EricTopol replies you'll see that they are actually trying to answer a different question. Instead of: 1) "is Omicron intrinsically milder" they are addressing 2) "Will ratio of hospitalizations/case be lower" than for Delta wave.
How effective are vaccines against Omicron?
Today 3 studies were posted of data on immune escape measured by reductions in "antibody neutralization titers".
We can use these to estimate VE, WITH SOME ASSUMPTIONS.
Thread based on paper w @billy_gardner_ that we'll post tomorrow
We've known since the discovery of Omicron's growth & posting of it's sequence that it has many mutations in its spike protein, & many of these affect binding of our antibodies. @jbloom_lab estimated that these would reduce binding of antibodies 20-60 fold:
We measure "neutralizing antibody titers" by determining how much we can dilute a person's sera (blood) & have it still neutralize the virus & stop it from growing in cell culture. Papers often use 50% reduction in "plaques" or "foci" as a cutoff so you'll see FRNT50 as response.
How much faster can we detect Omicron by sequencing more cases?
As many countries try to determine if Omicron is present, one simple approach is to sequence more. How much time does this buy us? A simple calc puts things in perspective.
tl;dr sequencing 5x more buys ~13-40d
The math:
The probability of detecting something by sequencing N samples given it is present at a prevalence P is simply:
1-(1-P)^N
Graphically, this relationship for two lowish prevalence values is:
So, the more the better, initially ~linearly when variants are rare, but w/ diminishing returns as prevalence increases & as N samples sequenced increases.
Observations on new variant detected in Africa (Omicron)
-Many countries have closed borders, but I haven't heard of any that are simultaneously sending 10M vaccine doses to Africa.
-Closing borders while R>1 locally is silly. Virus is likely already widespread at v low freq.
-w/ no data, it's a bit shocking to see reputable people promoting 1 doctor's anecdotal observations that Omicron causes mild illness. If claim was opposite the same (always optimistic) scientist would demand to see data & suggest we don't believe it w/out rigorous analyses.
-interesting to see strong knee jerk reactions from reputable scientists (i.e. calling Omicron a scariant that we shouldn't worry about), while others take sequence data & mapping to make initial assessment that is worrisome:
How do we get broad immunity to SARS-CoV-2 that will protect against future variants?
2 studies (are there more?) suggest that vaccination followed by infection gives broader protection than infection followed by vaccination. @florian_krammer@profshanecrotty@GuptaR_lab
1st paper (medrxiv.org/content/10.110…) shows: if you get vaccinated w/ mRNA vaccine & have a breakthrough Delta infection your subsequent antibodies are almost equally reactive in neutralizing Delta, Beta, Alpha, WT.
2nd paper (science.org/doi/10.1126/sc…) shows if you get infected (probably w/ D614G) then vaccinated w/ mRNA vaccine, your immunity is strong vs D614G & Delta but less so vs the most immune evasive variant so far, Beta.