The official definition of when a "pandemic becomes an endemic" is when the R value of a disease is 1 or below. We are a long distance from this -- especially with Omicron. Despite omicron, Covid-19 will become endemic. Here’s how. The variant has changed how we get from “pandemic” to “endemic,” but that doesn’t mean we’re back to square one. https://www.vox.com/future-perfect/22849891/omicron-pandemic-endemic With omicron rates soaring, you may find yourself despairingly asking when — or even if — this pandemic is ever going to end. The good news is that it will end. Experts agree on that. We’re not going to totally eradicate Covid-19, but we will see it move out of the pandemic phase and into the endemic phase. Endemicity means the virus will keep circulating in parts of the global population for years, but its prevalence and impactwill come down to relatively manageable levels, so it ends up more like the flu than a world-stopping disease. For an infectious disease to be classed in the endemic phase, the rate of infections has to more or less stabilize across years, rather than showing big, unexpected spikes as Covid-19 has been doing. “A disease is endemic if the reproductive number is stably at one,” Boston University epidemiologist Eleanor Murray explained. “That means one infected person, on average, infects one other person.” We’re nowhere near that right now. The highly contagious omicron variant means each infected person is infecting more than one other person, with the result that cases are exploding across the globe. Nobody can look at the following chart and reasonably conclude that we’re in endemic territory. Looking at this data might make you wonder about some of the predictions that were floating around before omicron came on the scene. In the fall, some health experts were saying that they thought the delta variant might represent the last big act for this pandemic, and that we could reach endemicity in 2022. The outlook is more uncertain now. So how should you be thinking about the trajectory and timeline of the pandemic going into the new year? And how should omicron be shaping your everyday decision-making and risk calculus? When we’ll know we’re finally in “endemic” territory Here’s one big question you’d probably like the answer to: Does omicron push endemicity farther off into the future? Or could it actually speed up our path to endemicity by infecting so much of the population so swiftly that we more quickly develop a layer of natural immunity? “That is really the million-dollar question,” Angela Rasmussen, a virologist at the University of Saskatchewan in Canada, told me. “It’s really hard to say right now.” That’s partly because endemicity isn’t just about getting the virus’s reproductive number down to one. That’s the bare minimum for earning the endemic classification, but there are other factors that come into play, too: What’s the rate of hospitalizations and deaths? Is the health care system overburdened to the point that there’s a precipitous space or staffing shortage? Are there treatments available to reduce how many people are getting seriously ill? In general, a virus becomes endemic when we (health experts, governmental bodies, and the public)collectively decide that we’re okay with accepting the level of impact the virus has — that in other words, it no longer constitutes an active crisis. With omicron surging right now and many governments reimposing stricter precautions as a result, it’s clear we’re still in crisis mode. “But so much depends on the burden it’ll place on the healthcare system,” Rasmussen said. “And that’s going to be different from community to community.” Even if it turns out to be true that omicron tends to result in milder disease than previous variants (we don’t yet have enough data to say conclusively), a massive increase in cases could still lead to a big increase in hospitalizations and deaths. That could further stress health care systems that are already in dire straits. That’s why Rasmussen concludes that “omicron certainly has the potential to delay endemicity.” But there are also some hopeful things to bear in mind. “The incredible number of infections is building up population-level immunity. That’ll be crucial in terms of muting future waves,” said Joshua Michaud, associate director for global health policy at the Kaiser Family Foundation. In addition to omicron potentially building up some immunity in the vast numbers of people who are becoming infected with it, vaccinations and boosters are also contributing to “a significant immunity wall that’s being built,” he said. But he cautioned that “that’s a wall to the variants we’ve seen already. There could be another variant which could evade immunity down the road.” Some experts are already conjecturing that getting infected with omicron may not give you much cross-protection against other variants, though a small early study showed positive signs on that front. This is why Ramussen says “the key determinant” of when the pandemic ends is how long it will take to make vaccines accessible around the world (and to combat ongoing vaccine hesitancy). Currently, we’re not vaccinating the globe fast enough to starve the virus of opportunities to mutate into something new and serious. “If only a very small proportion of people are getting access to vaccines, we’re just going to keep playing variant whack-a-mole indefinitely,” Rasmussen said. In the meantime, we do have another ace up our sleeves, which will hopefully also become available around the globe sooner rather than later: new treatments —like Pfizer’s paxlovid, recently approved by the Food and Drug Administration, and Merck’s molnupiravir, also FDA approved — that reduce the rates of hospitalization and death from Covid-19. “Very important in the context of endemicity is the antiviral pills,” Michaud said. “If we have those tools, we’re looking at a very different state going into 2022. People shouldn’t feel like we’re back to square one.” We’re not back to March 2020. But it makes sense to modify our behavior during the omicron surge. Dire headlines notwithstanding, we’re in much better shape than we were at the start of the pandemic. We’ve discovered a lot more information about how Covid-19 works. We’ve manufactured effective masks, vaccines, boosters, treatments, and rapid tests. We’ve also learned that having to hunker down comes at a real cost to our mental and economic health and wellbeing. The cost of a strict lockdown may have been worthwhile in March 2020, but by and large, that’s not what US experts are advising now. They are, however, urging us to take more precautions than we might have been in the weeks leading up to omicron. Take Bob Wachter, for example, the chair of the department of medicine at the University of California San Francisco. In the fall, he shifted from being very cautious about Covid-19 to taking some more calculated risks, including dining indoors at restaurants and even hosting an in-person medical conference with 300 attendees. But now that omicron is causing cases to skyrocket, he’s being more cautious again. “I see the next few months as a time to fortify one’s safety behaviors,” he wrote on Twitter. Here’s how he explained his reasons: The other experts I spoke to agreed that now is a time to limit risky activities. “I had taken my foot off the brakes in terms of my own behavior. But I’ve now started to put it on again,” Michaud told me. “I canceled plans to go to New Jersey to visit my family over Christmas. I’m avoiding more indoor environments. As of now, it does make a lot of sense to me to take additional steps to prevent yourself and those around you from getting infected.” After the omicron wave passes, he said, he envisions relaxing precautions again. Modeling suggests that omicron could peak in mid- to late January in the US, with case rates steeply declining — and activities becoming correspondingly safer again — in February. Rasmussen is also modifying her behavior in light of omicron, though she emphasizes that’s not the same as going back to a spring2020-style lockdown. Although she canceled an international flight over the holidays, she still felt comfortable going over to her colleague’s house for a Christmas meal. That’s because she and they had vaccinations, boosters, rapid tests, and great ventilation working in their favor. “We have a lot more tools at our disposal for dealing with this than we did in March 2020,” she said. We’ll know endemicity has arrived when those tools — and the long, painful experience of the pandemic itself — has enabled us to fully adapt to the virus, as the virus has adapted to us.
The Covid-19 case surge is altering daily life across the US. Things will likely get worse, experts warn https://www.cnn.com/2022/01/01/health/us-coronavirus-saturday/index.html The US is ringing in the new year amid a Covid-19 surge experts warn is exploding at unprecedented speed and could alter daily life for many Americans during the first month of 2022. "Omicron is truly everywhere," Dr. Megan Ranney, a professor of emergency medicine at Brown University's School of Public Health, told CNN on Friday night. "What I am so worried about over the next month or so is that our economy is going to shut down, not because of policies from the federal government or from the state governments, but rather because so many of us are ill." The nation broke records at least four times this week for its seven-day average of new daily Covid-19 cases, reporting an all-time high of more than 386,000 new daily infections Friday, according to the latest data from Johns Hopkins University. The high case count is already causing disruptions in the country. n New York City, the Metropolitan Transportation Authority (MTA) is plagued with staffing issues and announced three subway lines -- the B, Z and W -- which service various parts of the boroughs, have been suspended. "Like everyone in New York, we've been affected by the COVID surge. We're running as much train service as we can with the operators we have available," the MTA wrote on Twitter Thursday. New York continues to break its own record, adding 85,476 reported Covid-19 cases, according to Saturday's briefing from New York Gov. Kathy Hochul. Hospitalizations jumped to 8,451, up from around 8,000 in the report released Friday, according to the latest data. The state's seven-day positivity rate is 19.79%. The number of one day case additions has increased 219% since Monday, when the state reported an addition of 26,737 cases. Healthcare services -- exhausted after several surges of the virus and now stretched thin again by a growing number of Covid-19 patients -- are also already feeling impacts. The University of Maryland Capital Region Health this week joined a growing list of medical centers in the state to activate emergency protocols after a sharp rise in cases fueled staffing shortages and overwhelmed emergency departments. "The current demand for care is depleting our available resources, including staffing," UM Capital Region Health said in a statement on Friday. In Ohio, Gov. Mike DeWine on Wednesday announced the deployment of about 1,250 National Guard members as hospitals struggle with staffing shortages. On the same day, the mayor of Cincinnati declared a state of emergency due to staffing shortages in the city's fire department following a rise in Covid-19 infections. The mayor's declaration said if the staffing problem goes unaddressed, it would "substantially undermine" first responders' readiness levels. "Get ready. We have to remember, in the next few weeks, there's going to be an unprecedented number of social disruptions," Dr. Peter Hotez, dean of Baylor University's National School of Tropical Medicine, told CNN. Those include flight disruptions as well, he said, because of TSA agent and air crew absences. Thousands of flights have already been canceled or delayed throughout the holiday season as staff and crew called out sick. On Friday, the Federal Aviation Administration said an "increased number" of its employees were testing positive for the virus, and "to maintain safety, traffic volume at some facilities could be reduced, which might result in delays during busy periods." (More at above url)
Ontario closes schools until Jan. 17, bans indoor dining and cuts capacity limits https://toronto.ctvnews.ca/ontario-...oor-dining-and-cuts-capacity-limits-1.5726162
CDC: Omicron now 95 percent of new US COVID-19 cases https://thehill.com/policy/healthcare/588164-cdc-omicron-now-95-percent-of-new-us-covid-19-cases The omicron variant accounted for 95.4 percent of U.S. COVID-19 cases diagnosed during the week ending on Jan. 1, according to the Centers for Disease Control and Prevention (CDC). The new data shows how quickly the highly transmissible variant has taken over, displacing the previously dominant delta variant. Just two weeks earlier, in the week ending Dec. 18, omicron accounted for only 38 percent of U.S. cases, the CDC said. The omicron variant has fueled a massive spike in cases, to over 400,000 per day nationwide, but there is mounting evidence that the variant, on average, causes less severe disease than previous variants. Still, while most people will have mild cases, even a small percentage getting hospitalized poses a risk to the hospital system given the massive number of total infections. About 100,000 people are hospitalized with COVID-19, according to a New York Times tracker, about the same as the peak from the delta wave over the summer, and the number is climbing quickly. The CDC last month significantly revised down its estimates for omicron's prevalence. But the range of the latest estimate is smaller, indicating a higher level of confidence. "These @CDCgov Omicron data have changed substantially over the past 4 weeks," tweeted Eric Topol, professor of molecular medicine at Scripps Research, referring to the 95 percent estimate. "Likely by now this is true." Hospital leaders are warning that they are overwhelmed and urging people to take precautions. Hospitalizations are far more likely among unvaccinated people, and officials are also urging vaccinated people to get booster shots to lower their risk of infection, though two shots still provide important protection against severe disease.
Officials Take Action As Omicron Cases Surge Across New York City, Especially In The Bronx The Bronx currently has the highest positivity rate and in some neighborhoods that number is near 50%.
80% of Florida will have caught COVID-19 by end of omicron wave, report says. DeSantis disappointed, vows 100% compliance. 80% of Florida will have caught COVID-19 by end of omicron wave, UF report says https://www.wfla.com/community/heal...vid-19-by-end-of-omicron-wave-uf-report-says/ TAMPA (WESH) – According to a new report from the University of Florida, most of the state’s population will become infected with coronavirus in the latest omicron wave. UF biostatisticians have been studying the way that the omicron variant behaves. They say data shows that omicron is twice as infectious as delta and spreads quicker, too. “So you combine those two things and you get a very fast, large epidemic,” said Ira Longini. Longini is a UF professor and one of the researchers who worked on the report. So how large of an epidemic are they predicting? This large: “Probably 70 to 80% of the state will either get infected in this wave or have been infected in a prior wave,” Longini said. Researchers said the most recent wave is likely to cause many more infections in part because of the variant’s shorter incubation period compared to the Delta variant. “If you get infected with omicron, you start infecting other people about two days after you’re infected,” said Longini. With delta, he said it usually took about five days to spread. The quick transmission means an earlier peak. Last month, UF researchers predicted that the omicron wave would peak in February. Because of the significant growth in cases, they updated their prediction to next week. “It’s good news in the sense that the wave will be over certainly by the end of January,” said Longini. “The bad news it’s going to be very intense for the next couple weeks with lots of cases and it probably will put a strain on our hospital resources.” With the peak just days away, Longini said it is not too late to take precautions. “We may get more variants in the future,” he said. “So I think the more people we can vaccinate and keep vaccinating, especially our children who need to be vaccinated, especially the younger children, to keep doing that. Not let up is going to be very important going forward.” While researchers warn most of the state could become infected by the end of this wave, they add that majority of people will either be asymptomatic or have a mild case. They estimate that omicron will cause substantially fewer deaths, about a third as many deaths caused by delta.
America’s Omicron Wave Already Looks More Severe Than Europe’s https://nymag.com/intelligencer/202...-wave-now-looks-more-severe-than-europes.html From abroad, where COVID-conscious Americans now look for portents of our near-term Omicron future, nearly all the signs have been positive over the last few weeks. In fact, case numbers aside, the U.K. and continental surges and new research from labs in Japan and Liverpool and Cambridge and Hong Kong (among other places) have made Omicron look almost like a best-case scenario or at least what would’ve qualified as one just a few weeks ago, once we knew how quickly the wave was spreading but not yet how quickly the wave would subside or how much severe disease would be left in its wake. In all of these places, initial case growth was dizzying — if earlier surges were defined by exponential growth, with Omicron it seemed practically stratospheric. But the waves turned quickly — in South Africa, cases peaked just four weeks after the wave began, and in London, the wave has turned now too. In South Africa, the picture of severity was even more encouraging, since COVID fatalities there reached only a fraction of the level reached at the height of the country’s previous wave (in some charts you couldn’t even see a rise in excess mortality). In the U.K., where hospitalizations are still growing, especially among the elderly, the death toll is likely to be more significant, though still well below the levels reached by the country last winter. This reduced severity is no mystery — study after study is now demonstrating that Omicron is much less effective in the lungs, where it can do the most damage, than previous variants. And several small-scale studies have suggested that — despite early concerns that Omicron’s capacity for reinfection and breakthroughs meant it might not produce much “cross-protection” against other variants — infection with the new variant probably does offer enough cross-protection that a true “parallel pandemic” is an unlikely outcome. But while this is all encouraging, it is not clear that those same patterns observed abroad will hold here in the U.S. In fact, there are already early signs in hospitalization and ICU data that the experience of Omicron in America may be harsher than has been observed so far in Europe. This should perhaps not come as a surprise, given that Delta was much more lethal in the U.S. than in Europe — and the current data may still reflect some lingering cases of that variant. And it does not mean a tsunami of deaths is right around the corner or that this new variant will mean for the U.S. what Delta meant for India. (To begin with, the U.S. is, by global standards, very well vaccinated.) But the higher rate of severity observed so far is a reminder that the shape of a pandemic is not simply a matter of the biological properties of the virus; it is also determined by the social and immunological context in which that virus spreads. And it appears that, with Omicron as with Delta, the American context may be different enough to make a real difference, delivering perhaps considerably more severe illness and death than we’ve seen on the other side of the Atlantic. With Delta, many Americans observed a miraculously light British wave and effectively ignored the real carnage that followed here — 100,000 Americans dead, and September and October was the deadliest two-month phase of the pandemic outside of last winter’s horrific surge. With Omicron, the same pattern — optimism from Europe followed by overlooked suffering here — seems troublingly possible again. And if you’re hoping for an outcome resembling South Africa’s, where COVID deaths during the Omicron wave didn’t reach even 10 percent of the previous peak, keep in mind that the U.S. began this wave on a Delta plateau 50 percent as high as our previous peak of daily deaths. To this point in the Omicron surge, at least, American fatalities have not grown dramatically from that plateau, and the small rise we have observed is as likely to be the result of ongoing Delta cases as Omicron infections (that is how fast this surge has come upon us — our data are still telling a story about the last one). Anecdotal reporting from around the country suggests that while new patients are crowding hospitals and emergency rooms, to the doctors working in those hospitals the Omicron cases appear, on the whole, less serious. But while the New YorkTimes reported this week this wave is putting less pressure on ICUs than previous ones, state data tell a different story: A comparable proportion of hospitalized cases are already now in the ICU as was the case in New York during the winter surge of early 2021. Then, hospital admissions reached 9,000; now, we’re already past 10,000. ICU admissions got to 1,600; now, we’re at 1,404. And the numbers are still growing, quite fast. NYU epidemiologist Celine Gounder told me that between December 27 and January 3, ICU admissions in the city as a whole grew 55 percent. “That is not a small jump,” she said. It took place in just a week. Statewide, on the day before Christmas there were 4,891 COVID-19 patients hospitalized, 880 of them in the ICU; yesterday, there were 11,184 in total, with 1,404 in the ICU. In less than two weeks, in other words, hospitalizations had more than doubled and ICU admissions had grown by 60 percent. Cases had grown a lot too, from 49,708 on Christmas Eve to 84,202 yesterday. But a 70 percent jump in cases accompanied by a 60 percent jump in ICU admissions does not suggest a dramatic “decoupling” of the kind we’ve observed in South Africa and Europe and seemed almost trying to will into existence here. And since, in general, hospitalization surges lag behind case surges, it is worth keeping in mind that the data we have now about hospitalization levels all reflect infections from the Omicron upswing, not its peak, which may well be ahead of us. Gounder says she expects another week or two before a local peak here in New York, followed by another week or two before we reach a national peak — a rough timetable echoed Thursday by the epidemiological modeler Jeffrey Shaman. But already the country is reporting more than half a million new cases every day; the new daily case counts are rapidly approaching one million, four times as high as the worst days of the surge last winter. “This is the point I’ve made over and over,” Gounder says. “The simple math I give is even if it’s half as virulent — so half as deadly, your case fatality rate is reduced by half — if you have twice as many cases, you have actually the exact same number of deaths.” The way other concerned doctors and epidemiologists have put it is: A small fraction of a huge number is still a large number. “I think people have fixated on this idea that it’s mild,” Gounder says. “Mild means mild — relatively mild — for the individual who’s infected. But it does not necessarily mean mild at a population level in terms of numbers of deaths. If a lot of people get infected, even if it’s a relatively benign virus, enough of those people will still have to be hospitalized and die that this is really going to be very overwhelming for the health-care system. I think it’s gonna be really tragic.” “I’m very reluctant to quote, unquote, ‘learn’ anything from what South Africa and the U.K. experienced,” says Brigham and Women’s Hospital emergency physician Jeremy Faust. “There’s different levels of vaccination. There’s different levels of mitigation. And quite frankly, it’s a different time of year in South Africa.” The data are already looking different, as well. Consider this chart from the U.K.’s NHS dashboard: Total hospital admissions are indeed still rising in London, as are ICU admissions and the number of patients on ventilators. But the number of patients who have needed critical-care beds is bending well below the catastrophic NHS experience of last winter (as you can also see in these charts from John Burn-Murdoch and theFinancial Times). Now compare with the below chart, from the New York Department of Health, of statewide hospitalizations (in gray) and ICU admissions (in yellow). The spring 2020 peak is the first bump, the winter surge the second, and the Omicron wave coming ominously into view all the way at the right. These charts aren’t exactly equivalent — one shows patients in need of ventilators and the other hospitalizations and ICU admissions. But comparing the ongoing Omicron spike on the right to the large winter wave in the middle, two things are very clear. The first is, in New York, both hospital and ICU admissions are obviously still on the rise, even if we are at or close to a local peak of cases. The second is, by both measures things are already nearing or past the heights of our previous wave. From here, Omicron is certain to trace a taller curve, at least, and perhaps a larger one, depending on how quickly the wave subsides. And for the moment, it is not looking much less severe at the population level than the intermediate surge last winter; in terms of total people in the hospital and ICU, it is looking likely to be at least as bad and potentially considerably worse. In London, ICU demand is not just way down from last winter, it is already declining: In New York, it is not just approaching last winter’s peak but clearly on the rise: Of course, last winter was not New York’s worst period of the pandemic, as it was for much of the rest of the country (and England and much of Europe). New York’s worst phase came right at the start, in spring 2020, and though the next few weeks remain uncertain, it seems unlikely that the city or the state will reach the awful heights of that first wave, when more than 18,000 COVID patients were hospitalized, more than 5,000 of them eventually in ICUs. But a look at the country as a whole shows the same troubling pattern, as illustrated in this chart, by Burn-Murdoch and the FT: There is a national decoupling, yes, in the sense that cases are shooting up much higher than hospital admissions and ICU patients. But each of those levels is already approaching the worst heights of the pandemic, and Omicron is just now starting to roll through the hospital system. Burn-Murdoch estimates that in “in wealthy, well-boosted countries like the U.K., deaths may peak at 10–15 percent of the previous record. In others, they may hit 50 percent.” Those are encouraging estimates, especially given how large the case growth has been. But the U.S. began the Omicron wave at close to 50 percent of its previous peak, and those lines on the right are all pointing pretty sharply up. The ultimate outcome is not yet clear, but if the early course of Omicron through Europe suggested a decoupling of cases from hospitalizations and deaths, the early course of the variant through the U.S. suggests a decoupling from that encouraging European path. Why might our Omicron surge be different from the European one? Looking at the country as a whole, one big answer is obvious: Our vaccination rates are markedly lower than most European countries. (That is the hypothesis put forward by Burn-Murdoch, examining the divergent patterns of decoupling in the U.S. and U.K.) A second related answer is that we’ve done an even worse job, compared to our European peers, vaccinating and boosting the elderly. (Eric Topol of Scripps has emphasized this fact.) A third possibility is that the relatively high levels of severe disease we are seeing in New York and throughout the U.S. are the residue of that lingering Delta wave — either the effect of some limited amount of ongoing spread of the more virulent variant or the impact of cases that began their clinical cycle a few weeks ago and are still requiring treatment in the hospital. In some parts of Europe, like France, Omicron has been growing on top of Delta, but most of the continent and the U.K. had not been dealing with nearly as much severe disease this fall as the U.S. has been. This is Gounder’s hypothesis, echoed by other doctors and public-health officials who are advising caution in making any assessment of the American wave before Omicron truly takes over the hospitals — that we should wait for another week or two of data to see a clear picture of the new variant unclouded by the old one. But we may already be past that transition, given that 95.7 percent of cases sequenced in New York between December 19 and January 2 were Omicron, and more than 18,000 New Yorkers have been hospitalized since December 26. And while the “lingering Delta” hypothesis might well explain some early-Omicron-observed severity at the national level, New York didn’t have a big Delta caseload in the late fall to begin with — by national standards at least. On top of which, New York has a different vaccination profile than the country as a whole: 72 percent of New Yorkers have gotten at least two shots of vaccine, compared to 62 percent for the U.S. and 70 percent for the U.K. The Brits have done a considerably better at the critical job of delivering boosters — just over half their population has been boosted — but in terms of overall vaccination, New York State may be as close to the U.K. and other European countries as it is to the rest of the American states, where rates are often much lower. All this makes the concerning New York data potentially even more concerning, suggesting that outcomes here might not be representative of the American experience to come, but in fact milder, on the whole, than we will see in the rest of the country, assuming that Omicron cases soon overwhelm those places. But one apparent difference between New York and Europe may also prove significant, if our Omicron wave continues to be more severe: Even though our vaccination rates may be comparable, we appear to be seeing a much bigger share of cases among the unvaccinated here than they have over there. In fact, across Europe, wherever surveillance has been conducted, it has demonstrated that Omicron is spreading very proficiently among the vaccinated, which may be one reason why the overall severity of the surge looks so low (those people are much less protected against infection with the new variant, given its apparent immune-escape features, but especially if they are boosted they remain very well protected against severe disease caused by it). All of this data is better than the American equivalent, but it still has shortcomings and limitations: Some countries count two shots as fully vaccinated, some count three; some distinguish between the two groups, but some don’t; and none are sophisticated enough to carefully track the effect of immunological waning in their official reports. Nevertheless, taken altogether the picture European data gives is very clear, with the share of Omicron cases among each country’s vaccinated population equal to or greater than the vaccinated share of the population as a whole. In Germany, where 71 percent of the country is double-vaccinated, 78 percent of the country’s Omicron cases have been among the vaccinated,it was estimated. (A data error at first made it seem the share was even higher, but it has been corrected.) In Denmark, where 80 percent are, it is 81 percent. Because vaccination does protect so well against severe disease, in any particular place hospital admissions should skew much more dramatically toward the unvaccinated than do cases, and yet, in the U.K., more than two-thirds of their hospitalizations have been patients with two or more doses of vaccine. That these shares are large is not so surprising, given what we know about Omicron’s immune-evasion properties. And as we’ve heard again and again since the rollout of vaccines, as the vaccination level of a population grows, so too will the share among the vaccinated of new cases (and even, ultimately, severe cases). But the fact that the share of cases among the vaccinated so closely matches the share of the population that is vaccinated suggests that, in Europe, though the seriously ill are more likely to be unvaccinated, in terms of pure caseloads, Omicron has been spreading about equally through vaccinated and unvaccinated populations. This pattern is not what we are seeing in New York, where, according to the state, the unvaccinated were — at the end of December, after Omicron took over — eight times more likely to be diagnosed officially than were the vaccinated. Presenting this data alongside the European numbers does not make for a perfect comparison, since one is a raw accounting of spread and another a population-adjusted calculation of risk, and since neither accounts for the age stratification of vaccination, which is crucially important. But pandemic comparisons are never neat, especially this early in a wave, with so much noise in the data, and the contrast is striking nevertheless. And given how much more well protected the vaccinated are against severe disease, with Omicron as with every other variant, even a small difference in the share of spread among the unvaccinated could make the overall picture look significantly more severe. According to Gounder, two thirds of the patients newly hospitalized at Bellevue, where she has recently been on service, are completely unvaccinated — a reversal of the British data. And the data from elsewhere in the country is similar: 80 percent of hospital admissions in Louisiana were not fully vaccinated, and 71 percent in Connecticut. The reasons for this apparent pattern are not obviously clear, though it may reflect some amount of statistical noise; the particular subpopulations through which the variant happened to get an early foothold; the relatively larger number of unvaccinated Americans; or social dynamics beyond our intuitive grasp or modeling capability. If the pattern holds, though, it could prove a grim sign. To this point, however, reporting from inside American hospitals has been relatively reassuring — doctors have tended to describe less pressure on ICUs and, overall, a picture of less severe disease than has been observed at previous points in the pandemic. Doctors have also emphasized how many patients have been hospitalized “with” COVID, rather than “for” COVID. Indeed for the first time today New York State has begun, at the direction of Governor Hochul, distinguishing between those patients whose COVID is “incidental” to their hospitalization and those who were admitted expressly for the disease. In the first day’s data, 41 percent of COVID admissions in New York were incidental, and in many hospitals across the country, the number of patients admitted with incidental COVID outnumber those admitted for COVID treatment; in Los Angeles, among recent admissions, it’s been two-thirds. And in New York, 37 percent of those recently diagnosed at the hospital are asymptomatic. But while Gounder says there are “absolutely” more patients with “incidental” COVID during this wave, the two are not precisely defined categories. Faust has emphasized a third group — those who have other medical issues but have been “tipped over” into hospitalization by the presence of COVID. To me, he also mentions a fourth group — the “hospital onset” cases, where patients admitted for another issue catch COVID while hospitalized. For some of them, the new infection could be not trivial but a catastrophic complication, and, Faust says, hospital onset cases are now at record highs for the pandemic — among the worrying signs he’s watching at the moment. “I think that so far we have experienced what I would call a buffer between this massive rise in cases and the effect that has had on the hospitals” — the wave has not yet fully worked its way into the hospital systems, in other words. “That’s for a lot of reasons,” Faust says. “That’s due to population immunity. That’s due to maybe Omicron being a bit milder — I think that’s real. And in many places, it’s a result of a younger, healthier population being the ones driving the outbreaks at first.” This makes it hard to project early data on severity out through the end of a given wave, since the sorts of people sick now with Omicron aren’t necessarily representative. “It’s essentially the same thing as, as saying, if a vaccinated college has an outbreak and an unvaccinated nursing home has an outbreak, those produce two very different pictures,” Faust says. “20,000 sick college kids can have less of an effect on a hospital than 200 sick nursing-home patients.” A few weeks ago, Faust helped launch a hospital-capacity dashboard with Bill Hanage and Benjy Renton. At the moment, it shows that eight states, including California and Texas, have reached a circuit-breaker level — meaning that additional mitigation measures are needed to preserve proper ongoing hospital functioning. Thirteen more, including New York and Florida, are now operating at an “unsustainable” level. “What’s happened in the past few days is that threshold — how many cases we could tolerate before hospitals really feel it — has been leapfrogged by the cases,” Faust says. “So that’s where I’m getting worried. On top of that, the relative mildness of this disease has also made it so that ICUs have lagged, as well. And what gives me great concern is that in the past week or so, around the country, you started to see outbreaks in nursing homes. That was not happening before,” he says. “When I look at the data that I’m looking at, there’s a range of possibilities that could be absolutely catastrophic. And I can’t rule ’em out yet. And that’s why I’m sitting here sort of nervous.” What worries Faust most is what he calls “the sort of zombie-apocalypse scenario, where you truly have to pull patients off of ventilators and not have enough oxygen.” This was what famously happened early in 2020 in Italian hospitals and became the source of the largely successful “flatten the curve” rallying cry for Americans later that spring. “There was almost no place in the country that had to really use crisis standards of care,” Faust says. “We didn’t stomp out the virus, but we certainly didn’t get in a situation where there were 35 patients in an ICU but only ten ventilators, and so 25 of them were just dying.” And now? “There’s a great portion of the country right now that is at risk of entering into that kind of situation sometime soon,” he says. “Will that happen? I don’t know, but I always prefer when I can say, I don’t think that will happen.”
Omicron mild? Experts slam earlier presumption as US sees record hospitalisation "People forget the nature of exponential math. If you have 10x, 20x greater number within 2-3 weeks, that out swamps any benefit of 2x lower mild. That’s why we see hospitalization rates surging across multiple countries” with Omicron," Dr Eric said. https://www.hindustantimes.com/worl...s-record-hospitalisation-101641660806482.html (More at above url)
Omicron explosion spurs nationwide breakdown of services https://apnews.com/article/coronavi...on-pandemics-76830eee3a8c2a5688df4fc77488195a