We’re all feeling a little sense of relief that Omicron doesn’t appear to be as deadly as the previous strains, but there are still plenty of questions. This thread from one of my “go-to” epidemiologists takes a look at where we are and what might come:
I haven’t written much about omicron, because 1) there’s a lot we still don’t know; 2) others have written good shit that I’ve been RTing; and 3) I feel like I’m repeating myself from …everything I’ve written before. But maybe a few words on what’s concerning me right now.
What we definitely know about omicron right now: it spreads easier and faster person to person. It seems to have a shorter incubation period and people seem to move more quickly from exposed to positive.
What there is some evidence for: more mild infections in individuals with immunity, either from prior infection or those previously vaccinated. But it also shows more ability to escape immunity than delta & cause infections in immune individuals (even if not severe).
What’s still unclear IMO: average severity of infections in immunologically naïve individuals. & as many others have pointed out, even if omicron *is* less severe as a whole, if it causes more infections, that can still further overwhelm our hospitals.
Omicron & kids: seeing a spike in hospitalizations in kids in NYC (eg https://abc7ny.com/covid-in-kids-vaccine-omicron-variant-children-with/11393287/). Most of this is in unvaccinated children. Also have seen recent ⬆️ nationwide in deaths in children–spike predates omicron so unclear delta vs omicron, but either way concerning.
Booster protection for kids 12-16: not yet authorized. Recent boosters do seem to provide better protection versus omicron but many in this age group are 6 months or more out from vaccination, and are heading back to school soon.
Rapid tests. In lab, antigens from omicron seem to work well w/ most rapid tests. But concern is that if dynamics of omicron viral replication are different than alpha or delta, are we detecting it as well? Some (anecdotal!) suggestions throat might be better than nose swab.
This needs an evidence base ASAP because some people are using these tests in ways that they’re not designed or authorized currently–but also the govt response in Jan (and some schools) will rely heavily on testing to reduce exposures. Are they working as they have before?
With increased transmissibility, key message from many PH folks has been that better masks are needed for protection. CT is sending many out (https://www.usnews.com/news/best-states/connecticut/articles/2021-12-27/connecticut-to-distribute-at-home-covid-19-tests-n95-masks); I haven’t seen anything from other states. Issues of affordability & access still problematic…
…as many who are out working jobs in retail, customer service, food service etc. may not be able to afford good ones, order ones from valid places, replace them as needed, etc. (I usually offer @projectn95 as a place to start but govt assistance would be welcomed).
Some places have re-instituted mask mandates to slow spread. Others have almost no chance of doing so (hi Ohio). So many won’t wear them in any case since it’s so divisive. As I noted last year, that means spread will go on longer in these areas.
And that includes in schools. While some areas are all-in on masks and test-to-stay policies (which, back to point 7–will these work as expected?), many schools lack mask requirements. Add that to low vaccination rates in these areas & = January may be really bad.
My kid’s school did require masks all school year, which has kept transmission low, but with omicron I’m concerned it won’t be enough. A pivot to remote school for at least some kids could de-densify classrooms, but I don’t think school boards will approve.
So there are things we know to do that could help. ⬆️ vaccination in those who haven’t yet gotten any doses, but it’s getting harder for folks to change minds as attitudes have hardened. Boost. ⬆️ mask use but we’re back to 2020 with little support for that from authorities.
Increase ventilation but that’s a long game and with winter here, some of our local schools are barely heating their buildings as it is.
And so it’s back down to personal responsibility once again, and we’ve seen how well that works at the population level.
So once again, we’re hunkered down, undecided about what we will be doing with 8yo’s schooling next week(!), and with our university going back to fully in-person classes mid-January. 🙃
A possible bright side: the oral therapeutics, esp paxlovid. But will that be enough to replace some of the monoclonals that don’t seem to work well with omicron? Will we have enough? Will rapid tests detect early enough (& be available in an equitable manner?)
& concerned also about the new isolation guidelines (just one thread of many https://twitter.com/meganranney/status/1475627322363494400). Employers are already urging people to come in even if positive–worried this will put more pressure on workers to come back earlier. *Still* not enough freaking paid leave.
And this is obviously US-centric. We still need to vaccinate globally on top of everything else.
So, those are my thoughts for now. Probably incomplete–hit me up with what I missed in the comments.
Originally tweeted by Dr. Tara C. Smith (@aetiology) on December 28, 2021.
Ok. I think I’ll just stay home for a while. That’s fine. Plenty to do right here.