There is a growing consensus that the Omicron wave has peaked and will usher in the endemic phase of COVID. The data is generally supportive of this thesis, but we are not quite there yet, as hospitals continue to reel under the strain of the explosion of infections brought on by Omicron.
The hospital data continues to be less reliable than earlier in the pandemic because of incidental COVID admissions. As I discussed in my last post, in the Omicron wave there have been many more patients going to the hospital for an unrelated condition only to discover that they have a COVID infection because the virus is so ubiquitous today. Some estimates of incidental admissions are over 50%. But there is also a third category of patients with a serious underlying condition that Omicron has exaggerated enough to require admission. However, there are no standards for reporting cases by these different categories. So, while it is clear hospitalizations as a metric for judging serious COVID-related disease needs to be discounted, it is difficult to know to exactly what degree.
But the fact that many of admissions are incidental does not mean the hospitals are not stressed by Omicron. In addition to a heavy volume and the logistical challenges of isolating COVID patients, they are suffering staff shortages from employees who are also coming down with an Omicron infection. Even if asymptomatic, it knocks them out of work for, at least, five days.
With that in mind, new daily COVID hospitalizations in the US continued to skyrocket in the first two weeks of January, leaping from about 13,000 to 23,000 on January 12. However, since then, daily admissions have begun to ease. In the northeast, where Omicron first hit, daily admissions are falling quickly. Most of the western part of the country appears to be peaking now.
In Texas, the story has been similar to the western part of the country, with new admissions probably peaking in just the last few days.
In the Houston region, SETRAC’s daily COVID census tracker suggests that the peak probably occurred around January 12. Generally, Omicron appears to be peaking sooner in metropolitan areas.
Omicron is also complicating interpreting the COVID fatality data for two reasons. First, just as with hospitalizations, it is likely that there are now more “incidental” COVID fatalities. There are also cases where Omicron is exacerbating pre-exiting chronic conditions, causing a somewhat premature death and making determining the cause of death more problematic.
Also, because fatalities are such a lagging indicator, many of the fatalities currently being reported occurred a month or more ago and, therefore, are likely to be Delta rather than Omicron cases.
The CDC daily fatality data, which is mostly based on the report date, broke out of the 1,000-1,200 range to under 2,000 in the last few days.
After leveling off in the 50-60 range in mid-November, Texas fatalities (reported by date of death) have also begun to climb. The seven-day average for the latest days for which DHHS considers their data complete is a little over 70 but it appears that is going to track somewhat higher before it peaks.
COVID patients on ventilation, which has proved to be the best predictor of fatalities, appears to have peaked in Texas in the last few days. So, when we have the final numbers, the peak in fatalities will probably occur sometime in the last week of January. One encouraging sign is that about half as many patients are requiring ventilation during the Omicron wave as compared to earlier ones.
Before COVID, about 8,500-9,500 people died each day during this time of the year, depending on the severity of the annual flu season. If all of the fatalities being attributed to COVID are in addition to the normal level, then fatalities are running about 20% above normal. But based on the preliminary data that does not appear to be the case. The latest week for which the National Center for Health Statistics classifies its data as “complete” is the last week of December. Currently, NCHS shows only 52,000 fatalities which would be well below normal for the last week of the year. However, I have noticed that even though the NCHS calls a week “complete,” more fatalities are usually added.
There is some indication that Omicron-related fatalities may be replacing other typical causes of death for this time of the year, such as the flu. The excess death data from the UK is showing a short peak above normal in the last week of December, but none since then. All of this data is still preliminary, so it will take some time to assess the true impact of the Omicron wave on fatality. But there is some reason to hope that Omicron’s toll will not be as severe.
Daily vaccine administrations topped out during the Delta wave in December at about 1.8 million. That has steadily moved down since and is now below one million. Many of those are boosters, so the number of the fully vaccinated is moving up very slowly.
The CDC issued several reports which show the vaccines, especially when boosted, are very effective at preventing serious COVID disease and hospitalizations, but they are probably doing relatively little to slow down the spread of Omicron.
It also issued reports showing a significant increase in immunity from previous infections, further demonstrating the important role natural immunity is playing in reaching herd immunity. The immune response is especially robust in individuals who have had a prior infection and been vaccinated.
The CDC finally updated and expanded its adverse events data, which continues to show that the complications from the vaccine are very, very rare. The relative risk is, in my opinion, very clear. The vaccines add very significant protection from serious COVID disease, especially to seniors, for a de minimis risk of a vaccine-related complication.
The daily reports of positive test results peaked on January 10 at a mind-boggling 1.3 million. Of course, testing is only finding a small percentage of the actual infections. The IME model is estimating that actual infections are six times what the test data is showing. Many experts are estimating that by the end of February half of all Americans will have had a case of Omicron. There is truly nothing comparable to this in the known history of infectious diseases.
The testing and positivity rates, while still very high, have both turned down in the last week, further supporting the view that Omicron has peaked.
While the rate of descent of the backside of the Omicron wave is not yet clear, I do not have any doubt we are on the backside. We also do not know the extent of damage the Omicron wave will cause, but it appears it will be much less severe than Delta.
There remains the question of whether there will be another variant after Omicron that could throw the country back into an epidemic phase of COVID. That is very much an open question on which scientists are divided. Most seem to believe that it will be difficult for COVID to evolve to be much more transmissible than Omicron and, therefore, it will remain the dominant strain. It may become like other coronaviruses that cause common cold symptoms for millions of people around the world each year.
A minority of scientists are predicting yet another super-variant is just around the corner that will plunge the world back into an epidemic. One local researcher, who is promoting his version of a vaccine, has predicted that we will be back in an epidemic phase by the summer that will be worse than Delta or Omicron unless we immediately vaccinate the entire world.
I am skeptical of the more calamitous predictions and especially of anyone who says that COVID will not be brought to heel until the entire world is vaccinated. Do not misunderstand me, I think it would be great to vaccinate everyone in the world, but I also know we will never come anywhere close to that.
I would once again point out that every epidemic in history has ended without a vaccine because we have never been able to develop a vaccine before the epidemic phase of a disease subsided naturally. At two years and counting, COVID is already a bit long in the tooth compared to prior epidemics. So, another variant that would extend it even farther would be unprecedented as nearly as I can tell.
There may be some reasons that epidemics are going to last longer in the modern era. I personally suspect that a more connected global community and a larger immune-compromised population, where a virus can hang out for months and replicate, are factors that may extend epidemics in the future. However, our ability to develop vaccines during an ongoing epidemic may offset such factors to some degree.
It has been about fifty years since the last global pandemic that was anywhere near the scale of COVID. That was the Asian Flu pandemic of 1957-58. There are some estimates that as many as four million people died in that pandemic worldwide and about 100,000 in the US. The U.S. Army developed a vaccine very late in the pandemic but it is not clear how effective it was. Beyond that there was very little effort to stem the spread of the virus by public health authorities and certainly nothing like the response to COVID. The view at that time was more that epidemics were an act of nature that we had little control over.
I hope that in the aftermath of COVID, and after the partisan politicians feel they have rung all of the demagogic benefit they can from it, we have some serious respective studies to look at what worked and what did not work. I am increasingly convinced that some of the measures, especially the lockdowns, did far more harm than any benefit in reducing COVID’s toll. If we have that kind of clear-eyed examination, perhaps we will head into the next pandemic better prepared.