How severe are Omicron Infections?
nature.com
nature.com
Be reasonable.
Bad news is reported more, if bad things happen, you need to act fast so it's good to pay close attention to bad news, that's what news organizations want you to think.
And then you commented that as an educated scientist, you also think we should pay close attention to bad news. At least that's how I took it.
When I wrote my comment, my intended meaning was more specific to the current situation: I really wish people would be more united in taking action in the face of an infectious disease, the transmission of which is entirely preventable in the aggregate.
These are all things that we have to act on, as individuals. They are all bad news.
Then you have the rest of the 99.999% that you don't need to know, but you do need to know the very few stories. And for that you have to go through all the other ones.
There's plenty you need to stop doing.
That is actually a terrible heuristic. The need to “do something fast” leads to tremendous amounts of wasted time and resources and often a codified public policy that is unproductive or counterproductive.
The bias to action over inaction exists, among other reasons, because it plays out conceit that we control our own fate.
But if Omicron happens to be benign enough, it almost acts as a natural vaccine. This would be a very positive development for covid, not negative.
For some reason the focus still seems to be largely on case counts instead of actual outcomes.
Economic impact of lockdowns was mitigated somewhat by mass money printing and fiscal spending. If we lockdown again, will be disastrous for global economy as most monetary and fiscal firepower has been exhausted. Very troubling to see nations moving towards this again
Here's my speculation on the reason that the virus is seeming benignish so far... omicron requires fewer ACE2 receptors to bind to in order for it to infect a host(because of the incredible reproduction rate over delta once it takes hold). The younger are generally not taking as many precautions as the elderly did(elderly have more ACE2 receptors but have mostly been vaccinated or died already). so as the pool of eligible candidates for infection trend younger (fewer ACE2 required moves the bar of easy infection down younger) you have younger people generally having a better time with the infection because their immune system is slightly more robust. and that tracks with younger people (generally) during the delta wave and original variant; younger people tended to have fewer really bad outcomes.
You need a fully formed view to come to a conclusion based on details and those most qualified to do so are the least willing to do so.
The reason seems obvious - it’s been only 25 days since the discovery of the first case. There haven’t been many outcomes yet to focus on - as far as I remember, the average time between symptom onset and hospitalisation is something like 10 days, depending on the age group.
For vaccines, the focus still seems to be largely the percentage of effectiveness, as if that effectiveness will be a reliable constant for each combination of particular vaccine, particular variant, and particular undesired outcome (case, symptomatic case, hospitalized case, oxygenized case, ventilated case, long covid, death, whatever). However, that effectiveness will almost certainly vary both with the attributes of the person (e.g. age, sex and `comorbidities`) exposed to the variant and with the environment, particularly the number of times the typical vaccinated person is exposed to the variant and how heavily exposed. For example, if we now observe, when omicron is starting to spread, that a vaccine shows 50% reduction in cases or hospitalizations or deaths, what will be the observed reduction when omicron is more prevalent, when it may be common for typical persons to be exposed multiple times per day for a few weeks? Could the 50% reduction still occur? Could the vaccine give a percentage of people super-immunity and the other people none at all? Otherwise, will the increased presence of omicron in the environment overwhelm the effects of the vaccine and drive that observed reduction from vaccination (or boosterization, or whatever) down significantly? What do the experts know from experience about this?
I wish Mr Biden nothing but success in his efforts to get us all doing the right thing, and I hope that his emphasis on vaccination now brings good results.
and here's the plot for London https://twitter.com/theosanderson/status/1471907339397738502
It seems safer to believe bad news, and remain wary, than to believe good news and drop your guard.
So far, the data are scarce and incomplete
The rest of the article consists of anecdotes that could point in either direction. If you want good news, check out the piece from WaPo from a few days ago [0]
Just keep in mind the scarce and incomplete factor. Give it another 2-3 weeks and we'll know more. Meanwhile it's probably not a good time to stop whatever precautions you have already been taking.
[0] https://www.washingtonpost.com/world/2021/12/14/south-africa...
Extrapolating from hospitalization rates and limited sample sizes is mostly just guesswork. It’s probably not much worse, but beyond that is up in the air.
1) the “precautionary principle”
2) the consequence asymmetry: if we’re vigilant at a time when we could relax, the consequence is small, but if we relax when we should increase vigilance, the consequence is larger.
Unvaccinated who haven’t had the virus should be very worried due to the transmission. For people with some immunity, the jury is out but personally I am not looking forward to probable mild Covid, until recently I thought I had a good chance of simply not catching it due to being vaccinated. that seems to be no longer the case.
https://coronavirus.data.gov.uk/details/healthcare?areaType=...
Admissions are rising markedly, compared to flat for the rest of the UK. Omicron is surging in London, again (as yet) flat elsewhere.
Edit: @downvoters. How do you know hospital cases are currently Omicron? As far as i know there is a delay between new cases and hospitalized cases of multiple days. And the difference isn't shown in the article.
A hospitalized case of delta is averaged at ~ 8,5 days of hospitalization. So we have to wait at least another week.
https://assets.publishing.service.gov.uk/government/uploads/...
[1] https://assets.publishing.service.gov.uk/government/uploads/...
Even when new cases could be Omicron.
Either way, we will know soon.
[1] https://assets.publishing.service.gov.uk/government/uploads/...
[2] https://www.who.int/news/item/26-11-2021-classification-of-o...
To know the difference, we should at least wait another week after Omicron takes over new cases in statistics.
>>main infections in the UK are currently from Delta.
Since hospitalization lags, we cannot assume hospitalization based on case numbers.
There's a graph here of cases vs deaths for the 4 waves in SA showing pretty much no sign of deaths shooting up in this one while they shot up in waves 1,2 and 3. For those saying - ah the South Africans were immune, why didn't that work in wave 3 but did in wave 4 if not for the virus being different? https://mobile.twitter.com/ScottGottliebMD/status/1472664060...
The "16 December report from Imperial College London found no evidence of diminished hospitalizations" thing is ridiculous if you look at the paper - they didn't find statistical significance in English data because there was hardly any at that point and didn't even bother looking at African data because why bother. Bit like me saying there is no evidence of Ebola being more dangerous than having a cup of tea because I've done a study in my kitchen and no one has died there.
So I like how the bar has shifted, because everybody is so fed up with the disruptions to their daily life. Understandably so. But most virulent disease every is still pretty bad. Just from a logistical standpoint.
For me, the real problem is what comes after Omicron.
HIV is a completely different disease with a different etiology but it never went away. Treatments just got better with time.
I suspect the pandemic will force a lot of adaptations and legislation. I’m most excited about rapid testing at home though. I feel like that’ll do a lot to stifle the pandemic.
Historians will look very poorly on the authoritarian type policies being implemented that are, in fact, ignoring the science (actual data, second order effects), not following it.
the problem with that kind of lagging reaction to policy is that if you wait for the results of the variant you may have a situation where you are unable to contain or curtail the virus enough to not overwhelm the hospital systems. deaths and hospitalizations are a very lagging indicator of the effects
You can think of any hypothetical worst case and make irrational policy on the basis. Maybe next year's flu strain will cause any who catch it to die one year from infection?
At the moment, the evidence we have available suggests that Omicron is much more transmissible than Delta, and between 0-30% less likely to result in hospitalisation. It certainly seems like policy is being made with that in mind.
Stats from a recent Denmark study show 60% fewer
https://twitter.com/BallouxFrancois/status/14726914313367265...
But people don't want good news with covid. They want to fearmonger as if we can eliminate 100% of cases through authoritarian policy. Which think I don't need to state, will never happen, regardless if 100% of society is vaccinated with a booster and we perpetually lockdown.
It's an endemic disease, that's life.
Zero heed is paid to the extremely costly second order effects of these extreme policies. One of which was a massive increase in wealth inequality, by the way
Edit: I guess I don’t see why there would be time for a DOI or peer review, but I could see there being time for a preprint. Why wouldn’t you just link to the primary source when it’s ambiguous like this?
I honestly don’t recognise your portrayal of fearmongering or a desire for negative news. In fact I’ve been particularly surprised by the response to this variant in some circles, which is to hop right on to the tiniest shred of potential positive evidence as a cast-iron guarantee that it’s no big deal. Everybody really wants this to go away, and there is extensive debate in every country about the second-order effects of control measures.
The population looks at multiple variables. IE their quality of life, their financial situation, their desire for social connection.
Any policy that looks at a single or small number or variables, vs the holistic system is a policy that's not "following the science".
If you drive through the south of the US, you'll find that nobody masks and they live life as if covid never existed. And their health outcomes are basically exactly the same as NY or CA. So what effect do these policies have? The science shows, basically nothing other than harming quality of life
This is one of those enough information ask again later situations.
We know that vitamin D helps prevent this kind of thing. We know that most (Americans) are deficient in the winter months. There is evidence to support the idea that it is protective against Covid-19. It is also very safe to take even if you're not deficient.
I have yet to see a PSA or recommendation on this. That could have been proactive rather than lagging.
What I have seen is newer research suggesting that vit D doesnt help, but always with some caviotte like "in people who are not deficient" or one where they administered high doses to people already on ventilators.
On the other hand, an official proclamation that people should ensure their vitamin D levels are okay would cause a rush on it with many people taking much more than they should. We've seen this with other medications that have not been systematically shown to help COVID but still obtain meme-like status. Ivermectin for example also has only equivocal evidence for its use, but has resulted in overdoses [2] and a spike in calls to poison control centers over its use [3]
Maybe there's a middle ground there on something like vitamin D, which as you say is often deficient. But it's a fine line to walk when the evidence is uncertain about its impact on COVID.
[0] https://www.covid19treatmentguidelines.nih.gov/therapies/sup...
[1] https://www.mayoclinic.org/diseases-conditions/coronavirus/e...
[2] https://www.newsweek.com/man-covid-overdoses-ivermectin-doct...
[3] https://www.npr.org/sections/coronavirus-live-updates/2021/0...
well it was actually pretty promising in some countries data early on. the problem is when you extrapolate that data to the world at large you have problems with populations. so yes, ivermectin is useful in areas that have parasites that can cause the host to die from when in a weakened state due to the immunosupressing drugs that they give to stop the cytokine storms that kill covid patients, exactly the populations that the data showed a benefit from and also standard course in those countries. when done in places without a high risk of secondary parasitic infection the data was that it was not useful.
There were/are some studies done now because it's so cheap but it's not really all that effective outside of it being an secondary treatment in those parasitic prone countries.
But since it showed promise there the antivaxxers were hell bent on using it regardless of the why because it wasn't a vaccine and here we are.
Too much vitamin D is bad too and you definitely don't want that and without data supporting it being highly effective against covid it's not useful as a prophylactic. That said, vitamin D is generally correlated with a better immune system response against respiratory illness. supplementing a reasonable amount is not usually considered harmful but it's wise to talk to a doctor.
The second two are just about misuse of ivermectin.
I think informing the public of this option is a good idea. They could also be informed not to take it in excess. This whole concept about withholding information or trying to influence peoples behavior is part of the problem.
Vitamin D should have been proposed in the beginning due to its documented effects on reducing respiratory illness, but even then anything people suggested was being shot down as not FDA approved treatment for Covid. But there weren't any such treatments at the time.
The first two links specifically say there is not enough information to make a full determination. Public health policy shouldn't be based on "We don't really know, but maybe?"
Also it's not withholding information:
Proper nutritional guidelines are published all over the place, including recommended daily intake of vitamins, and we've known pretty much from the beginning that otherwise healthy people are much safer from COVID. That seems more than sufficient to provide people with guidelines about how to stay low risk for COVID with respect to their diet. The government shouldn't have to spoon feed every detail, a little self-reliance should be expected of the population. Especially when singling out any one substance could result in unanticipated consequences.
They say that up front but then go on to site some rather compelling results. Then they mention some of the failures - like giving it to people who are already on deaths doorstep and not being effective. They also mention that "observational studies" are ongoing, which also suggests there is hope.
>> Also it's not withholding information:
Proper nutritional guidelines are published all over the place, including recommended daily intake of vitamins, and we've known pretty much from the beginning that otherwise healthy people are much safer from COVID.
Nobody is reminding people of that in regard to Covid. ALL the messaging is "get the vaccine". I've said in other threads that I've had Covid, and that offers better protection than the vaccine, so why do people keep insisting that I should get it? The response (which is valid) is that it will offer even more protection, and that we should do everything we can to slow the spread. Well, if we want to do everything we can then why is "everything" restricted to just getting the vaccine? Where are the calls for people to keep in shape, lose weight, make sure they get good nutrition - in relation to preventing Covid?
Should they also be saying avoid second hand smoke to minimize respiratory problems if you get COVID? Should tell diabetics to keep their blood sugar between 70 and 120, and their A1C below 7, to avoid additional complications if they get COVID? Should they be plastering PSAs all over the news media to tell the millions of obsese people to lose weight due to COVID?
No, of course not. Some things, like following established nutritional guidelines, are just obvious and it would be an overbearing nanny state to expect the government to be condescending enough to do this sort of thing.
Poor "I feel lucky" sources:
https://patient.info/bones-joints-muscles/osteoporosis-leafl...
https://www.medscape.com/answers/128762-54281/what-is-the-pr...
Note: reason might be vitamin d supplements in ordinary food is more common in the UK.
Do we make all policy on the basis of one variable, or do we look at the multivariate system holistically? Majority of countries are doing the former, which is not "following the science" but cherry picking a subset of the science that reinforces your view.
I can assure you everybody on earth catching covid would be less severe and painful than the GFC was for global population. Which is pretty easily borne out by the data (the science).
A second global lockdown would have pretty similar results to the GFC, given that ammo for stimulus is spent.
I don't think history will look poorly on a scenario of "A more infectious version of COVID emerged, so for the following 6-8 weeks we asked people to increase social distancing and mask wearing".
If the mandate was "Cancel Christmas and arrest people found at holiday parties" then yes, "authoritarian" history would look poorly on that. As it stands, I haven't seen any governments take drastic steps towards more lockdowns due to Omicron. It's all "urging more caution".
Strict limits will be placed on the number of people who can meet - a maximum of two guests aged 13 and over will be allowed in people's homes, and four on 24-26 December and on New Year's Eve and New Year's Day.
https://www.npr.org/sections/goatsandsoda/2021/12/17/1065315...
I trust almost nothing that comes out of Imperial College these days. The architect and the salesman of the first lockdown (to Boris and then Trump) clearly did not believe in them enough to apply them to himself.
https://en.wikipedia.org/wiki/Neil_Ferguson_(epidemiologist)...
Unfortunately a lot of the world which isn't Europe and North America seems to fit into this category.
Also if you do wanna take the hot take of omicron spreading and displacing other variants, then it's still very important to get the booster shot. The vaccine has a much bigger effect on those variants than on omicron. In Norway at a party of 120 fully vaccinated people, 80 of them got infected with omicron. So no matter what, it's still important to get your boosters!
Early lab tests suggest the antibodies generated by the immune system after the booster shot are able to target and eliminate Omicron particles. “ Those who did not receive the booster shots, had no neutralization ability against Omicron. Researchers said the booster increased this about a hundred fold.”