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Comment by akmarinov | Hacker News Reader

If it’s milder than Delta - then that’s good right?

Or do the increased cases lead to more hospitalizations than Delta?

Scary thing is. Milder disease is a constant factor improvement in hospitalization. But faster spreading (higher R value) is an exponential worsening in hospitalization.

It's probably better to have a 50% hospitalization rate and an R value of 0.8 than a 5% hospitalization rate and an R value of 2. After 3 'generations' of spreading the second situation already has more hospitalizations.

The CDC has estimated the overall hospitalization rate since the start of the pandemic at about 5%. Now with vaccines and other improved outpatient therapies the hospitalization rate is dropping.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

The Omicron variant R0 value appears to be somewhere in the 7 - 10 range.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2...

> It's probably better to have a 50% hospitalization rate and an R value of 0.8 than a 5% hospitalization rate and an R value of 2. After 3 'generations' of spreading the second situation already has more hospitalizations.

Sure, but those aren’t the only choices. Over the last 30 days the daily case average has increased by 500%. During that same time the daily average hospitalized has risen 100%.

And the test positivity rate has increased to almost 30%, which implies an almost comical undercount in actual cases.

The contagiousness and severity are diverging in an extraordinary way. We’re likely undercounting cases by 1/5 or 1/10th.

The testing positivity rate is relatively useless at this point. For example, in my State, there is no way to report a positive test from a rapid result. Only PCR tests administered by a medical professional are considered valid for statistical purposes, even though the government is giving out free rapid tests.

This is for good reason. Rapid tests are substantially less sensitive and often give false negatives, especially for asymptomatic cases. There are also a lot of rapid "at home" tests out there that have high false positive rates, so even if non-PCR tests were added to the data the only reasonable approach would be to still require them to be administered by a medical professional to make sure the test is correctly administered and that the test itself is relatively high quality.

The idea that rapid tests are less sensitive and therefore not valuable is summer-2020 thinking and outdated.

Rapid tests are perfectly fine and should be counted by health departments.

Case in point. My family of 4 all tested positive on rapid tests. 3/4 of us had symptoms. None of us received PCR tests because the next available appointments (other than a 6 hour wait at a state run testing center) were a week away.

Thats 4 people not counted. And we were part of an outbreak that included 3 other families that all tested positive via rapid tests.

I don't think it's useless. I think it's a pretty good indication that there are many multiples of actual cases for every confirmed case. If covid cases have risen 5,000% in 30 days, but hospitalizations have only risen 100%, that's an extraordinarily positive outcome.

Unknown cases don't use up ICU and hospital beds and don't result in deaths, so who cares?

It's pretty important to determine actual severity rates.

An R value of .8 would quickly go extinct.

Exactly!

Maybe but “exponential growth” is a conspiracy theory promoted by epidemiologists. In reality, growth follows the S-curve, so a milder, faster spreading disease will also saturate the population (flatten the S-curve) much sooner, so overall the impact will be much less.

I've seen this argument elsewhere and I don't get it. From my understanding the limitation on exponential growth, the flattening of the top part of the S-curve, comes from total population. There is no one left to infect, basically.

If the rising part of the S-curve is steep, that means people get infected within a shorter timespan and a corresponding higher load on hospital beds and healthcare personnel, which is what we are trying to avoid with the lockdowns.

What am I missing?

Also, calling exponential growth a 'conspiracy theory' seems unnecessary

A conspiracy theory lol. When they talk about exponential growth, they are talking about an R0 > 1. Yes, after some point it drops under 1 and flattens out because there are fewer and fewer people to infect.

You want to keep the number of cases in a range that the health care system still can deal with. Reaching the the flat part of an S-curve (i.e. infecting everyone as fast as possible) is NOT desirable because that leads to many cases in very short term.

That what I hope for. It looks like uk is like this. But is USA like this?

Anecdotally, the hospital my partner works at has been frantically converting almost all of their floors to covid floors due to the influx of patients. But, few require ICU/ventilator.

So yes it's bad/dangerous in that hospitals may fill to overflowing and struggle to treat covid or non-covid patients, but not bad in that Omicron is directly killing more people than Delta et al.

Here's a good take on it:

https://news.sky.com/story/covid-news-latest-nhs-backlog-is-...

> Professor Andrew Hayward, of University College London, earlier told Sky News that it is unlikely there will be a variant more severe than Omicron.

He said: "This one will be hard to outcompete... given how successful it is."

Professor Hayward added that for a "variant to stick", it needs to have "some advantage over the existing variant and that advantage needs to be really in terms of increased transmissibility or escape from immunity".

He said: "There's no advantage to the virus itself becoming more severe."

> He said: "There's no advantage to the virus itself becoming more severe."

I thought the virus doesn't care about becoming more or less sever since its transmission capability is all that matters to it and symptoms are hidden (thus increasing transmission between individuals) in the first days of infection and that's what evolution is driving him to be: more transmissible.

The fact symptoms appear sooner than delta seems to be a step backward for the virus in terms of efficacy and it's compensated by being way way way more virulent.

What am I getting wrong here ?

Also:

Omicron could as well have been more severe (and the jury is still out on long covid anyway). If there's another variant less virulent but compensated by hiding symptoms longer... then this would take over omicron and this variant could as well be more severe.

Is that totally out of the realm of possibilities ?

My regular joe thinking tells me that we can only be sure of the direction it's going to take when spring comes. 2021 had 5 vocs, it's only the first days of January.

Yes, I believe the high transmissibility before symptoms appear is the most beneficial trait to Omicron. However, if a variant appeared with exactly the same traits except that it was 10x more deadly, then a lot more people would be taking it more seriously, self-isolating and driving down infections. From an evolutionary perspective, there is an incentive for the virus to become milder rather than more deadly because of how the news of a deadly virus changes human behaviour.

But future human actions do not put evolutionary pressure on the virus. First the possible new variant emerges, our actions come later.

It's not like strains of the virus are made by intelligent design. The point is that Omicron became dominant because people due to a lot of factors, its high transmissibility and people's disinterest in quarantining among them. If Omicron 2.0 came out with the same transmissibility, but a notably higher lethality, people's interest in quarantining would have increased significantly, which could have prevented Omicron becoming the dominant strain in spite of its increased transmissibility.

Stats for symptom onset delay need to be disaggregated by vaccination status. Search text for "Kato" here:

https://thezvi.substack.com/p/omicron-post-12

I remember 6 months ago some researchers also said that Delta was so contagious that it is very unlikely that even more contagious variant arises. Oh well, sometimes unlikely events happen.

Based on what we see in other viruses, the practical evolutionary upper limit on R0 for respiratory viruses appears to be about 18.

https://www.vaccinestoday.eu/stories/what-is-r0/

Preliminary data on the Omicron variant indicates an R0 value in the 7 - 10 range. So SARS-CoV-2 might still have a little more room to evolve even higher contagiousness.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2...

One thing that gives me pause here; at one time people were saying that _Delta_ would be very hard to outcompete, given how infectious it is.

Something as infectious as Omicron but with better immune escape would presumably do very well, even once the Omicron waves pass.

This doesn't make any sense, unless the variants directly compete against each other. But what we've seen with Omicron is that it can infect someone who just had Delta. So if there's a mutation that can infect someone that had Omicron, but is more severe that mutation can flourish, even if it is less transmissible than Omicron. It just flourishes in parallel.

They do directly compete, this s Is why delta is shrinking in these places.

So far in the UK hospitalisations are increasing, but not dramatically so. There's also brouhaha about how London (where the wave is the worst) is at its peak, or already on the way down.

https://coronavirus.data.gov.uk/

[bear in mind, the hospitalisation number is not quite what it seems. It is "people in hospital who happen to have Covid", not "people who got Covid so bad they need to be hospitalised". So if you have asymptomatic Covid and a broken leg, you count for this purpose. Still, you do require the whole Covid-safe theatre, medical staff in PPE so it's also not like "meh doesn't matter"]

According to your link there's definitely a bump in hospital admissions. Only time will tell how high that bump goes. Let's play it safe and reserve judgement just a little longer...

https://coronavirus.data.gov.uk/details/healthcare?areaType=...

Hm, that's [that 'bear in mind'] correct: https://coronavirus.data.gov.uk/details/about-data#daily-and...

Just wanted to check that since (at at least one London hospital) they're on different wards (as in, even discounting that obviously you don't want 'broken leg with covid' on a general 'broken bones' ward with neg/query patients) so seems odd to me they'd report data like that vs. those needing treatment for it.

My understanding is, there's a fair few people at hospital with "bad Covid" who aren't in Intensive Care. For example, if you have steroids and Remdesivir given to you, you already need to be hospitalised.

So there's at least three categories: people with really bad Covid, people with Covid bad enough they can't be at home, but not (at the time) awful, and people who don't suffer with Covid at all but could infect others, and something else is wrong with them.

I think they are all challenging to the healthcare system in different ways. Ultimately, if you project a complex situation onto R^1, it can't be too accurate.

Yeah, at the one I'm familiar with it's (as far as I know and not necessarily limited to) may-need-intensive-care; intensive-care; out-of-intensive-care; and isolation (the covid+, but only there for the broken leg example).

> Ultimately, if you project a complex situation onto R^1, it can't be too accurate.

Absolutely, and it's all too easy to make 'obvious' armchair policy..! I was just a bit surprised since my assumption would be it counted the relevant wards (if it were up to me, I think that would be the first three; only not the isolation-but-there-for-something-else).

The "peak" in London last week (if it really was the peak) had 1 in 10 people infected. Those are huge numbers, even if most people don't need hospitalisation.

Yes, I was speaking specifically about hospitalisation only.

This guy is a uk health professional who go through the numbers in a easy to understand way. https://www.youtube.com/watch?v=wfZ62aWf6pk

It very much looks like Omnicron is an upper respiratory infection vs previous variants that are lower respiratory infections.

No...@ that's good right

Fewer % hospitalizations, but you have a much larger population getting it in a shorter amount of time.

When hospitals get oveerwhelmed you're going to get a knock down effect on non-covid issues where medical attention is needed but cannot be provided.

More cases means usually faster ability to spread, which again usually indicates that the virus is getting milder, so to answer you first q: yes.At this point covid realistically cannot be eradicated, i would say even if you achieve 80%+ vaccination rate worldwide(which we won't).To answer your second question i doubt we'll have more hospitalizations than delta.And to also state the obvious: by the time we get a 'jab' against omicron, we'll have another variant out there, whether identified & named or not.

Its milder than Delta but way more transmissible. The more people get this, more will be the chances of a new variant which can be more deadly/transmissible.

It’s possible, but most coronaviruses do not seem to have followed this in the past, nor flu-based viruses. More deadly variants usually don’t win it from less deadly in a selection process.

However it is important as the WHO recommends to do way more to export vaccines to countries that need it. Not just developed countries to prevent the chance of new variants.

> the WHO recommends to do way more to export vaccines to countries that need it.

My understanding is that in many of those countries, the vaccine is readily available, but people don't want to take it for various reasons.

If this is all so likely and rapid, why does this not happen constantly every single year? Why did it take so long for one particular virus to leak when it seems like with so many humans we should see some super virus come up constantly.

It does happen from time to time, but it's usually not _quite_ right. In the last couple of decades, there've been at least four or five pandemic false alarms, mostly flu variants. In the event, none of them quite made it. But now that covid _has_ made it, minor variations on the already-very-dangerous-thing can be a big problem.

>Why did it take so long for one particular virus to leak

why long? The EcoAlliance's gain-of-function (with the "Human Subjects Included" checked) NIH grant for Wuhan started in 2014, the human-specific DNA modifications of the virus were described in the EcoAlliance's 2018 DARPA grant proposal, and in the end of 2019 - voila!

With regard to omicron - we may be also witnessing the continuation of the same magic of the fast "gain-of-function" by the virus :

https://www.reuters.com/business/healthcare-pharmaceuticals/...

"By inserting this particular snippet into itself, Omicron might be making itself look "more human," which would help it evade attack by the human immune system, said Venky Soundararajan of Cambridge, Massachusetts-based data analytics firm nference, who led the study posted on Thursday on the website OSF Preprints.

This could mean the virus transmits more easily, while only causing mild or asymptomatic disease."

I guess you're alluding to the "lab leak" theory. I can't say I know how serious it should be taken, but just this: If this really was a lab leak and China knows something we don't know, then I'd be really scared of their current behaviour of locking down entire agglomerations over two-digit numbers of mostly asymptomatic cases.

Very serious. Check out this article. Title not representative . Can skip first 10-20% if wanted.

https://www.newsweek.com/how-dr-fauci-other-officials-withhe...

It's a good article, as far as I can tell - in particular as actually presents some evidence for reasonable assumptions. Though to be fair, it was known before that GoF research was conducted in the WIV (I believe) and there is not yet any evidence that the research actually resulted in this virus.

What's new to me though is how deep the involvement of US entities apparently was and how close to SARS-CoV-2 territory the whole endeavour came. So in this case, absence of evidence is definitely not evidence of absence.

Also that one of the drivers of shutting down the lab-leak theory was apparently commissioning the WIV to do GoF research! (Though I still wonder what all the other scientists supporting that editorial were doing.)

If those FOIA papers will be used for more investigations in the near future, thing should definitely become interesting.

I don't think this logic is correct. Viruses can not become infinitely transmissible/deadly; clearly there is an upper ceiling. Second, people gain immunity after infection. We'd expect the first variant that infects most people to win, effectively closing the door behind it.

But we're seeing evidence that Omicron provides some immunity from the more dangerous strains like Delta.

If we're worried about Omicron mutating to become more deadly, why aren't we worried about the other human coronaviruses doing the same? 229E, NL63, OC43, HKU1 that have been around for ages?

There's nothing magic about Omicron, its just a repsiratory virus thats relatively new to humans so there's not so much population immunity. And looks like we're rapidly getting exposed to it, so its about to lose its advantage.

> 229E, NL63, OC43, HKU1 that have been around for ages

They can only insert themselves into specific cells (acidic ones in lungs, nose, throat, stomach) and thus are respiratory viruses.

SARS-Cov-2 can insert into most cells of your body and loves the organs like the heart, brain, testes, lungs, etc.

It is airborne like a cold but can damage your brain and heart where a cold cannot.

I'm not sure its that different. For example NL63 binds to ACE2 just like covid. Its just less damaging.

Many viruses can attack multiple organs in the body if the infection is bad enough and the viral load is big enough to spread that far - e.g. see https://www.healthline.com/health/viremia

It's still largely the same severity of the original Wuhan variant tho. It's the people getting immunity that's lowered mortality.

Hospitalizations are down 70%, yet in South Africa only 26% of the population is vaccinated, this goes to show that Omicron is less severe than the original variant.

The reason for this is Omicron replicates mainly in the upper respiratory areas and does not invade vital organs. This is also why its so contagious.

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