NYT: Omicron is not just milder, its risk is akin to the flu

So writes David Leonhardt, the country’s most reliable communicator on the pandemic. Unfortunately, Leonhardt reports for the New York Times rather than run the CDC or FDA, where they put the panic in pandemic. For the first time, thanks to the mutations of COVID-19 and the widespread deployment of effective vaccines — although not widespread enough — we finally have a contagion that’s roughly at the same risk level as the flu.

That’s not to say there’s no risk, as Leonhardt reminds us, but that it’s manageable on a long-term basis:

The latest evidence about Covid is largely positive. A few weeks ago, many experts and journalists were warning that the initial evidence from South Africa — suggesting that Omicron was milder than other variants — might turn out to be a mirage. It has turned out to be real. …

Before Omicron, a typical vaccinated 75-year-old who contracted Covid had a roughly similar risk of death — around 1 in 200 — as a typical 75-year-old who contracted the flu. (Here are the details behind that calculation, which is based on an academic study.)

Omicron has changed the calculation. Because it is milder than earlier versions of the virus, Covid now appears to present less threat to most vaccinated elderly people than the annual flu does.

The flu, of course, does present risk for the elderly. And the sheer size of the Omicron surge may argue for caution over the next few weeks. But the combination of vaccines and Omicron’s apparent mildness means that, for an individual, Covid increasingly resembles the kind of health risk that people accept every day.

Indeed. However, Omicron’s not the only variant getting passed around at the moment, a point that bears on the subject of assumed risk. Delta is still around, but the latest CDC genomic surveillance suggests that Omicron is perhaps crowding it out of the population now. That also has a couple of caveats, however:

First caveat: the CDC screwed up this data a few weeks ago and reported that Omicron had been 73% of all genomic identifications when the real number was 23%. Assuming that the CDC has corrected whatever caused that error, this is good news but still describes a proportional relationship between the two variants and the original COVID-19 virus. Four percent of 450,000 daily cases (the latest report from the CDC) is still 18,000 cases a day of Delta, as compared to 94,000 cases a day of Delta alone at the most recent low spot of reported cases at the end of October. Those 18,000 cases can still create a lot of havoc, including excess hospitalizations and deaths. Plus, we’re still not sure that Omicron infections will pre-empt Delta cases, but the data is definitely leaning in that direction — otherwise we’d see more competition between the two. (The drop in Delta from October looks significant enough for that assumption too.)

Finally, Omicron’s case amplitude is just so high for now that even the flu-level risks will still result in a significantly higher hospitalization and clinic utilization curve than the flu. Omicron still gets people sick enough for acute intervention, even if the outcomes are a lot more positive, Leonhardt stresses:

Hospitalizations are nonetheless rising in the U.S., because Omicron is so contagious that it has led to an explosion of cases. Many hospitals are running short of beds and staff, partly because of Covid-related absences. In Maryland, more people are hospitalized with Covid than ever.

“Thankfully the Covid patients aren’t as sick. But there’s so many of them,” Craig Spencer, an emergency room doctor in New York, tweeted on Monday, after a long shift. “The next few weeks will be really, really tough for us.”

The biggest potential problem is that overwhelmed hospitals will not be able to provide patients — whether they have Covid or other conditions — with straightforward but needed care. Some may die as a result. That possibility explains why many epidemiologists still urge people to take measures to reduce Covid’s spread during the Omicron surge. It’s likely to last at least a couple more weeks in the U.S.

January and February will probably push health-care systems to the bending point, if not the breaking point. (Unnecessary staff dismissals won’t help.) We can also expect the run on those resources to continue from asymptomatic and mildly symptomatic Americans who are panicking about the risks in the Omicron wave, thanks in part to a testing shortage that forces people into clinics for a diagnosis. All of that utilization could produce excess deaths from an inability to respond effectively to seriously acute cases, but we have to also remember that this isn’t April 2020 either. Not only have we vaccinated 73% of the overall US population, we now have a number of effective therapeutics to treat acute COVID infections, including new outpatient anti-viral regimens.

Leonhardt’s assessment is not just accurate, it’s overdue from a public policy standpoint as well. We need to soberly assess the risks as they currently stand, both publicly and personally, and calculate our policies in the knowledge that COVID-19 is an endemic virus with which we will have to live for the long run. If Omicron crowds out more virulent strains and spreads across the entire population now, we will likely come out the other end in a few weeks with effective herd immunity and the tools to manage normal life again.

Except for the tests, it seems. Note well that the date on Ron Klain’s tweet is June 2020. His boss has been president for almost four times the amount of time between the pandemic’s start in the US and this tweet. What have Joe Biden and Klain done in the past year to fix the testing problem? Diddly-squat.

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