Author: chogan@directresearch.com

This post tries to communicate a few related points:

• This is no longer a pandemic of the unvaccinated.  The majority of new cases are among vaccinated individuals.
• And yet, only the unvaccinated remain at high risk of hospitalization and death.
• As a result, the apparent severity of the average new case has fallen.  That’s not because “the virus is getting weaker”.  It’s because new cases are increasingly occurring among the vaccinated who, by and large, won’t die from it.
• But now, nothing stops chains of infection.  Not vaccination, because efficacy against any Omicron infection is low.  Not masks, because the overwhelming majority of the population faces little risk of serious illness, and they’re not going to mask up merely to protect others.
• As a result, this is a really bad time to be an unvaccinated elderly person.  Plausibly, the worst since the start of the pandemic.

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In my prior post, I noted our current bout of pandemic agnosticism.  One year ago, anything like the current new case rate and increase would have led to prayers for divine relief.  Now, we just shrug it off.

This is mostly rational, I think.  Assuming that people act in their narrow self-interest.

There are still only about 300 deaths a day attributed to COVID (based on the CDC COVID data tracker).  All the breathless headlines you read about how COVID-19 deaths are doing this-or-that are therefore mostly nonsense.  When you get down to an average of six deaths / state / day, with new case loads shifting rapidly across states, anybody who thinks they can parse out the fine points of time trends is kidding you.  And likely kidding themselves.

(As a point of reference, a typical U.S. flu season results in maybe 37,500 deaths, mainly over a five-month period, or an average seasonal flu death rate of about 250 deaths a day.)

And we still haven’t hit 3,000 new hospital admissions per day.  Nor are there any states where the hospital system is stressed by the COVID-19 case load (as measured by more than 30% of ICU beds devoted to COVID-19 patients.)

(Again as a point of reference, a typical flu season results in about 380,000 hospitalizations, or about 2500 a day during a (say) five-month flu season.  The whole flu-versus-COVID writeup starts with Post #1400, part 3.  Note that in both cases, if you’re vaccinated, your risks are far lower than the risks you would face from seasonal flu, as the unvaccinated disproportionately account for COVID-19 deaths and hospitalizations.)

I attribute both of those to the peculiar way in which the vaccinated (and possibly those with prior infections) are losing immunity against the BA.1.12.1.  As shown in yesterday’s post, vaccines still provide good protection against severe disease.  But at this point, they appear to provide little protection against getting infected.  As a matter of arithmetic, then, as immunity against any infection fades, a higher proportion of all infections is occurring among the vaccinated.  And so, occurring in a population for whom infections are far less likely to proceed to hospitalization and death.

Six months ago, this was truly a pandemic of the unvaccinated:  The overwhelming majority of cases (and hospitalizations, and deaths) were among the unvaccinated.  Here’s Virginia as of September 2021.  This chart is a little extreme, but not atypical for that time period.

Here’s the same chart, with the most recent data from Virginia.

Source:  Calculated from Virginia Department of Health, COVID-19 cases by vaccination status, accessed 5-12-2022.

It’s no longer true that this is a pandemic of the un-vaccinated.  Not in terms of new cases.  That’s in small part because the number of vaccinated persons has increased.  But it’s in much larger part because the efficacy of the vaccine against any infection (from BA.2 or BA.2.1.12) has fallen.  As a result, depending on the week, in Virginia, the unvaccinated account for the bare majority of cases (or, in weeks just prior, were actually the minority of new cases).

But in terms of deaths and hospitalizations, sure, this is still a pandemic of the unvaccinated.  As of February, COVID-19 still had a 2 percent case mortality rate among the unvaccinated.  One-in-50 of those formally diagnosed with it died from it.  Regardless of the new monoclonal-this-and-that now available to treat it.

You see a lot of popular-press and social-media mis-reporting of this phenomenon.  Despite any significant change in the virus, people are reporting this as if the virus itself has somehow magically become weaker.  Independent of its relatively stable genome.  And those who report that, and repeat that, never stop to consider the literal impossibility of that, absent major change in the virus’ genes.

This “virus has gotten weaker” meme simply isn’t true.  Omicron (BA.2) is the same now as it was five months ago.  It’s just that the vaccinated are getting infections at a high rate now, and those infections by-and-large do not progress to serious illness.

There’s an odd consequence of this, in that the U.S. population now splits into a vast majority that really has nothing major to worry about from COVID.  And a small minority — call it the unvaccinated elderly — who remain at high risk of death, if they should become infected.

If this new-case growth keeps up, it’s going to be a really bad time to be an older person who is unvaccinated.  Why?  Because at this point, there’s no way to stop the chains of infection.  Sure, almost nobody is dying from it, or even being hospitalized for it.  But on the flip side, almost nobody is maintaining COVID-19 hygiene in any form.  And a mostly-vaccinated population now provides almost no barrier to circulation of the disease.

Back when vaccination provided good immunity against any infection, a mostly-vaccinated retirement community / assisted living facility / nursing home provided pretty good protection for those who refused (or could not undergo) vaccination.  The vaccine holdouts lived within an infection-resistant herd.

But now?  As of February, vaccination provided only scant protection against infection.  It appeared to cut your odds of any infection in half.  By now, it’s probably less.

The upshot is that for the unvaccinated at-risk (e.g., elderly), this is a new phase of the pandemic.  New-case rates are higher than they have been for most of the pandemic.  But now, in terms of disease transmission, it’s almost as if vaccines and masks don’t exist.  Vaccines, because they no longer protect (much) against any infection, masks because most won’t wear them now.

And, as icing on the cake, we have a popular press telling those vaccine holdouts that it’s OK, “the virus is getting weaker”.  When that’s simply not true, and the case mortality rate for the unvaccinated remains at 2 percent.

And so this most recent wave of the U.S. pandemic is devolving into an odd sort of inadvertent Darwin test.  We’re not merely back to the point where nothing will materially prevent the spread of infection.  We’re at the point where most people see no reason to engage in any COVID-19 hygiene either.  And then we have a small fraction of the at-risk population who won’t get vaccinated and so remain at risk of serious illness from COVID-19.

And so, we approach a sort of rational no-golden-rule equilibrium.  Sure, all of us can spread it now, but few of us face significant risk from it.  For the unvaccinated who have not yet been infected, arguably, a given level of daily new cases puts them at higher risk now than it did at any prior time in the pandemic.

Source:  CDC COVID data tracker, accessed 5/12/2022

 

Now 25 new cases per 100K population per day, up 30% in the past week.  A week ago, it was 19.

Data source for this and other graphs of new case counts:  Calculated from The New York Times. (2021). Coronavirus (Covid-19) Data in the United States. Retrieved 5/10/2022, from https://github.com/nytimes/covid-19-data.”  The NY Times U.S. tracking page may be found at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

 

I was going to attribute the increased growth rate to Pennsylvania, a large state that did some catch-up reporting yesterday.  But the graph says otherwise.  Things ticked up pretty much across the country.

I don’t want to make too much of a one-day increase, but this is interesting in that it seems to be nation-wide, or nearly.  And yet, it’s bad science to make up plausible explanations for it after-the-fact, if it turns out to signal an inflection point on the curve.  So maybe it’s better to speculate on possible causes ahead of time.

Given the lags involved (between infection, symptoms, care-seeking, testing, lab turnaround, reporting, and then a seven-day moving average), today’s reported uptick, if real and not just a data-reporting issue, is a consequence of an increase in infection events that occurred around the very end of April.

As far as I can tell, that correlates with absolutely nothing.  It’s too late for Spring Break and associated religious holidays, for 2022.

The only rational explanation is that we somehow angered Hygeia on or about 4/30/2022.  (Or one of the myriad health deities.  Seems to be a fair bit of competition for the god/goddess of health gig.)

In short, there appears to be no rhyme or reason to this particular uptick.  At least none that I can see.  Perhaps it’ll disappear tomorrow.

That said, a comparison against the last two years shows what an impious lot we have become.  A year ago, an upturn like this would have evoked at lot of prayerful pleas, I think.  Now, we’re like, don’t cancel the barbecue on account of a little thing like that.

 

Data source for this and other graphs of new case counts:  Calculated from The New York Times. (2021). Coronavirus (Covid-19) Data in the United States. Retrieved 5/11/2022, from https://github.com/nytimes/covid-19-data.”  The NY Times U.S. tracking page may be found at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

In related non-news, mask use is at a pandemic all-time low.   In the past, there was an average one-month lag between changes in the new case rate, and changes in mask use.  But mask use has always been driven primarily by peer pressure.  So I’m betting that mask use does not recover until this winter’s wave.  Not because that makes any sense, but because we don’t associate nice spring weather with spread of disease, but we do associate winter weather with colds and flu.  Masking up only for the winter wave is not rational, but to most it will feel more normal.  And so, I’m betting that’s what we do.

Source:  Carnegie-Mellon COVIDcast.

Hospitalizations are up, some.  The CDC COVID data tracker website currently shows 2500 admissions per day.  Doesn’t sound like much, except that at an average cost of around $25K per admission, that represents about $60M/day (or $22B per year) in additional health care spending.  Because the U.S. doesn’t spend enough on health care already.

Deaths are still not up.  I attribute that to the waning of immunity of the vaccinated population, and the resulting shift in infections such that a greater fraction of those with any infection are vaccinated.

How safe are you if you have gotten a booster?

Caveat:  In terms of timely data on vaccine effectiveness, out of CDC, all we have is observational data.  That is, all they can do is observe the rates of infection, hospitalization, and death among the populations that chose to get a booster or not.  The resulting “real-world” or “bottom-line” numbers will reflect not only the effectiveness of vaccine booster, but also the characteristics and behavior of those who chose to get the vaccine or not.

It’s all we have to go by, for better or worse.

That said, as of February, the CDC showed that risk of dying from COVID-19, for the vaccinated and boostered was about 5% of that for the un-vaccinated.  (Shown as “20X” on the graph below):

The same chart shows that, by February 2022, boosters didn’t appear to do much to stop any infection.  (Hence the mere 2.0X for the risk of testing positive.)

The only national information from CDC that’s more timely than that is for risk of hospitalization.  Here, I’m focused on those who got a booster shot, so I am only looking at the 65+ population (because, as I recall, they were the only ones who had carte blanche to get a booster in the U.S.  For all others, the only eligible populations were high-risk population).

Here’s how that looks. As of February/March 2022, the risk of hospitalization for the boostered, relative to the unvaccinated, is around 10%.  So the booster remains roughly 90% effective against hospitalization from COVID-19.  (Among the elderly, at least.)

Source:  Calculated from CDC COVID data tracker, accessed 5/11/2022.

The level shown above for boostered people —  in February, they were about 10% as likely to be hospitalized for COVID-19 as the un-vaccinated — is a pretty good match to the CDC mortality estimate (that they were only about 5% as likely to die from COVID-19).  The result is a consistent story about booster effectiveness.  After a few months, the booster does almost nothing to prevent a mild case of COVID-19 (50% reduction, relative to unvaccinated).  It does a pretty good job of preventing a case severe enough to require hospitalization (90% reduction, relative to unvaccinated).  And it does a slightly better job of preventing a case so severe it kills you (95% reduction, relative to unvaccinated).

But, as the data clearly seem to show, immunity wanes over time.  In this case, for the boostered population, effectiveness at preventing hospitalization appears to wane at about 2.5 percentage points per month.  (The start date of the curve corresponds to the peak week of booster shot delivery, so despite the fact that it took a couple of months to deliver all the booster shots, that’s still a pretty good estimate for the speed at which immunity wanes for any one boostered individual).

The upshot is that, as of now, regarding getting a case of COVID severe enough to land you in the hospital:

• Vaccination reduces your risk by about 75%
• Vaccine and a well-aged booster reduces your risk by about 90%
• Vaccination and a fresh (second) booster arguably reduces your risk by about 97%.

Make up something that’s wrong, pretend that it’s true, then complain when reality fails to match your imagination.

As far as I can tell, this is just standard operating procedure for some classes of individuals.  If you don’t have any solid argument grounded in reality, just make something up, and use that as if it were true.  So that you can complain about something.

I first noticed this when reading newspaper article comments about climate change.  My favorite crazy comment being that this topic used to be called “global warming”, then the United Nations IPCC had to rename it “climate change”, because the earth isn’t warming.  Not realizing that the IPCC has been around for four decades.   And that the CC in IPCC doesn’t stand for carbon copy.

But what I really marvel at is the constancy and pervasiveness of this tactic.  For the decades that I have been tracking reporting on climate change, as the earth’s mean surface temperature has continued to rise, completely in line with predictions made three decades ago, I still get to read that “scientists said such-and-such, and that never happened, so climate change is nonsense”. Where the “such-and-such” is inevitably something completely fictional. 

So the world divides into two types of people.  For people like me, when the preponderance of evidence suggests that something is true, I am forced to accept it as true, whatever my preconceptions.  But, unfortunately, a whole lot of people live by Adam Savage’s dictum:  I reject your reality and substitute my own.  Because, for a lot of people, it’s just easier to make up “facts” than to change their minds.

If you read comments on news articles regarding a second COVID booster, the stupider portion of the American public seems dumbfounded that boosters are required to keep up immunity.

Apparently much of right-wing American has forgotten getting a tetanus booster as a kid, or getting a flu shot each year.  Or they’ve never had kids, and so don’t realize that most vaccines against childhood diseases are given in multiple doses.

In fact, if you just glance at the CDC’s schedule of recommended vaccines for children, you’d be hard-pressed to find any vaccine that only requires one dose.  Even among these highly-effective vaccines against the formerly-deadly diseases of childhood.

Source:  Adapted from CDC.

If you think that all vaccines should only require one shot, should last a lifetime, and be 100% effective, the problem isn’t with the COVID-19 vaccine, it’s with your understanding of vaccines in general.  Few fit that model. Most don’t.

In any case, it is what it is.  You want the additional immunity, you get another shot.  That’s the deal.  If you are surprised by that, then the fault is in your understanding of reality, not in reality itself.

Although, to be clear, I wish reality were different in this case.  But it’s not.  So I deal with it.

To me, the sole question is whether the benefit is worth the cost and risk.  Most of the harm reduction you are ever going to get from COVID-19 vaccination, you already got from being fully vaccinated.  Boosters are gravy.

But in my case, the vaccine is free and harmless.  I get a sore shoulder for a day or so, that’s all the adverse reaction I’ve every had.

I got my second booster yesterday, as did my wife.  It seemed like the rational thing to do.

Two weeks from now, we’re going to be in a lot of crowds at our daughter’s college graduation.  I want to spend the least amount of time possible thinking about COVID-19.  Hence, second booster now, rather than waiting for the likely winter 2022-23 winter wave of COVID.

 

Now 22 new cases per 100K population per day, rounded to the nearest digit, up 22% in the past week.  The latest strain — BA.2.12.2 — still is not yet the dominant strain in the U.S.  Deaths still are not rising.

Data source for this and other graphs of new case counts:  Calculated from The New York Times. (2021). Coronavirus (Covid-19) Data in the United States. Retrieved 5/10/2022, from https://github.com/nytimes/covid-19-data.”  The NY Times U.S. tracking page may be found at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

Source:  CDC COVID data tracker.

Since the start of this latest COVID-19 wave (the BA.2.12.2 wave), cases are up 150 percent, hospitalizations are up 50%, and deaths are down 50%.  The calculated average length of stay (per COVID-19 case) is well under 5.5 days now.

Source:  Calculated from CDC COVID data tracker.

A common mis-interpretation of the data

You might start thinking that this latest version (BA.2.12.2) is “weaker” than Omicron (BA.2) itself.  You can see numerous popular press articles that naively look at the raw numbers and say exactly that.

I think that’s incorrect.

Sure, average cases severity appears to be declining.  But I don’t think that has anything to do with changes in COVID-19.

Instead, I think this is a consequence of the increasing share of cases occurring among the vaccinated.  At this point — well after the last wave of booster shorts — vaccine and booster do little to prevent an individual from having any COVID-19 infection.  But they still work quite well to prevent severe infections. Here’s a CDC graphic I’ve shown before:

Source:  CDC COVID data tracker.

As a consequence of that loss of immunity against any infection, the vaccinated and boostered will now make up a larger share of all new cases.  So a larger fraction of the infected population has vaccination-acquired resistance to severe infection.  And so, per observed case, severity is declining.

That doesn’t mean “the virus is getting weaker”.  It just means that vaccination is now working mostly to reduce severity, not to prevent illness.  And by drawing an increasing share of the vaccinated into the overall pool of reported infections, the average observed severity of illness is falling.

Unfortunately, the CDC’s data split by vaccination status is ancient.  The most recent observation is from the end of February.  At that point, for sure, the case mortality rate for Omicron, for the unvaccinated, was two percent.  That is, as of the end of February, Omicron was still killing one-in-fifty of unvaccinated individuals with a reported infection.

The only point I want to make from the chart above is that even a modest shift in the mix of vaccinated and unvaccinated among new infections could account for a declining case mortality rate.  (And, for that matter, a reduced hospitalization rate).

 

 

Now 21 new cases per 100K per day, up from 20.4 yesterday. Still rising about 25 percent per week.

Continue reading Post #1504: COVID-19, finishing out the data week, now 21 new cases / 100K

 

Now 20.4 new cases per 100K per day, up from 19.4 yesterday.  Still rising about 25 percent per week.

And, at this point, there are double-digit weekly increases across all of the six geographic regions that I have used to track this pandemic. Continue reading Post #1503: COVID-19 trend to 5/5/2022: Double digit increases everywhere.

 

Now 19.4 new cases per 100K per day, still rising about 25 percent per week.

Continue reading Post #1502: COVID-19 trend to 5/4/2022

 

Now 18.5 new cases per 100K population, up 26 percent in the last seven days.

Data source for this and other graphs of new case counts:  Calculated from The New York Times. (2021). Coronavirus (Covid-19) Data in the United States. Retrieved 5/4/2022, from https://github.com/nytimes/covid-19-data.”  The NY Times U.S. tracking page may be found at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

The CDC updated it’s estimates of incidence of COVID-19 variants yesterday.  The most recent reading is that the latest one — BA.2.12.1 — accounted for around 37% of new cases, as of the week ending 4/30/2022.  That’s up from about 26% last week, so that fraction is now growing at slightly less than 50% per week.

Source:  CDC COVID data tracker, accessed 5/4/2022

That’s far slower than the rate at which Omicron took over from Delta.  That’s probably due to a) more immunity in the population, following the Omicron wave, and b) only modestly higher infectiousness of BA.2.12.1 compared to Omicron (BA.2).

That said, as these new-case rates rise week after week, eventually states are returning to levels that we had hoped we’d left behind us.  As of today, rounding the estimates up just a bit (because the trend is up, and there’s no indication that will change any time soon),

• Vermont is pushing 60 new cases / 100K.
• Rhode Island, Maine are at or above 50 / 100K.
• New York, Massachusetts, and Washington are around 40 / 100K.

That said, hospitalizations continue to rise less rapidly than new cases, with hospital admissions for (with) COVID up just 15% in the past seven days.  Deaths have not yet started to rise.