Author: chogan@directresearch.com

Post #1373: Omicron average case severity in the U.S.

 

The point of this post is to try to get some handle on the actual, as-observed average severity of Omicron, compared to Delta, in the U.S.A.  The bottom line is that the U.S. results look more like research from Scotland and England — the case hospitalization rate for Omicron is about one-third that of Delta.  They don’t look as good as the results from South Africa, which suggested that the case hospitalization rate was one-fifth that of Delta.

The same analysis verifies that there has been an uptick in pediatric hospital admissions with COVID-19, as a fraction of the total.  Not a huge increase, but a marked increase that coincides with the Omicron wave.  Given that we have no national database that shows current new cases broken out by age, there’s no way to tell whether that’s just an artifact of higher infection rates among the pediatric population.

Finally, I think it’s too soon to say much about U.S. mortality rates from Omicron compared to Delta.  The well-aged South African data seem to show a case mortality rate for Omicron that is about one-fifth that of Delta.  But data from European countries — which may or may not be well-aged enough to provide a valid estimate — show a much smaller difference.

All told, this means that Omicron is not quite as benign as the flu.  Best guess, with current data, case hospitalization rate is about twice that of flu, and my guess for a case mortality rate would be about four times that of typical seasonal flu in the U.S.

You can see my original comparison of Omicron and flu in Post #1364.  If our results had matched those of South Africa, then Omicron would have had a flu-like case hospitalization rate.  Now that it’s looking like our results aren’t that good, the best estimate is that Omicron has not-quite-double the case hospitalization rate of typical seasonal flu.

U.S. case hospitalization rate

Let me start with the case hospitalization rate.   That is, the fraction of newly diagnosed COVID-19 cases that are admitted to the hospital.

Below is the crude case hospitalization rate.  The plot is the seven-day moving average of new adult and pediatric admissions with confirmed COVID-19 at time of admission, divided by the seven-day moving average of new COVID-19 cases.

Source:  Calculated from U.S. DHHS unified hospitalization data set, and new case counts from the CDC COVID data tracker.

You can clearly see what appears to be the Omicron impact circled in red.  I date the Omicron wave to 12/17/2021.  Before that, the case hospitalization rate was about 6.5%.  As of the last day show, it has plummeted to 4.0%.  That fairly abrupt change certainly has all the earmarks of cause-and-effect, given the relatively stable rate prior to that point.

That’s the easy part.

The hard part is guessing what the Delta/Omicron mix is, corresponding to that 4% case hospitalization rate.  And here, I’m not going to get all fancy.  That’s a seven-day moving average ending 12/27.  So the median day is somewhere around 12/23 or 12/24.  Which is roughly contemporaneous with the last CDC estimate of Omicron’s share of cases (week ending 12/25).  So I’m just going to take the CDC’s number.  I’m just going to assume that 59% of those cases were Omicron.

The rest is just a bit of trial-and-error with Excel.

  • If the case hospitalization rate under Delta was 6.5%,
  • and the case hospitalization under a 31%/59% Delta/Omicron mix is 4%,
  • then the case hospitalization rate for Omicron must be 2.3%

To sum that up, it looks like Omicron’s case hospitalization rate is about one-third of Delta’s rate.  That’s in the ballpark of more careful estimates from Scotland and England.  But much higher than the South African estimate that Omicron had just one-fifth the case hospitalization rate.  Plausibly, that would depend, in part, on differences in propensity to hospitalize persons in those countries.

A little sensitivity analysis is called for.  By far, the most uncertain aspect of this is the fraction of newly-diagnoses cases that are Omicron.  The CDC didn’t actually say that Omicron accounted for 59% of cases.  The CDC actually said that there’s a 95% chance that Omicron accounted for between 42% and 74% of new cases.  Like so:

Source:  CDC COVID data tracker, accessed 12/29/2021.

We can use the range of the CDC’s confidence interval for the percent of  cases that are Omicron to show how this calculation of the estimated case hospitalization rate would change.  Same algebra as above, just a different set of assumptions.

I think the important lesson is from the bottom line of the table.  At worst — using the upper bound of the CDC’s confidence interval for its estimate of Omicron as a share of cases — the case hospitalization rate for Omicron is less than half that of Delta.

Some caveats.

Is it too soon to say anything meaningful about Omicron’s case hospitalization rate?  No.  I already dealt with the objection that hospitalizations lag new cases in prior posts.  There are plenty of real-life lags between (e.g.) date of infection, symptom onset, and hospitalization.  But as-reported, with all reporting lags included, the new cases and new hospitalizations series are very nearly exactly contemporaneous. The average lag between changes in reported new cases and changes in reported hospitalizations is one day.

Is this estimate going to mistake changes in vaccination rates and such with differences between Delta and Omicron?  No.  Because Omicron has grown so quickly, I can compare the U.S. today to the U.S. just a couple of weeks ago.  More-or-less the same population, more-or-less the same vaccination rate.   Not much changed in the past couple of weeks.

It’s possible that there may be significant demographic differences between the Omicron-infected and the Delta-infected.  But a) I doubt that, and b) there’s no timely data source in the U.S. that would tell us that.  So that remains a caveat.

Footnote:  Pediatric admissions as fraction of total.

There have been a lot of stories about increased pediatric admissions for COVID.  But, you know, anything having to do with dying children always gets a lot of press coverage.  So the question is, for the U.S. as a whole, is it true that pediatric admissions with COVID-19 have increased disproportionately?

The short answer is yes.   Below you see that pediatric admissions have gone from about 2.5% of admissions with COVID-19 to about 3.5%, over the course of the Omicron wave so far. As with the graph above, that short, sharp increase has all the earmarks of being cause-and-effect.

Source:  Calculated from U.S. DHHS unified hospital admission data. accessed 12/29/2021.

In terms of the absolute number of cases, this amounts to about 350 children per day admitted to the hospital with COVID.

There are two things to keep in mind.

First, we don’t know what fraction of those are admitted for treatment for COVID, versus admissions where the COVID is an incidental finding.  Near as I can tell, the U.S. data track something akin to “COVID present on admission”.  They are not tracking cases with COVID as the principal diagnosis (the reason for admission, see Post #1351).

Second, we don’t know what fraction of new cases are pediatric cases.  This might just be tracking the trend in new cases, for all we know.  There is no timely national data set that breaks out the new case counts by age.

Case mortality rate.

I can’t even hazard a good guess here.

In addition to the case hospitalization rate, I’d like to have some idea of the case mortality rate. What fraction of diagnosed Omicron cases go on to die from it?  In the U.S, for Delta, for the most recent period, that number has been just over 1 percent.

It’s too early to see Omicron’s impact on the U.S. case mortality rate.  There’s roughly a two week lag between reported new cases and reported deaths, and two weeks ago Omicron was barely on the horizon in the U.S.

Instead, I looked at three countries where Omicron hit earlier than it did in the U.S.  It’s not clear that any of these provides a good comparison.

In South Africa, the most recent data are all Omicron.  Between they had a material increase in vaccination rate between their prior (Delta) and current (Omicron) waves.  The apparent five-fold reduction in case mortality might be due, in part, to concentrating vaccinations among the highest-risk (e.g., elderly) population.

For two other countries where we can plausibly compare the mortality rates (Great Britain,  Norway), you really can’t see much of an impact of Omicron on the case mortality rate.  I don’t really know why.  I can only guess that this remains an artifact of the long time lags required to gather the mortality data.  In both cases, we’re looking at new cases that appeared in late November/early December.  Even with those countries, Omicron probably wasn’t a big enough factor to have generated large changes in the mortality rate yet.

At the end of the day, in the U.S., all I can do is take a guess.

I’m going to guess that we’ll see about the same effect on case mortality as we see on case hospitalization.   Probably, the ultimate case mortality rate for Omicron is going to end up being somewhere around a third that of Delta.   (I say that mostly because that’s how the Virginia numbers look, for vaccinated versus unvaccinated persons, under Delta.  The reduction in the mortality rate due to vaccination is always similar to the reduction in the hospitalization rate.)

If so, that will make Omicron considerably deadlier than seasonal flu.  A one-third reduction relative to Delta would result in a roughly 0.4% case mortality rate for Delta in the U.S., compared to a 0.1% case mortality rate for flu in the U.S.

My conclusion is much the same as for hospitalizations.  Omicron appears much less virulent than Delta.  But it’s an exaggeration to say that it’s no worse than flu.  Best guess, given what I can get my hands on today, it’ll result in about twice the hospitalization rate and four times the death rate of flu.

(And, of course, those who claim COVID is no worse than “a cold” are just ill-informed.  First, “a cold” is not a single well-defined disease, but refers to the symptoms of any number of upper respiratory viral infections.  Second, near as I can tell, you can’t even find a case mortality estimate for “a cold”, presumably because deaths attributable to complications of a cold are so rare.  Third, the same goes for a case hospitalization rate for “a cold”.  People who claim COVID is no worse than a cold have probably never even tried to look up the actual case hospitalization and mortality data.)

In short, if you’re in one of the higher-risk populations, I think it’s still well worth your while to avoid this strain of COVID.  It’s as prevalent in the population now as it was at the peak of last year’s winter wave.  And while your odds of hospitalization and death, if infected, are lower now than they were then, they are still non-negligible.  Best guess, as of today, if you get infected, you’ve got a better than 1-in-50 chance of ending up in the hospital.

Post #1371: The path of Omicron in six countries.

I’m just trying to get a handle on where things are likely to be headed in the U.S. for the near term.  I’m just going to present the last three months of new cases, with a little commentary.  These plots all come from Google searched for COVID and the country’s name.

Here’s the game I’m playing:  How hard is it to interpret what you are seeing as a peak in new cases?  In other words, how much wishful thinking is required to say that a country has already passed its Omicron peak.

South Africa is an example of a short, sharp peak.  No wishful thinking required.  There were almost no cases of COVID-19 in circulation just prior to the Omicron wave there, so that’s pretty much a pure Omicron wave.  And it’s receding at just about the same rate that it grew.

Norway has peaked, but more gradually than South Africa.  Again, not much imagination required to interpret the graph below as showing a peak.  But Norway was already having a winter wave of Delta when Omicron came along.  The early part of that wave is Delta, the latter part is Omicron.  That might explain the relatively slow ramp-up compared to South Africa.

Denmark hasn’t reported post-Christmas data yet.  Too soon to tell.  Maybe a hint of a peak just prior to Christmas.  But with no post-Christmas data, it takes a lot of wishful thinking to call that a peak.

Great Britain’s first post-Christmas data looks high, but that one bar is three days’ worth of data.  With just a bit of wishful thinking — break the last bar into thirds and fill in last three slots with that — yeah, maybe that looks peak-ish.  But it’s too soon to tell.  That relatively low first post-Christmas data point might be an artifact of testing availability and behavior over the holiday.

Canada’s COVID trends tend to mirror those in the U.S. (or vice-versa, depending on which side of the border you reside).  I can see a peak there, if I just focus on the shape of the blue bars, not the seven-day-moving average line.    Another few days ought to determine that one way or the other.

U.S.A. data reporting is so ragged, it’s hard to say much.  But, trying to be positive here, take that last blue bar, break off a piece to fill in the reporting hole two days’ prior, and things haven’t really changed much in the last six days.  Sure, the seven-day moving average is still rising sharply.  But it’s not completely out of the question that (e.g.) growth in new cases has at least slowed.

Post #1369: COVID-19 trend to 12/27/2021, not quite a new record

I thought that we’d break the U.S. record for daily new COVID-19 cases today.  But we’re just a touch short.  Looks like we’ll almost certainly break it tomorrow.

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 12/28/2021, 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 good news is that the official hospitalization counts out of the CDC show no proportionate rise in hospitalizations.  Note that, as scaled, this is the first time in the pandemic where the hospitalizations line is below the new cases line.

Source:  CDC COVID data tracker.

You’re going to see people dismiss this as “too soon to tell”, but my best analysis says that’s incorrect.  (Or, for that matter, just look at the peak from January — looks like the lines were pretty much in sync then.)  I went over all this a coupe of posts ago.  There are significant lags between (e.g.) infection, symptom onset, and hospitalization.  But that’s not the point.  Near as I can tell, on average, for the two lines shown above, reported new hospitalizations lag reported newly diagnosed cases by one day, on average.

For sure, people are still being hospitalized and dying.  But at a lower rate, per case, for Omicron than for prior variants.

The problem is, while the hospitalization rate is lower, it doesn’t appear to be anywhere near as low as early research suggested.  But I think I have the answer for that, in the next post.

That said, this wave isn’t stopping, it’s continuing to accelerate.  And before the words “post-Christmas-surge” leave your lips, please note that a) this wave started before Christmas, and b) owing to the typical lag between infection and reporting, the cases showing up today were infected well before Christmas.

My expectation of a short, sharp wave, based on what occurred in South Africa, appears incorrect.  Sharp, yes.  But so far, no strong indication that this is going to be sort.  South Africa and Norway did indeed have a short, sharp peak.  Great Britain and Denmark did not.  As of today, it looks like the U.S. is going to fall into the “not” group.

We can hope that this last uptick is some sort of reverse holiday effect.  Maybe a lot of people decided to get tested before joining relatives for the holidays.  If so, that would be unique to this year.  That certainly didn’t happen last year.  But if so, that will wash through the data in just a few days.

As you can see from this final chart, cases are up in all regions.  The daily new case rate has not-quite-doubled since the start of the Omicron wave on 12/17/2021.

 

Post #1368: COVID-19 trend to 12/26/2021: Unexpected growth.

Bottom line:  The holidays don’t seem to be making a dent in the growth of reported new U.S. COVID-19 cases this year.

Tomorrow, when all the states report new data, you’ll see that the U.S. has broken the record for daily new cases, set at the peak of the last winter wave. 

For now, here’s my best guess for the U.S. trend through 12/26/2021.  This is the actual U.S. average through 12/23.  Beyond that, it’s based on the growth observed in the ten states that consistently reported data from 12/23 to 12/26.

Based on that hybrid estimate, daily new cases have now roughly doubled in the nine days since the start of the Omicron wave.  Best guess, as of today, the U.S. averages about 76 new COVID-19 cases / 100K / day.

We will get actual data from almost all states tomorrow, at which point I’ll replace this “hybrid” estimate with the actual data.

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 12/27/2021, 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.

That said, I think it’s finally dawning on a lot of people that the simple count of cases doesn’t tell you much, if you’re replacing Delta with a far-less-virulent Omicron.  I’ve made that point here, and I’m now seeing that in mainstream media (example).

As far as I can tell, there has still been no commensurate surge in hospitalizations.  The CDC still has not updated its COVID-19 data tracker, so this graph is my calculation from the US DHHS hospitalization data itself.

Source for hospital data:  Calculation from this U.S. DHHS file.

I believe this is consistent what what’s being observed in those states that produce timely hospitalization data.  So far, even for states where new cases are skyrocketing, there has been, at most, am increase in hospitalizations that is far less-than-proportionate to the increase in newly diagnosed cases.

Post #1367: COVID-19 hospitalization trend to 12/25/2021. No big uptick, and other surprising aspects of U.S. COVID hospitalization data

Main result

As of Christmas Day 2021, there had not yet been any jump in U.S. COVID-19 hospitalizations to match the recent jump in cases.  Continue reading Post #1367: COVID-19 hospitalization trend to 12/25/2021. No big uptick, and other surprising aspects of U.S. COVID hospitalization data

Post #1366: COVID-19 trend to 12/23/2021.

 

My wife just invited her sister over for Christmas Day.  Without bothering to ask if I thought that was advisable.  Said sister-in-law having possibly been recently exposed to COVID at work.  My son is going out to the local bar to hang out with his buddies.  Ditto.  I’m still going grocery shopping in person, where maskless customers remain an increasingly common sight.

Meanwhile, the U.S. trend for new Omicron cases where I live (Washington DC suburbs) remains more-or-less vertical.  As it is in several other locations around the nation.

I think I can connect the dots.

At six days into the Omicron wave, we ought to be close to our darkest hour, based on what we’ve seen in other countries.  And that’s working out for me. Continue reading Post #1366: COVID-19 trend to 12/23/2021.

Post #1365: COVID-19 trend to 12/22/2021: Think of it as hyper-contagious flu.

 

The bottom line is this:  There were a lot of new cases of COVID-19 diagnosed yesterday.   But you probably already knew that.  What’s more newsworthy is that there aren’t a lot of new hospitalizations.  Not anywhere you look.  Consistent with the best available research at this time.  And, while it’s too soon to count the deaths, it’s a good guess there won’t be many deaths, either.  As I see it, with Omicron, our winter wave of COVID has morphed into something akin to an unbelievably bad flu season.  Lot of people sick.  Lot of work time lost, events cancelled, business closed, and other economic losses.  But not a lot of severe illness or deaths, per infection.

Despite Omicron’s lower case severity compared to prior strains, it remains a really good time to do what you can to avoid exposure.  Because nobody wants to be sick.  But the odds of getting extremely sick, if infected, seem to be vastly lower under Omicron than under the prior strains.

See Post #1364 if you want the straight-up crude comparison between Omicron and flu, in terms case hospitalization rates.  The big difference now is that Omicron spreads ten times faster than flu.  (Literally:  R-nought is about 1.25 for seasonal flu, but between 10 and 15 for Omicron).

Tomorrow will likely be the last day we get any clear data on what’s happening in the U.S.  Not only are states shutting down reporting for the holiday’s, even the CDC’s COVID data tracker website won’t update tomorrow.  So after this, everything will be guesswork until after 1/1/2022

As has been my practice for the past few days, I’d like to offer a few calming thoughts before discussing today’s trend data. Let me do that by focusing on the worst U.S. states.

What the heck is “calming” about about focusing on the hardest-hit states?  Well, for one, you can be glad you’re not there.  But more to the point, they provide a great illustration of what you’re not reading in the news, despite the incredibly rapid growth in cases.  You’re reading about the huge increase in cases.  But you aren’t reading about overflowing hospitals and morgues.  And that’s a good thing, as these things go.

Worst in the nation today:  Washington DC, 166 new COVID-19 cases / 100K / day, seven-day moving average.

Source:  New York Times.

Omicron appears to be hitting metropolitan areas first, and spreading from there.  That follows prior waves of new variants.  They enter the U.S. via international travel from already-infected areas.  And so appear first and in greatest number in places with lots of international travel.

The worst hit area, so far, by far, appears to be Washington DC.  That’s depicted above, via the New York Times.  As you can see, the daily new COVID-19 cases shatter all prior records for the city.  They are very nearly as high as have been observed in any state over the entire pandemic.

That’s so nearly vertical that I would normally think it was a data error, but there’s Maryland right alongside it.  And about half the population of Maryland lives in the DC Metro area.

That’s what you’ll see reported.  But as important is what you’re not seeing:  Reports of overflowing hospitals.  And you aren’t seeing that because it’s not happening.

I downloaded DC’s data from their dashboard.  They track “patients in hospital”, which is the number of persons who are inpatients, and have COVID-19.  They don’t appear to track daily new admission to the hospital, for COVID-19.  Here’s the picture of last year’s winter wave, and the Omicron wave:

Source:  Calculated from Washington DC COVID-19 dashboard, accessed 12/23/2021.

In Washington DC, for the past seven days, the count of persons:

  • diagnosed with COVID grew about 1000 per day.
  • in the hospital with COVID grew about 7 per day.

That’s probably a slight understatement of the seriousness of the situation.  Plausibly, some of the persons just diagnosed were not sent immediately to the hospital, but will show up in a few days.

But I think that’s the gist of it.  At the Delta hospitalization rate, the current rash of Omicron cases would have been an unprecedented public health disaster.  By contrast, at the Omicron hospitalization rate, it’s not even close to maxing out hospital resources.

Second worst state:  Rhode Island:  125 new cases / 100K / day.

Unlike DC, Rhode Island had been in the grip of a serious Delta winter wave before Omicron came on the scene.  Accordingly, what you see in their data is a blending of rates, as Omicron displaces Delta.

And, as Omicron displaces Delta, despite rising new case counts, the number of COVID-19 cases in Rhode Island hospitals has started to fall:

Source:  Rhode Island Department of Health

If you wanted to be contrary, you could point to the short timeframe of the decline.  It could be a blip.  But Omicron has only really taken off in the U.S. in the past week.  So that short timeframe is about right.

Honorable mention:  New York City

New York state is third in the nation, with 110 new COVID-19 cases per 100K per day.  And, much like DC, it wasn’t having much of a Delta wave prior to the onset of Omicron.

But the center of the wave in New York is New York City.  Let’s look there.

By now you know the drill.  Below is a graph of new cases, followed by a graph of new hospitalizations for COVID-19.  The hospitalization data are incomplete.  And it’s a short timeframe.  But when you see the same thing time and again, it’s probably real, and not an error in the data.

Source:  Government of New York City.

U.S. trend to 12/22/2021

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 12/23/2021, 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 rate of U.S. new COVID-19 cases / 100K / day is now up 37% since the start of the Omicron wave on 12/27/2021. 

If we go back to the pre-Thanksgiving basline, cases are rising at an average rate of 16 percent per week.

As I stated in a just-prior post, it makes no sense to compare the simple count of Omicron cases to Delta cases.  It’s like comparing a count of $5 bills and $1 bills, without noting that the $5 bills matter a lot more.

But it’s what everybody does.  And all the better information — hospitalizations, deaths, and possibly some other indicators of morbidity — all arrive with some time lag.  So I’m counting cases, along with everybody else.  Even though it makes no sense.

Post #1364: We have to start discussing Omicron and the F-word

 

The F-word in this case being flu.

This whole debate about how COVID-19 compares to influenza has been so poisoned by the nut-o-verse that it’s hard to have a rational conversation about it.

But things have changed a lot since that early disinformation regarding COVID being no worse than flu.

COVID hospitalization and mortality rates in the U.S. have fallen since that initial New-York-centered outbreak.  And now, it appears that the latest mutation of the virus is resulting in far fewer hospitalizations and deaths.

And so, what was once a right-wing fantasy (“no worse than the flu”) is, in my opinion, no longer so far fetched.

Without beating this into the ground, I’m just going to show you the numbers that have me thinking about this.

First, you have to look up what the CDC gives for the closest analogs of case hospitalization rate and case mortality rate for the flu.  You can find the CDC estimates at this link.

There are significant differences in methods between a “case hospitalization” or “case mortality” rate for COVID versus the flu.  For COVID, a case is a formally diagnosed case — more or less, a positive test result.  By contrast, the CDC’s “case” for flu is an estimate of all symptomatic cases.  So the denominators differ.  One is all persons with a positive test, the other is an estimate of all persons that had symptomatic disease.

The deaths for COVID are fairly straightforward, but deaths for flu involves considerable estimation, as reporting of flu diagnoses on death certificates is not as clear-cut.

So there are difference in methods.

That said, let me just lay out what appear to be the facts.

Per the CDC, eyeballing their chart, I estimate the following for a typical flu season:

  • Flu case hospitalization rate 1.2%
  • Flu case mortality rate 0.1%

For Delta, most recently, this is my recollection of the current rates:

  • Delta case hospitalization rate 6.5%
  • Delta case mortality rate 1.2%

If those aren’t exactly right, they’re close.

But now, per the South African study released today , the current estimate is that Omicron has about one-fifth the case hospitalization rate of Delta.  If that’s true, then for the U.S., we should eventually find that:

  • Estimated Omicron case hospitalization rate, 1.2%

Compare to flu above.

Further, I’ve already noted the near-total lack of deaths in South Africa from Omicron.  So while I won’t attempt a formal case-rate calculation, it’s not beyond the pale to suggest that the Omicron case mortality rate is at least 80% lower than Delta, if not more.

Let me sum up.

Once upon a time, nobody was vaccinated against COVID, nobody had any immunity, and there were no effective treatments for it.  Hospitals didn’t really know how to treat it.  By contrast, just about everyone except newborns had some prior exposure to flu, 60% of the population got a modestly-effective vaccine each year, and hospitals had decades of experience treating the worst cases.  During the initial outbreak, in the U.S., the case hospitalization rate for COVID was easily 10x that of flu, case mortality rate was nearly 100x that of flu.  At that time, people who said that COVID was no worse than flu were just flaming idiots.

At present, most are vaccinated for COVID, others have some immunity via prior infection, hospitals have gotten considerably better at treating it, and there are some modestly effective treatments (monoclonal antibodies, anti-viral-replication drugs) available.  Even then, with that, if you’d said Delta is no worse then flu, you’d have been an idiot.

Looking forward, if Omicron really results in cases with such lower average severity, you know, I don’t think I’m at all crazy for saying that Omicron’s case hospitalization and case mortality rates are starting to look flu-like.

There’s still an issue of total illness burden.  Not just because a third of our population still has no immunity to it.  But also because there is no comparison in this simple-minded analysis that looks at the average symptomatic-but-non-hospitalized case.  Nobody talks about “long flu”, for example, but “long COVID” is a real thing.

That said, at some point, it looks like we’ve going to have to live with this in circulation.  Assuming Omicron sticks around, and the South African estimates pan out, we probably need to start thinking of this the same way as flu.  Get your vaccine every fall, stay home if you’re sick, and hope for the best.

I hope it remains legal and customary to wear face masks during winter flu/COVID season.  This is common in Asian countries, and in hindsight now just seems like common sense.  I don’t want to be denied the right to give myself a little extra protection.

But the bottom line is that if it reaches the point where the risks from flu and COVID are not so different, and the population has some resistance to it, we’re going to have to start using the F-word in this context, and just ignore the history behind that.