All my various postings tracking the COVID-19 pandemic through the end of 2022.
The government of the U.K. is still running more than a week behind in publishing total COVID-19 hospitalization numbers. That doesn’t help in tracking what’s happening with Omicron, because the big runup in new cases in the U.K. happened in the past week. Continue reading Post #1359: Brief update on the British Omicron wave
Things just keep getting more interesting in South Africa. Today’s new case data not only confirm that their outbreak has peaked, it sure looks like Omicron is receding as fast as it grew.
Which, to me, makes absolutely no sense, based on what I think I know about models of epidemics. Could be I just don’t understand the math. Or it could be that everybody is going to be as surprised by this as I am.
In any case, it is what it is. It’s starting to look like Omicron in South Africa took three-and-a-half weeks from first case to peak. And now it’s starting to recede at an equally rapid rate.
Below, the peak is now clearly visible in the three-month view of daily new COVID-19 cases in South Africa. That was clear yesterday. What’s new today is how sharp the decline in cases appears.
The six-month graph below gives you a much clearer view of it. You can clearly contrast the shape of the last COVID-19 wave (left) with the shape of the Omicron wave (right). The prior wave was a broad hilltop, the current (Omicron) wave certainly appears to be shaping up to be a sharp point.
And just to round out the story, the Omicron deaths that weren’t appearing in South Africa, still aren’t. Here’s the same data source, showing the six-month chart of COVID-19 deaths.
This information all comes from the lowest common denominator of data in the modern world, Google. If you’re on a computer and you Google “South Africa COVID”, Google will supply you with the graphs you see above. They’re right at the top of the search page. They are instantly available to anyone who will look for them.
My point is, it’s not like this is a secret. It’s the most common of common knowledge.
And yet, as I have discussed several times in recent posts, below you see my best depiction of what you’re going to hear from professional public health sources, regarding the possibility that the Omicron outbreak is both self-liming and results in vastly lower average case severity than Delta.
Source: Amazon.com
You are going to hear every conceivable version of “that might be due to something else”. Followed by a few mumbles about vaccination rates, prior infections, time lags in the data, international comparisons are fraught with potential error, and so on. You’re never going to hear any public official clearly state that Omicron appears to be substantially less virulent than Delta.
Because if they do that, the public will slack off.
And, to be clear, Omicron isn’t harmless. People are still being hospitalized and dying from it, just at a much lower rate than with Delta. Work days are being lost, some types of group activities are curtailed, some college life is being disrupted, some school life will be disrupted. Omicron imposes real costs.
I’ll try to make that the topic of my next post. That is, a straight-up comparison of Omicron and the flu, to the extent that can be done.
In any case, if South Africa is an example, stonewalling on this issue will be easy enough. The outbreak will be over before anybody can call you on it.
I’m being flip, but I see the most recent developments in South Africa as being really good news. If it plays out here as it has in South Africa, we might have passed the peak of our Omicron outbreak as early as New Year’s Day. And we’ll do it without overrunning the hospital system or stacking bodies in refrigerated trailers. Which is great news, as these things go. It’s just that nobody in a position of authority can tell us that, for fear that we’ll all party down and increase the spread of this still-harmful strain of COVID-19.
For the week ending last Friday, there were six new COVID-19 cases found at William and Mary. So the rate is back under one new case per day on average.
Source: Calculated from William and Mary COVID-19 dashboard.
In hindsight, that little blip of 11 new cases in the prior week might plausibly be attributed to infections acquired over Thanksgiving. If you think of W&M as a bubble of sorts (98%-vaccinated, mask-mandated, rule-enforced, low infection rate), Thanksgiving forced students to step outside the bubble in large numbers. It wouldn’t be a surprise if they brought a few cases back to campus.
The timing is about right. My best guess, for the U.S. as a whole, is that it takes an average of about 4 to 5 days for symptoms to appear following infection, and then about another 5 or 6 days for the typical individual to seek care, be tested, and have the test results tabulated. Call it 10 days on average. Which would mean that the bulk of infections incurred around Thanksgiving would show up in the data for the week ending 12/10/2021.
We’ll never know for sure one way or the other. But the timing is right.
I guess it seems a bit compulsive to have continued to track this, given the low infection rate. But not all colleges have been as lucky as W&M. In particular, Cornell shut down just four days ago due to an outbreak of COVID. Apparently, what they have is an outbreak of Omicron. Which tore through the student body despite a mask mandate and a 97% vaccination rate.
And if you’re of a mind to indulge in some gloom and doom, note that Cornell was not the only instance. Most of these new campus outbreaks are being attributed to likely Omicron infections, as they are all occurring in places with vaccination rates similar to those of William and Mary.
So, lucky. I think that’s the correct term. That’s an odd word, given all the precautions taken by W&M administration and students. But if you look at Cornell, and other cases like Cornell, that appears to be the right word for it.
Our kids appear to have brought back just good old Delta, after Thanksgiving. So we got a little bump in cases, but that’s the end of it. If a few of them had stumbled across Omicron, my guess is that we’d be singing a different tune.
Let me preface this with a few old saws.
Free advice is usually worth what you paid for it. Opinions are like belly buttons, everybody has one. YMMV. So take this FWIW.
I’ve been tracking the data on Omicron just about as carefully as a person outside of the official U.S. public health bureaucracy can. And I’m a Ph.D. health economist, so I’ve had a lot of experience dealing with the ins and outs of health care data.
My opinion on Omicron now falls far, far outside of the mainstream. In a nutshell, I’m betting that the U.S. Omicron wave will be short and sharp, that it might lead to more peak cases than the just-prior Delta waves (but not vastly so), and that despite that, we’ll see far fewer hospitalizations and deaths than we’re seeing under Delta.
If you want to see how I arrived at that opinion, just start reading back through my last dozen or so posts. Starting with what I posted earlier today (Post #1356), on the peak of the Omicron wave in South Africa now occurring just three-and-a-half weeks after the first cases of it were detected.
For sure, when W&M students return to campus near the end of January 2022, they will do so under Omicron, not Delta. That’s a given at this point. The U.S. will likely pass the point where Omicron is the dominant strain some time next week (Post #1353).
In addition, I’ll bet that the U.S. Omicron wave will have already peaked in mid-January. Weeks before the late-January general return to campus. How fast new Omicron cases will fall, after the peak, is yet to be determined. It’s well worth continuing to watch South Africa in that regard. I’m not even going to hazard a guess absent hard data.
By that time, if the severity of the typical Omicron infection is as low as I believe it to be, that fact should be apparent from South African data, as well as data from Great Britain. In other words, if the typical Omicron case really is as mild as I think the preliminary data show (see prior posts), it should be hard to ignore that.
But that’s not going to stop people from trying. As of mid-January 2022, our official public health infrastructure might still be telling us that it’s just too soon to tell about the overall severity of Omicron relative to Delta. As I noted in my just-prior post, they more-or-less have an ethical duty to do that for as long as possible.
At that point, colleges will face some interesting choices about return to campus. And we can all be glad that we aren’t college administrators.
Best available evidence shows that two shots of vaccine doesn’t produce much of an antibody response to Omicron. In other words, Omicron blows past the standard two-dose vaccination regimen. That’s how you can have a huge outbreak on a campus that’s 97% vaccinated. But three vaccine shots, by contrast, produces some reasonable antibody response (though only about half as much for Omicron as occurs for Delta).
Given that, I would be completely unsurprised if W&M requires everyone to have a booster shot before returning to campus. If I were running the show, that’s the first thing I’d do. And, given that it takes time to build immunity, they’re going to have to announce that no later than in early January. Which will be good timing, because the U.S. should be squarely in the grip of a large wintertime wave of Omicron just about then.
At which point, my sincere hope is that folks will just roll up their sleeves and get it done. In the hopes of having something approaching a normal semester. Because, after that, the tools consist of things that are a lot more disruptive, both of quality of life and quality of education.
If it were up to me, the obvious next step would be to mandate not just use of masks, but use of high-filtration masks. I’d require use of NIOSH-certified N95 masks (respirators). Those are no longer in short supply (you can pick them up at Home Depot, e.g.). Given that they are cheap and plentiful now, it’s not like recommending N95 masks for all is a novel idea (see Post #977). And that can easily be enforced because every NIOSH-certified N95 mask has to have that literally printed on the mask.
That said, when I supplied my daughter with a “mask sampler” of masks that I judged to be adequate, the hands-down winner was an ear-loop-style KF94 mask. It was the LG Airwasher, to be precise: See Post #1236 and Post #1246. So at some level, it’s not entirely about the best possible mask. It’s about getting people to wear the best mask that they are willing to wear. Possibly, the school administration would merely encourage people to wear only good masks, and provide a list of masks that meet some standards of adequate filtration, if the list needs to be broader than NIOSH-certified N95.
That said, my emphasis on quality masks reflects my own take on the data (see, e.g., Post #935, If you have 10-cent lungs, by all means, wear a 10-cent mask.) You might also check out Post #942, where I do the math to show why an N95 results in exposure to vastly less viral load than a typical cloth or procedure mask.
Once you get past a) better vaccines and b) better masks, things get fairly intrusive in terms of the educational and social experience on campus. We’re back to remote learning, hybrid classes, restrictions on social gatherings, no indoor dining. And all the rest of that stuff.
So if you don’t like vaccines or masks, well, guess what? Nobody does (see All the masks I’ve ever loved, Post #987). It’s just a question of the lesser of evils. I’d rather see on-campus learning, masked, than remote learning in any form.
Finally, what’s going to make this all the more interesting is that W&M administrators will have to make all these choices in advance. Which, given how fast Omicron appears to be moving, means they’ll probably be making them around the time Omicron is peaking in the U.S. And that will almost certainly be before any official U.S. pronouncement regarding the severity of Omicron relative to Delta.
In other words, those decisions are going to have to be made when things are looking pretty bleak. I’m sure glad that’s not my job.
This morning’s news seems to be a full-court press on the COVID-19 doom and gloom front. Accordingly, I though I might bring the graph below to your attention.
As you know, Omicron was discovered in South Africa and adjacent regions about a month ago. Today, Google “COVID South Africa” and you’ll be given the following graph, using Johns Hopkins as the underlying data source.
That appears to be a peak. I wouldn’t normally point that out so early, but this has been predicted for almost a week now. That prediction was based largely on the trend in test positivity rate that, a factor that has been associated with peaks throughout this pandemic. Finally, starting yesterday, multiple news outlets have called that as the peak of the Omicron wave in South Africa.
If you look for it, you can track down a string of reporting first predicting a peak, and then more-or-less confirming it.
Finally, December 18 New York Magazine, here’s a view of this that absolutely mirrors my own. This is “Gauteng’s Omicron Wave Is Already Peaking. Why?“,
That article is a long read, but I found it worth the time. Particularly if you need some cheering up about the situation, from people who clearly are well within the mainstream of scientific thought.
Most importantly, the author points out the apparently self-limiting nature of these COVID-19 surges, something I have noted repeatedly in prior postings. His point being that all COVID-19 waves prior to this one stopped well short of exhausting the vulnerable populations. That is, well before traditional epidemiological models said they should stop, based on the estimated level of immunity in the population and the ability of the virus to spread.
To put it another way, those waves stopped well short of the point where the population had herd immunity.
The way I’ve put it is that we always get right to the point where the hospitals are full, and the COVID-19 wave crests. Despite the fact that plenty of targets for new infection remain in the population. And that has always puzzled me.
No one is quite sure why, but the best guess that I read in this article is that, as a population, we don’t “mix” thoroughly enough to allow full spread. To some degree, we each seem to have our own social or business strata. Chains of infection travel within those strata, but find it much harder to cross those strata. And as a result, chains of infection do not spread as far or as thoroughly as standard epidemiological models expect them to.
Separately, I particularly liked this exchange regarding the virulence of Omicrion, where the author actually got a trained epidemiologist to say, reluctantly, that yeah, if the numbers out of South Africa are real, then it probably has to be due to a less virulent virus:
"Does that seem plausible to you? Some of the numbers that we’ve seen today — the hospitalization rate may have fallen by 91 percent, the death rate of people in hospital may have fallen by two-thirds — do you think you could get that large in effect just through additional acquired immunity? This is just compared to the last wave, so it’s not all that long ago. Could you get that scale of an effect just through acquired immunity? It would seem to be that reduced virulences has to be at least a part of the story, no? Yeah, if those numbers are real, then I think you would have to have lower intrinsic severity."
In any case, here’s my cheerful observation: The South African Omicron wave took three-and-a-half weeks, from first case to peak rate. That seems to be how it’s playing out in that location.
Not to be too crude about it, but it appears to me that if the virus spreads about twice as fast, then the whole wave unfolds on fast-forward. I don’t think that’s exactly rocket science.
But consider what that implies if, as was the case with prior waves, there is some limit to the number of persons that can be infected in any one wave. If that limit is anywhere near where it has been for prior variants, you’ll run through this wave’s vulnerable population in half the time.
Let me emphasize that: It’s not like the numbers are going to go straight up for the next two months, because the last wave lasted two months. If they go straight up, best guess, they’re going to go straight up for a much shorter period of time. In other words, my best guess — now that we’re seeing it in South Africa — is that there’s going to be a tradeoff between rapidity of spread and total duration of the wave. It’s going to spread like wildfire, but only for a few weeks, not for two months.
Prior COVID-19 waves averaged about two months from start to peak. Prior COVID-19 variants had a doubling time of about 4.5 days. This COVID-19 variant has a doubling time that’s about twice as fast. And so? It hits its limit — it goes as far as it can go in this wave — in a far shorter amount of time. Something like half the time. Or less.
But if there is a limit to the number of people infected in this wave, won’t it be higher than prior waves. Yes. To be clear, traditional epidemiological models tell us that, all other things equal, the greater transmissivity of Omicron should result in more people being infected, in total, than with Delta. In effect, the pandemic should run further with a more transmissible variant.
But I’m guess that, in fact, it’s not going to be hugely more. Wishful thinking? No. Aside from what we’re seeing in South Africa now, that’s based on our own history in the U.S.
Recall that Alpha was more transmissible than the native strain, and Delta was more transmissible than Alpha. And the peaks for both of those waves, in the U.S., were well below that of the winter 2020-21 peak, which was the native strain.
Here’s the pandemic, through 12/17/2021, with the peaks labeled.
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 12/18/2021, 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.
One thing that is not held equal is the level of immunity in the population. Alpha was shut down by vaccination, and Delta faced a population with high existing immunity both from vaccination and from prior infections. As a result, we have not yet seen anything approaching the peak of the 2020-21 winter wave, despite spread of new variants that are far more transmissible than the native (Wuhan) strain.
A second factor not held constant across waves is the level of COVID-19 hygiene. And my observation is that that has pretty much gone to hell. At least around here. Even in the upscale DC suburbs, I’m seeing more people in the stores unmasked, and more workers with perfunctory masking (e.g., mask hanging below the nose).
In the past, COVID-19 hygiene has lagged the waves of COVID. People only masked up once things got really bad. So I don’t have much hope that we’ll get people masked up for Omicron pro-actively. Currently, about 60% of Americans say that they routinely wear masks in public spaces, down from more than 90% just past the peak of the 2020-21 winter wave.
Source: Carnegie-Mellon COVIDcast.
On the other hand, people know the drill now. At least, responsible people. For example, even though there are no government mandates, we’re seeing a lot of big group events being shut down in this area. Voluntarily. E.g, my wife and I like to sing Handel’s Messiah at this time of year, and the one sing-along that had been offered in Northern Virginia has now been cancelled due to Omicron. (Which, I think, was the right thing to do, given that singing is about as bad as coughing in terms of spreading airborne droplets (Post #678, 4/30/2020). I see similar reporting of London bars and restaurants voluntarily closing in the face of this latest wave.
So, we’ll see. Maybe there will be a much higher peak. Maybe not. All other things equal, sure, there would be. But all other things aren’t equal.
In any case, if we’re going to blow through last winter’s peak in the U.S., we ought to see that soon enough. The one thing that everybody agrees on is that this Omicron spreads fast.
Just a bit of realpolitik here. Nobody in any official position in a public health organization could possibly state that Omicron cases appear to be much milder, or that that Omicron wave is likely to be shorter than prior waves. It’s simply not going to happen. So don’t hold your breath waiting to hear that.
If things turn out better than public health experts predict, then, well, from their viewpoint, there’s no harm done. In fact, there will be lives and hospitalizations saved if they can scare people into more responsible behavior than would otherwise occur. From that viewpoint — minimizing harm from this deadly disease — the only ethical thing for them to do is run with worst-case scenarios.
Now that they have the population’s attention, regardless of the facts, this is an opportunity for some impactful public health messaging. And it would be unethical of them to waste it.
And consider the alternatives. If they underplay this wave, and the situation is much worse than predicted, there would be repercussions.
I surely know which way I’d lean if I were in their shoes.
But for me, how many times, in how many different countries, have we seen what appear to be remarkably lower hospitalization and death rates from Omicron? And in every case, officials brushed them aside with the same sets of potential alternative explanations. And so, somehow, we’re supposed to believe that between Delta (last month) and Omicron (this month), every population, in every country, has managed to develop much more resistance to COVID-19? All in just about exactly the same proportion.
I’m an Occam’s Razor kind of a guy. Either there’s some unique set of circumstances in each country that, separately, manages to explain the data. And that, somehow, all just happen to have just about the same magnitude. Resulting in remarkably similar outcomes across-the-board.
Or Omicron is a lot less virulent than Delta.
I’m going for the latter option.
To which I’ll now add, and it sure looks like the wave is going to be a lot shorter, too. Based on the idea that the virus moves faster, and if there is some natural limit to each wave (as has been true for all past waves), we’ll hit that sooner.
As a result, my opinion now falls far, far into the fringe. I’m betting that the U.S. Omicron wave will be short and sharp, that it might lead to more peak cases than the just-prior Delta waves (but not vastly so), and that despite that, we’ll see far fewer hospitalizations and deaths than we’re seeing under Delta.
Just to keep you up to date, for the past week, in the U.S., here’s what we’re seeing this week under Delta:
Source: Carnegie-Mellon COVIDcast, Notations in red are mine.
So, if you manage to catch any data on case hospitalization or case mortality in Europe, for Omicron, compare it to this most recent week’s U.S. rates for Delta. No matter how I slice it, absent some absolutely incredibly large number of new cases, we’re going to see hospitalizations and deaths fall as Omicron displaces Delta.
In addition to Great Britain and South Africa, Norway and Denmark have a high proportion of Omicron COVID-19 cases and a rapidly increase new-case count.
In the prior post, I looked at the data from Great Britain and South Africa and concluded that Omicron results in cases with far less average severity that Delta did. For example, in Great Britain, the current case hospitalization rate for Omicron patients seems to be about 0.3%, versus the 1.7% observed for the prior Delta wave.
In this post, I’m going to look at the case hospitalization rates for Norway and Denmark. But first, I need to clear up some misleading verbiage.
As with Great Britain and South Africa, all the official sources in Norway and Denmark appear to downplay the apparent lesser severity of Omicron relative to Delta. At present, everyone is urging extreme caution. And, I suppose, as public health agencies, that’s their job.
I continue to see this phrase repeated: “There’s a lag between infection and hospitalization, so we can’t make much of the low hospitalization rates yet”. This is the universal excuse for not paying attention to the observed case hospitalization rate for Omicron to date.
This statement is both true and not true. But first, let’s assess the lag between the count of diagnosed cases, and hospitalizations, using U.S. data.
Source: CDC COVID data tracker, accessed 12/18/2021. Notes and marks are mine.
I think it is reasonably clear, by eye, that in the U.S., there is essentially no lag between new case counts and new hospitalizations. The peaks and troughs in one curve are mirrored in the other, almost to the day.
I can now show you a counterexample — deaths — where there’s an average of about a two week lag, owing to the median time from diagnosis to death for COVID-19 decedents. Not that in the graph below, the peaks and troughs don’t coincide, but deaths generally lag new cases. You can simply look at it, and see that it looks like the orange line is shifted to the right, relative to the maroon line.
Source: Same as above.
So, yes, there is a lag between infection and hospitalization. Absolutely. I would guess that it is, on average, roughly the amount of time it takes for symptoms to emerge, plus a day or to to see that those symptoms are serious. So, perhaps six days on average?
But the point is, that lag between infection and (reporting of) hospitalization is more-or-less the same length as the lag between infection and reporting of that infection. With the net result being that the new cases, as reported, and the new hospitalizations, as reported, are more-or-less perfectly in sync.
And so, if my goal is to calculate the case hospitalization rate — the fraction of new cases that get hospitalized — it’s perfectly legitimate to take these early numbers and do that. There’s no excess lag in hospital reporting that would result in my under-stating the case hospitalization rate. (At least, not in the U.S. data.)
More to the point, the presence of some lag between infection and hospitalization is not a legitimate excuse to ignore the early hospitalization numbers. At least, not in any country where data reporting is at least as good as it is in the U.S.A.
There is, in fact, a lag between infection and hospitalization. We haven’t yet seen all the hospitalizations that will arise from cases infected today. But, equally, we haven’t see the positive COVID-19 tests reported, from individuals who were infected today. And, by and large, we’ll see the hospitalizations just about the same time we see those positive tests.
So there is a lag, but that’s not a legitimate excuse for ignoring the early estimates of case hospitalization rate.
Finally, it is completely true that (e.g.) the use of ventilators will lag the hospital admission rate. As a case progresses from admission to (say) death, it takes some time for them to get bad enough to get onto the ventilator. Empirically, because that ventilator step lies somewhere between admission and death, the corresponding times series data will have a lag somewhere between (roughly) zero (admission) and two weeks (death). So I would not make use of preliminary data on ventilator dependence in the early hospitalization data to argue that hospitalized cases are particularly mild.
First, there are the anecdotes.
Norway already had one Omicron superspreader event, and it made the news that despite 150 cases, there were no hospitalizations. Officials of course immediately dismissed this as due to age, good heath, vaccination rate, and so on. The lack of hospitalizations was also noted in a scholarly analysis of the incident.
In terms of systematic data, I’m having a hard time finding any one system that reports both cases and hospitalizations for known Omicron-infected individuals.
For Denmark, as of Wednesday, this news reporting puts total known Omicron cases as 6047, and total known hospitalizations of Omicron cases at 10, based on a statement from the Danish government agency (SSI) that tracks this. That would be an Omicron case hospitalization rate of 0.2%. That’s not hugely different from the 0.3% that seems to be holding in Great Britain (see just prior post).
For Norway, all I can find is a government projection. In an assessment dated 12/13/2021, the Norwegian Institute of Public Health projected cases and hospitalizations. The Government of Norway published a summary of the results here. “According to a preliminary scenario from the Norwegian Institute of Public Health, the forecast is that the number of cases could rise to 90 000–300 000 per day 3 weeks from now, and 50–200 hospital admissions per day if the measures do not adequately slow down developments in the pandemic.” Those numbers imply an expected case hospitalization rate of well under 0.1%.
What I don’t have for either of these is the case hospitalization rate for Delta, which still accounts for the majority of cases in both countries. (That is, maybe somehow they just don’t hospitalize COVID cases).
Unfortunately, a lot of European countries track the number of people actively in the hospital, but not the total ever hospitalized.
That said, even a cursory glance at the Denmark hospitalization data show that they hospitalize quite heavily. At the peak of the 2020 winter wave, they had almost 1000 persons in the hospital with COVID-19 (via this source, which I believe is the Government of Denmark). At the peak of that winter wave, they were only getting about 3500 new infections per day.
Maybe I just keep finding the information I expect to find. Maybe I’m just missing all the reporting showing the hospitalization rates closer to what would have been expected under Delta.
But so far, every place I look, it’s the same story for Omicron infections.
What I find most annoying is that with the exception of South Africa, in all these cases, we are looking at the same country, same population, and almost the same time period, for Delta a few weeks ago, compared to Omicron today. (In South Africa, the time gap is closer to six months for their comparisons).
And even though it’s the same country, same population, and almost the same time, when faced with the dramatically lower observed hospitalization rate of Omicron, public health officials uniformly point to factors like vaccination rates and immunity from prior infection as the explanation.
Well, no. To a close approximation, all of those factors were the same under Delta two weeks ago, as they are under Omicron today. To a close approximation, the only thing that has changed is the virus. If there is something like an order-of-magnitude reduction in the hospitalization rate, that’s far more likely to be due to the virus than to those other, nearly-constant factors.
And so, on this issue, I find myself in a position contrary to mainstream thinking, and aligned with the nutsos. It still looks to me as if Omicron is vastly less virulent than Delta.
So much so that my prediction is that Great Britain’s hospitalization rates should now start falling, even as total COVID new case counts are rising. That’s the next thing I’ll be on the lookout for.
They are getting a lot of new cases. That was expected, with Omicron. In both countries, daily new cases now exceed the peaks of last year’s winter waves.
But that’s happening to their hospitalizations? What’s happening to their COVID deaths? That’s what inquiring minds want to know.
In South Africa, for the past week, the case hospitalization rate for Omicron was 91% lower than for Delta. A broad measure of deaths (excess deaths) was also remarkably lower than under Delta. (This, per Bloomberg). (You can see another take on the same data here.)
In addition, several sources report that Omicron has already peaked in Gautenberg Province, South Africa. That’s where this outbreak was centered. That’s also significant, because it means that this wave might be as self-limiting as all the prior waves. I think there is a general expectation that because this spreads so fast, it must also result in vastly more total cases. But that does not seem to be the case in South Africa, assuming the reported peak in Gautenberg province is real.
Public health officials seem to be doing their best to downplay the lower average severity of Omicron, and explain it as the result of anything but Omicron resulting in less severe cases.
But as far as I can tell, the two most-frequently-cited potential explanations (vaccination, prior infections) just don’t hold water. That’s because these estimates (91% lower) are comparisons between the Omicron wave, and South African’s summer/fall 2021 Delta wave. And the fact is, South Africa today just isn’t all that different from South Africa five months ago.
Between the Delta and Omicron waves, perhaps another 15 to 20 percent of the population is vaccinated. Presumably more now have a prior infection due to the Delta wave itself. (But all immunity from prior infection will have faded by a further half-year or so).
In other words, the modestly higher vaccination and prior immunity rates in the Omicron wave might plausibly generate slightly lower hospitalization rates and death rates. To me, they are nowhere large enough to create the order-of-magnitude differences being seen currently.
I am finding it difficult to get current statistics for hospitalizations in the U.K. Accordingly, I’m going to rely on some piecemeal reporting.
Per this report from Reuters, in terms of confirmed Omicron cases, as of 12/17/2021, Great Britain had the following cumulative totals:
To be clear, that’s an apples-to-apples comparison. That’s all the cases that have been genetically sequenced and found to be Omicron. (It’s not total cases, because only a sample of cases is sequenced.).
It’s probably too early to see many deaths yet. So I don’t think you can make much of the deaths data. But as far as I have ever seen, hospitalizations are concurrent with the new case counts.
That gives a case hospitalization rate for Omicron, so far, of 0.3%, or about one-fifth the British rate for Delta. I note that this is unchanged from my 12/13/2021 posting, despite a vastly higher total number of cases. So that appears to be a relatively stable number.
My bottom line remains that Great Britain should now see total COVID-19 hospitalizations fall, as Omicron takes over from Delta. We can’t see that yet, unfortunately, as the official UK data on total COVID-19 hospitalizations is almost a week out of date.
Source: Government of U.K.
Right now, as best I can tell, it’s simply failing to rise, per the most recent data. Give it another week or two. If the case hospitalization rate for Omicron is as I’ve calculated, total COVID hospitalizations should fall as Omicron displaces Delta in the U.K.
Source: Climatecrocks.com
Near as I can tell, everything out of South Africa and Great Britain so far points to Omicron having vastly lower average severity of cases compared to Delta. And, while you can find that if you look, you won’t find any official sources saying that. Certainly not with any clarity.
And I bet you never will.
Why not?
My best guess is that public health officials the world over are downplaying the reduced severity of Omicron.
That’s not due to some grand international conspiracy. It’s because, within the context of their profession, that would be the ethical thing for them to do. They really don’t want people to let down their guard over the holidays. Downplaying the reduced severity of Omicron is the public health “messaging” that would result in the fewest additional hospitalizations and deaths. And that’s their goal.
I’m reminded of the CDC’s initial advice on masks. The initial advice was that masks were unnecessary. Then the advice was to wear a cloth mask. That “cloth” part was pure social engineering, as cloth masks are nowhere near as good as a proper N95 respirator. But the CDC didn’t want public demand to strain existing supplies of N95 masks.
As a result, CDC advice was part science, part social engineering. Public health messaging was not based on strictly medical advice (wear the best mask you can get), but was tailored to achieve what the CDC then saw as a better result (wear a mask that is unsuited for medical use.)
The CDC never changed its mind about that, by the way. The CDC didn’t ever rescind it, and certainly never apologized for it. Even now, the most recent update (August 2021) of CDC advice points you to a page that tells you to wear a cloth mask, and leave the N95s for health professionals.
Instead, the CDC did what it though it had to do. And that bad information has eventually faded into irrelevance.
Don’t hold your breath waiting for CDC to come out and tell you to wear an N95. Likewise, regarding any official announcements that the latest strain of COVID-19 is vastly milder than the prior strain, on average.
It’s just not in the DNA of a public health agency to say anything of the sort.
In the U.S., the winter wave continues to be mainly a wave in the Northeast states. That area is now worse off (in terms of new cases per day) than it was at this time last year. Rhode Island is still the only only state with new COVID-19 case rates in excess of 100 / 100K / day. Continue reading Post #1353: COVID-19 trend to 12/17/2021
For the U.S. as a whole, the winter wave has stalled. Continue reading Post #1352: Winter wave, still stalled
Hospitalizations with a principal diagnosis of COVID-19 are:
Hospitalizations with a secondary diagnosis of COVID-19 are:
By region, this is still a winter wave of the Northeast in isolation.
There are a handful of states in the Midwest with high current case rates, but not high growth in those rates.
Here’s a graphic showing the current rate (new cases / 100K / day) and the change in that rate since the day before Thanksgiving.
You can see that a cluster of states in the upper Midwest — Minnesota, Iowa, the Dakotas, and Nebraska — all have relative high new case rates. But there hasn’t been much growth in those case rates since before Thanksgiving. But the U.S. East Coast, from Delaware north, is characterized by high rates that are continuing to rise.
In short, we’re just a couple of weeks from the new year, and our winter wave is going sideways. The area of high current rates and upward growth is really confined to one region of the country.
I still see headlines talking about this year’s terrible winter wave, and I just don’t quite get it. New case rates for the U.S. as a whole are half what they were last year at this time.
Nor is that merely an artifact of some areas (e.g., the Pacific states) having no winter wave to speak of. If I look at individual states, and count the days on which their new case rate exceeded 100 / 100K / day, by this time last year, we had had 240 state-days in excess of that 100 cases per day threshold. So far this year, we’ve had 33.
So it’s not merely that the average is down. It’s that the widespread “hot spots” of last year’s wave aren’t re-appearing. Last year, the country was full of places where they ended up stacking bodies in refrigerated trailers. This year, there were crisis levels of care in Alaska and Idaho. And that’s about it.
We are having a winter wave this year. It’s quantitatively different from last year’s wave.
