Tsunami

  

U.S. Covid cases to 8 January 2022, New York Times

7-day average

 

Also 7-day averages from the NYT 

The omicron variant of covid has walloped the world, including the United States. The graph at the top shows U.S. cases from the start of the pandemic. The foothill to the left of the spike is of course the delta variant. The spike is omicron. In thinking through all the epidemics in American history, this one can only be compared to the 1918 flu pandemic and the more localized epidemics of yellow fever and smallpox in the 18th and 19th centuries. This despite effective countermeasures – testing, masks, vaccines, improved ventilation. Why?

The phrase “pandemic of the unvaccinated” has become a point of contention between public health professionals and hard-core libertarians. Is it? Well, yes and maybe. The case spike seen on the graph represents what virologists, immunologists, and vaccinologists have long feared. Omicron more easily evades the neutralizing antibodies raised by our vaccines. As we have known for many decades, antibodies (whether from infection or vaccination) wane over time. That does NOT mean covid vaccines are worthless. We are seeing the proof of this with ICU admissions and deaths from covid, which have not followed the same upward slope that the case count has with omicron. It appears that being fully vaccinated (and I firmly believe with mRNA vaccines that means two doses followed by a third dose months later, what have been called boosters) significantly protects from the need for ICU care and death. We know the current vaccines (like most vaccines) do not provide sterilizing immunity; they provide protection from symptomatic disease.

Omicron threw a real curve ball at humanity with its astounding transmissibility. As this pandemic has progressed, each significant variant has shown an increase in transmissibility over the predecessor it displaced.  There are data that omicron is 3X more transmissible than delta and that the R0 (reproductive number, R0 >1 means the virus will continue to propagate in the population) for omicron may equal or exceed that of measles (12-18). Top that off with higher viral loads compared to delta. As the transmission is by aerosols, even after someone has left a poorly ventilated space, their infectious aerosols may hang around for hours. That certainly comports with many of the stories emerging of place of transmission (work, school, etc.). That huge spike of cases leads to the increase in hospitalizations. The unvaccinated are far more likely to need an ICU or to die.

So, we have a pandemic of the unvaccinated in our ICUs and our hospitals and a pandemic of the vaccinated suffering mostly as outpatients with symptoms that are often a little different from prior variants. Like a sore throat that feels as though you had been gargling with razor blades. Like 103O fevers in healthy people in their 50s and above. Like drenching night sweats. And with the risk of long covid. The unvaccinated and unmasked continue to chant libertarian nonsense about freedoms while they put themselves and others at risk. 

There is some hope. Epidemiologists who model this sort of disease transmission think there is a good possibility that this surge will peak and begin subsiding by the end of January. Meanwhile prudence says to use the tools at hand to avoid omicron infection. It would be easier if Americans were united but as we are seeing, even the Supreme Court seems to be siding with the libertarian nonsense instead of factoring in reasonable control measures. We are indeed living in interesting times.