January 12, 2022

Omicron! Omicron! Never before have the numbers been more… More people in the hospital than at the peak of the pandemic a year ago just as vaccinations were starting to come on line. Three quarters of a million new cases daily in the US alone. The local case positivity rate is well over 10% (it needs to be under 5% to consider spread in the community under any sort of control). The death rate continues to inch up and is now at about 1700 deaths daily (from under a thousand a few months ago). Everywhere you turn, it’s a plethora of bad news.

What does all of this mean? It means omicron is much more infectious than previous strains and much easier to contract through casual contact than the previous circulating variants. Given this ease and rapidity of spread, omicron’s R0 (estimated number of individuals an infectious person can spread disease to) is about 7. The original strains of Covid were closer to 2-3. With one person in 440 in the country being diagnosed daily, that’s 1.6% of the population a week or 7.2% of the population in a month. No matter how you slice it, it’s everywhere and unless you’re a hermit, you’ve got a good chance of encountering it if you are in contact with anyone outside of your home. Fortunately, we’re two years into pandemic life and we should all know what to do as a society. First and foremost, vaccines work. They’re not perfect at preventing infection but they are working very very well at keeping people out of the hospital and the morgue. Unvaccinated individuals are somewhere between 13 and 17 times as likely to require hospitalization and are about 20 times as likely to die as vaccinated individuals. Vaccinated individuals that require hospitalization tend to be those over 65 and those with significant other disease processes. If you are a non-elder, relatively healthy, and are vaccinated (and boosted), you’re somewhat more likely to die in a traffic accident than from Covid.

Shutting society down was a necessity early in the pandemic to mitigate spread as we had no weapons to fight back. We’re not in that position any more thanks to vaccines which remain the best thing we’ve got to save health and lives. (There are monoclonal antibodies and antivirals as well, but they are nowhere near as effective). Western society has made the decision – no more shut downs. We should probably keep them on the table, but neither our government nor our populace is going to go for them without a hellacious fight. So we’re going to have to rely on other mitigation measures. What else have we got other than vaccines? The same things I’ve been talking about for months and months. Masks (and this is the time to break out the N-95s you’ve been saving), hand washing, and appropriate social distancing. If we would all do those three simple things, we’d be in a much better position, but alas, if my recent trips to work are any indication, the population of Alabama is more or less over those basics as well.

Flatten the curve is so 2020 but it’s really necessary at the moment. Even though omicron appears to be less virulent, and the breakthrough cases in vaccinated individuals don’t require the intense inpatient therapy that those stricken early in the pandemic needed, the absolute number of people becoming infected is creating a huge influx of folk needing at least some hospital care. The numbers of Covid inpatients at UAB, which had been down around a couple dozen a few months ago, are now over 200 and everyone is battening down the hatches as hospitalizations lag diagnoses by about two weeks so it’s going to get a lot worse before it gets better. So everyone, get those vaccines to keep yourselves out of the hospital and reduce the burdens on the health care system. Local vaccination rates have gone up but the state as a whole still remains about 45% unvaccinated. In the last two years, given all of the strains on health care, and they have been many, roughly 20% of the healthcare workforce have left their jobs. I haven’t seen numbers on how many of those were rehired elsewhere in the healthcare system but every hospital system I know of is having difficulty fielding nursing, provider, and other ancillary staff due to resignations and individuals being out sick themselves. (And the messaging about isolation/quarantine by health care workers is all over the map – get it together CDC…)

We’re getting close to a fairly catastrophic failure of inpatient care. That doesn’t mean that hospital buildings are going to collapse a la Surfside condominiums or hand out closed signs, it just means that they will not be able to provide the services we depend upon them to do as part of the infrastructure of society. Those wounded in a car accident or a fall won’t be able to be treated and will die of their accidental injuries. Patients will not get cancer treatment. There will be no one to deal with the sudden heart attack or stroke where precious minutes can count. Covid related deaths without covid infection. And once the infrastructure is shattered, it’s going to take a lot more time and money to rebuild than we as a society have been willing to invest in social services for some decades. The US health system, ranked #37 nationally between Slovenia and Costa Rica for outcomes, will plummet down the international scales . We may continue to delude ourselves about exceptionalism in American medicine but I fear we’re going to be exceptional going forward for all the wrong reasons.

A lot of what happens next is out of the hands of any of us as individuals. Society as a whole is going to have to decide how things progress. The problem with that is we’re living in two distinct societies currently, red and blue for want of a better shorthand. Red society, with its disdain for expertise, basic public health measures, vaccinations, and anything that resembles a ‘mandate’ will continue to place great strain on the medical system and continue to put the chronically ill, and those who cannot be vaccinated, including their younger children, in the path of potential harm. Blue society, with its acceptance of vaccination, social norms of masking, distancing, and willingness to isolate in case of breakthrough infection, will be able to resume a certain normalcy in social interactions and activities, even in the face of omicron. But we don’t live in purely blue and red communities, we’re all living in a mosaic of various shades of purple where the choices of both sides are likely to affect what happens to you as an individual. I’m afraid that until we get some strong leadership from the center that can appeal to both sides (is that even possible these days?) we’re going to be doomed to dealing with pandemic issues for some time to come.

In the meantime, there are a few things y’all can do and you know what they are. Get those vaccines and boosters. Wear an N-95 mask at least until omicron has started to die down. Keep those hands clean. Think about your distancing when inside with others. Do your socializing outside as much as possible. Try not to be a link in the infection chain… Yeah, I got it but to my knowledge by isolating for five days and masking up since, I haven’t spread it to anyone else.

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