More Cheery Omicron News

A brief update on the state of Omicron. We are still very much in informational fog. Again there is a disconcerting shortage of actual hard information, except for evidence that it is spreading rapidly in some areas, such as New York City, with its test positivity rate doubling in 72 hours.

The only sort of good news, as GM points out, is with Omicron cases rising so rapidly in New York and Florida, we’ll have a much better picture of Omicron severity, as opposed to spread, pretty soon.

Forgive me for looking hard for the flaws in some of the optimistic takes on emerging information. While it’s possible they will be largely correct, the bias is overwhelmingly towards positive interpretations. Yet at this stage, the precautionary principle argues strongly for looking for and preparing for the downside, and easing up only when solid favorable findings comes in.

One factoid that looks encouraging is that infections and hospitalizations in South Africa are starting to retreat.1 However, we don’t yet know if this pattern will be sustained or if it translates to other countries.

Recall that when the UK had its July 19 Covid restrictions “Freedom Day,” many including yours truly expected the obvious, that case counts would rise. Instead they fell. Was it due to summer? To widespread criticism of the Johnson move leading some to adopt subtle or overt protective measures, like going to stores at off hours, masking more, or even just being more vigilant about not getting close to others in public?

By early August, many US outlets were saying the UK had proved that Delta could be controlled. But then a new Delta wave began in October, with public health experts calling for new restrictions. Recall that a UK study in August had also found that the risk of hospitalization was twice as high with Delta as with Alpha, although that hasn’t been reflected in official statistics due to rising vaccination rates.

Some Twitterati were also finding good news in a recap of how the participants in the Oslo Christmas party were faring. Recall most got Covid despite being vaccinated and by virtue of some having been confirmed as having Omicron, the authorities have assumed that the majority did. However, it is hard to conclude much except a high attack rate (70%) isn’t so hot, by virtue of the fact that 3/4 are still sick:

And even though the list of symptoms does not look so bad, fatigue can cover a multitude of sins. Long Covid victims often report regular bouts of absolutely debilitating, mono-level fatigue.

The country with the best population-wide testing is Denmark, and the information from there is much less cheery. One expert worked back from its Omicron cases and Omicron hospitalizations to estimating its severity, as in what proportion of cases wind up in the hospital.

I didn’t initially understand how this model worked, but to work from cases to hospitalizations when you have a rapidly rising infection rate, you can solve for the how many cases end up in hospitalization by assuming what the average number of days from testing positive to winding up in a sickbed is.

Below is an early version of the model, with both Delta and Omicron plotted. Then there’s a later version with new data of Omicron only.

As GM explained:

They are taking the cases and the observed so far hospitalizations, then they are shift them by a given number of days and calculate the hospitalization percentage relative to cases. They don’t have the information on the actual time between a PCR positive test and hospitalization — the authorities have that but they have not released such an analysis.

Because it is exploding so fast, the vast bulk of the cases are from the last few days, and because it takes time to actually worsen to the point where you need to be hospitalized, it is hard to judge how severe Omicron is.

This is a way to evaluate the parameter space.

Based on this analysis, there are three possibilities

1. If the time between PCR test and hospitalization is short — 4 days or so — then Omicron will be as bad as Delta has been in Denmark, i.e. 0.5% of cases are hospitalized. This is rather “mild” (there was a time when we were not testing enough and the CFR was 10% in a lot of places), but it is the result of the vaccines reducing severe outcomes for Delta. Thus it would imply that Omicron is inherently less virulent because we have a lot more immune escape in its case.

2. If the time between PCR test and hospitalization is 8-9 days, then Omicron is 1.5-2x worse than Delta and 1% of cases will be hospitalized. Again, this is in a vaccinated population. This could be largely accounted for by antigenic drift and residual protection from the vaccines

3. If the time is 11-12 days, then Omicron is both more severe inherently and it is destroying of the vaccines more than expected.

We have a real problem even in the first scenario just because of how fast it spreads, which means a lot of sick people in a very short period of time.

But option #3 is a complete catastrophe.

The usual time to hospitalization is 8 days, but that is from onset of symptoms.

To underscore GM’s point, even in the most favorable “mild” scenario, hospitalization levels are similar to those of Delta. That is a train wreck given its speed of propagation…unless patients respond better to existing therapies, most important oxygen, and so average duration of hospitalization is much lower. Remember we have some bad news already on the treatment front, that Omicron indeed resists all monoclonal antibodies except for GlaxoSmithKline’s sotrovimab which may be in short supply. So at the margin, some, perhaps many patients who could have been kept out of the hospital with monoclonal antibodies won’t be.

An update of the model with more current information pushes the line upwards, which as I understand translates into more severity. For instance, in the first version, the 1% admissions to cases ratio equated to about 8.5days. In the version below, it’s now 6 days. And remember 1% is about twice as bad as Delta:

Now perhaps this picture will ameliorate as yet more information comes in. But this sure doesn’t look so hot now. Oh, and recall that Denmark is over 90% vaccinated.

And this last sad sighting shows America literally fiddling, well guitaring, as Omicron burns. I am not exaggerating. It’s 40 seconds of a mere 3 minute news clip starting at 2:08.

We’d do better if we were led by sheep. At least sheep, to my knowledge, do not run off cliffs all together like lemmings.


1 I must pre-debunk a new tweet with South Africa data: This is yet another example of the desperation to work with available, as opposed to representative/conclusive data leading experts and commentators to ignore obvious bias.

The most recent data in that tweet is for the period Nov 7 to Dec 4. For Omicron, that represents effectively ~Nov 20 to Dec 4, or at most 14 days, and the number of Omicron cases would be heavily weighted towards later in that time frame. Recall were 77 confirmed Omicron cases as of Nov 26. You can assume there were actually 10x as many as of then, but also with a doubling time of three days. Recall also that the initial outbreak occurred on and near a campus, so the first cases would tend to skew towards the early 20s.

That isn’t long enough to see deaths. I’ve looked quickly at some studies. For instance, a large scale study in Belgium for the less nasty wild type (v. Delta) found the median length between symptom onset and hospitalization range between 3 and 10.4 days, while the median length of stay for patients that recovered was between 5 days for the young to 15.7 for the elderly.

Consider also that for the famed Oslo party, which we mentioned above, about 3/4 of the positive cases are not done being sick. They are still symptomatic. The party was November 26.

The chart in the tweet appears to try to finesse this problem by presenting “cases with outcomes”. But you can’t have outcomes with patients who aren’t done having symptoms! With early Covid variants, the pattern was for some patients to be not all that sick, typically 5 to 7 days, and then get worse and need more aggressive treatment, such as monoclonal antibodies or hospitalization. Recall famously that Boris Johnson kept working and then had to go to hospital.

So this chart looks to include only Omicron cases that recovered by December 4, which would effectively select for less severe cases. Again, it may well be that more data will fall in line with these happy findings, but we can’t conclude that from this too-short window.

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  1. svay

    sotrovimab which may be in short supply.

    It’s super-expensive and given by intravenous infusion, and only around a million doses have been sold so far – it’s not clear if they have been produced yet. I think it is definitely in short supply.

    “Including the contracts announced today [17 November], GSK and Vir have received binding agreements for the sale of more than 750,000 doses of sotrovimab worldwide, with additional doses reserved through other agreements including the previously announced Joint Procurement Agreement with the European Commission.”

    1. Kris Alman

      If this is in vitro versus in vivo data, we should be wary.

      Medicine by press release has truly been a game changer for pharmaceutical investments. Financial speculators Covidtopia.

    1. foamroller

      Definitely, a case should be made for mandatory retirement at 65 or maybe earlier! Applies to the supreme court most of all!

    2. lordkoos

      Wow. He’s playing what looks to be an extremely expensive custom made guitar as well. Fiddling while Rome burns etc.

      1. QuicksilverMessenger

        And what was that inlay? Some kind of DNA strand? Dual wave patterns? A representation of the chaos in his mind?
        But who could argue with his lyric:
        “We’ll thank the people of science
        Who brought the pandemic’s end”
        I’m sure Harold Arlen would have approved

      1. juno mas

        That video is even more revealing. He appears to be playing at his home. There is a grand piano, four guitar hard-cases, and what appears to be a high-end electric keyboard in his “music room” with hardwood floors. (Has this guy been exploiting inside info while trading Pharma shares?)

        If it’s not apparent his music skill is basic ’60’s. (1960’s)

  2. GM

    One thing to add — those long lines for testing, especially in Florida, are not asymptomatic cases. People who get tested regularly for professional reasons do that through other means, not through drive-through sites like this. And this is Florida, the most laissez-faire state of them all, with the fewest restrictions in general.

    Which is also why the drive-through is not overwhelmed like this when cases are low.

    So all of those are people with symptoms who went to get tested because they have symptoms

    Now the question is how many of those will progress to severe outcomes.

    But the sheer number is really scary — Florida reports whenever it feels like when it comes to deaths, but cases are somewhat regularly reported, and they have been stable at ~1500-2000 for a couple months.

    But it has tripled to almost 7,000 in less than a week.

    1. mrsyk

      Thank you GM. Some of the people in that line might be testing before holiday socializing/travel. My younger (28yo) gets tested in this manner regularly.

    2. Tomfoolery

      One bit of testing anecdata. Daughter goes to a US college in the Northeast. ~95% vax rate. LOTS of kids sick, but NONE of them are taking tests – if they took a test and it was positive, they’d have to isolate and miss their finals. And of course they’re all heading home any day now …

    3. ScoFri

      I took a “FlowFlex” COVID test yesterday just to check myself after a friend I was with complained a day later about having a “Head Cold”. It was $10 for one test and was easy to perform. I am negative, for now I guess. But at that price I do not see it as a sustainable option for the larger population.

      I am impressed with what Colorado is doing and I plan to bring it up to my representatives.

  3. Redlife2017

    Reporting from central London:
    So for what feels like the thousandth time over the past 2 months (actually 5th time), I have to go get a PCR test with my 5 year old and partner due to a positive test in my kid’s class. Several months ago, we were able to go to a walk-in test centre that was less than a mile away. The past 3 times we’ve had to go 3.5 miles away, which means we have to either take a taxi or public transit (so, not REALLY a walk-in). And today? The closest walk-in is 5.6 miles away. Interestingly it will take the same amount of time to get to as it’s easier to access. My borough is one of the worst hit right now and the testing availability shows it.

    On another related note – the traders at my firm are getting realistic:
    Trader 1 [continues]: My wife works at a local school – “clear your desks. we’re unlikely to be back in January”

      1. The Rev Kev

        Sorry to hear what you are going through, Redlife2017. It’s a mongrel of a situation. Might want to stock your cupboards as I would not be surprised to see lockdowns happening in the UK sooner rather than later. Hope the test for you and your family goes well for you.

        1. Redlife2017

          Thanks! And yes, indeed, one should be stocked up. There’s been so many issues with weird things missing over the past 4 months that I try to keep at least a couple months supply of dry(ish) goods refreshed. And on 1 January the UK will finally put some of the customs barriers in place with Europe (ex Ireland), so in particular the timing is, uh, bad.

  4. Samuel Conner

    Dr. Collins should get a guitar with a single-stranded helix for happy-CV performances.

    Will that video eventually be suppressed as too embarrassing to tPtB?

    Was quite disheartened by the discussion in comments yesterday in the prior “informational fog” post

    on the long-term implications for individual likelihood of cancer from what sounds like a kind of long-term immune suppression. Perhaps that will be the longest of long COVID, and it sounds like it could be common. MDR bacteria, move over — you ain’t the biggest threat any more.

    Pharma must be licking its chops; so much money to be made not only from acute disease, but also from long-term sequelae management.

    Will there be a “warp speed” government funded push to develop cancer therapies? My hopes are pinned on this one, which appears to be stalled for lack of supply of pharma grade purity forms of a decades old antihypertensive med that isn’t used any more. It’s only sold at research grade levels of purity. That ought not to be a hard problem to solve, me thinks. But maybe there is money to be made by slow-walking it.

  5. Petter

    Checking the Reuters vaccine statistic for Norway suggests that the country has received enough vaccines to double dose 86.9% of the country. The real numbers according to – a tabloid but good on Covid – shows 79,1% one dose, 72,2% two doses, 21,1% booster dose. Over 20% still not vaccinated. I wonder what the numbers are for Denmark?

        1. Yves Smith Post author

          Huh, the Reuters link said 90.3% based on # shots v. population. Obviously the health ministry has better data but 6% is a pretty big gap.

  6. Arizona Slim

    When will the United States PTB realize that we can’t vaccinate our way out of a pandemic? And that, maybe just maybe, it’s time to start looking at early treatment?

      1. jefemt

        I was wondering in SA — for Covid (any strain) cases — whether ‘they’ are using the must-not-be-named but seemingly accepted and available medicine which by many accounts lessens the severity of symptoms?

        The lack of data / fog of information, and controlled narrative is maddening.

        1. Arizona Slim

          The Thing That Can’t Be Mentioned is already used widely in Africa. And, when I say the words “early treatment,” yes, I am including The Thing under that umbrella.

      2. clarky90

        Ivermectin is one of many early treatment options being investigated by the noncompliant; doctors, nurses, citizen investigators, traditional healers…….

        “Budesonide nasal spray is used to treat an itchy or runny nose, sneezing, or other symptoms caused by hay fever (allergic rhinitis). It is a steroid (cortisone-like medicine) that works by preventing the inflammation that occurs with allergic reactions.”

        Also, Kalongi (Black Seed, aka Nigella Sativa) from the spice section of an India Mart……..

        “The Science” (a wholely owned subsidiary of The Vanguard Group) is “helpless” in the face of The Pandemic, but we little people, are NOT! (I’m shouting this)

    1. Mikel

      Not only the non-sterilizing vaccines won’t get the world out but a health care system that is all about cuts to increase profits won’t either.

      Staffing issues? Check still exist and worse.
      Supply chain issues? Check. Still too many emergency products related to health have to travel thousands of miles.
      Price issues? Check. The shots may be free (for now) but all the other treatments and costs are going up. And with the pandemic keeping the pressure on the health care system, we are paying more for “insurance’ that won’t do you any good if no one is available in a clinic or hospital to treat you or they don’t have what they need to treat you.

      The shots can’t stop the spread or the burden on health care systems. SYSTEM REFORM will only do that.

  7. Joe Well

    If you’ve never had chronic bouts of fatigue and brain fog, just imagine that at random moments you suddenly felt like you had been up for 30 hours straight but you somehow still have to do whatever you have to do (work, family, chores, errands) because you don’t know how long the bout will last

    Inevitably you cancel “fun” things to take advantage of the moments of clear headedness because you just couldn’t do much of anything at the scheduled time. You end up scaling back ambitions and lowering expectations for everything. Then there is a whole feedback loop with depression.

    1. jr

      And who isn’t depressed these days? If you have a pre-existing mental condition, brain fog would make life a gray, inert, empty experience. I dread it in my bones.

    2. Objective Ace

      While hopefully it doesnt come to that, there may be medicines for such a scenario (at least the fatigue, not sure about the brain fog): Modafinol, d-modafinol, and Adderall to name a few

  8. JTMcPhee

    This epidemic sure seems to be producing a rash of opportunities for the professional managerial class. Studies, statistics, media, policies, profits, corruption…

  9. ambrit

    Mask denialism is strong here Way Down South.
    I had some last minute business for the Grand Jury to attend to yesterday. I visited a Primary School to “check it out.”
    The school itself was an older building and had two reasonably big openable windows for each classroom. Naturally, the windows were closed. I asked why, (this is not in my remit, but, well,) and was told that no guidance from the School Board was available about this. Secondly, the children, primary grade students, were masked on the busses and in the halls, but not in the classrooms. None of the adults working there, except for the cafeteria workers, were masked. When I asked about this, I was told, in all sincerity: “We have a 100% vaccinated staff.” These are “professionals.” Not stupid people by any means.
    I felt quite the odd man out for wandering about the school wearing my “Double Trouble Mask Set.” ‘Social Distancing’ was observed, but, with small children, compliance must be a problem. (I saw this during ‘line up time’ for going to the cafeteria and outside to play.)
    Getting there and back was also an experience. Due to automotive functionality ‘issues,’ I rode the bicycle there and back. (H/T the Slim Ranch Racers!) There are two decently high hills on the way, so, I dismounted and walked up the slope each time. (I am older than I imagine myself to be. Phyl laughs and tells me to shop ‘whining.’ Self image is a classic case of delusional ideation.) [So much for self pity.]
    Mask wearing ‘on the street’ is spotty at best. Outdoors, I can see a quasi-legitimate case for not using a mask. Proximity to others would be the key. But indoors, since I took a long look inside several shops, gas stations, and fast food joints as I tooled along, I saw almost no masking in evidence. The few maskers I saw were almost all like me, geezers. I also passed several groups and singletons of obviously homeless people. Under one of the road bridges on the pathway, I spotted an abandoned wheelchair. The handles and part of the big wheels were visible from overhead. I was very leery of going underneath any of the bridges to take a look see. Some of the ‘homeless’ looking I encountered were decidedly “rough” looking. [There is a resignation in the eyes that warns you off. It says: “I am ready to do anything to solve my crisis.”] Later on, I noticed a wheeled luggage unit, partly unpacked, sitting just inside the tree line of a wooded location. No people in evidence. I know that this was a crime scene, but I wasn’t sure just how many crimes were represented.
    Anyway, that’s my story and I’m sticking to it.
    Stay safe. Be kind. Be wary. Society is doing a slow collapse around us.

    1. Jack

      In the South here too. Central South Carolina. Your last sentence really hit home. I see the signs of collapse every where around me. People not wearing masks. I always wear one when I go into a store or inside anywhere and usually get funny looks from some people for wearing one. I would say less than half the population wears one. The bars are crowded, at least from what I can tell by observing from outside. No way am I going in. I monitor the positive case % daily on the health department website (DHEC) and it is now starting to trend upward. The first reported cases of Omicron were reported in the state yesterday. The number of “homeless” panhandling at the busy street corners has increased. Perhaps its the holidays, but I put “homeless” in quotation marks because many of them do not look homeless. Many of the shelves are bare in the grocery and retail stores. Its spotty. One day it might be no sour cream and butter at all. The next its canned beans. Have not seen a run on tp yet though. The price of meat is sky high. I am a big bacon eater and bacon has almost doubled in price in the last 6 months. Car dealers lots in some cases are bare. Seems to be foreign models for the most part. Two used cars I bought over a year ago are now worth considerably more than I paid for them according to Kelly Blue Book. Our home has gone up over 30% in value in 8 months according to Zillow. The houses in our neighborhood are on the market for less than a few days and they are sold. One close friend put her home on the market and in one day had 5 offers. The one they accepted was $20k above asking price. I am beginning to think that soon something is going to break and it will all come crashing down. That always seems to be how it works. We just limp along and everything sort of works and we get by; until we don’t.

    2. Tom Doak

      It’s not just the South anymore; mask discipline has fallen almost everywhere. I have traveled some this fall, but even back at home in Michigan, only 10% – 20% are masked in the grocery stores, in Costco, anywhere. Mostly, as you say, they’re geezers who may actually read the news, instead of just listening to the TV.

      1. Bakes

        Yep, even in the northeast. More anecdata: Mom reports no one wearing masks at Stop & Shop unless they have grey hair. And then only 50/50%.

  10. PhillyPhilly

    I really appreciate the presentation of the uncertainty in the lag parameter (average days between testing positive to hospitalization). It’s refreshing to see a range of outcomes presented, instead of the worst-case scenario that NC and GM typically present.

    The analysis underscores how little we actually know at this point, and it’s very unsettling to see that even in the best case scenario we are really in for it.

    Best of luck to all. Stay well.

    1. Yves Smith Post author

      It is not correct to say GM always presents worst case scenarios. He was shocked that the vaccines last only (at best) 6 months. He’d assumed the re-up cycle would be closer to a year. He has also been genuinely shocked that the West ex New Zealand and Australia quickly abandoned eradication (and as we know those two later abandoned it). And he had been pretty convinced that not matter how badly we screwed up, that we’d have nasal vaccines by late 2022, which would be close to sterilizing, and so we’d be on our way to getting out of it by early 2023. Instead he reports that Novovax, (“Nevervax”?) which had been working on a nasal vaccine, isn’t any more. As he put it:

      There is a bigger fear here, that promising vaccine tech will be discarded because of the fighting for positions within Big Pharma (especially because much of the promising tech is from “Small Pharma”).

      How exactly are we going to move to intranasal vaccines?

      Which of the major companies is making one? I am not aware of any.

      Half of the FDA is on the indirect Pfizer payroll.

      Moderna seems to have some backing, but it is the better RNA vaccine and yet the market share is much smaller than Pfizer, and likely to stay that way.

      So again, how and when are we going to move to better vaccines if we have locked ourselves into using Pfizer products?

      1. PhillyPhilly

        Thanks for the context. To be fair, a horrifying number of the worst-case scenarios presented by NC throughout the pandemic have come to fruition. When I saw the omicron post the day after Thanksgiving I nearly threw my phone across the room out of frustration.

        I’ve been following the NC coverage throughout. In February 2020 my wife, not a reader of NC, thought I was paranoid and a little crazy . By April 2020 she thought I was clarvoyant.

        1. Skip Intro

          And some of the worst case scenarios, as usual, are shown to have been naively optimistic.

          “No matter how cynical I get, I just can’t keep up” – Lily Tomlin

      2. MonkeyBusiness

        Novovax should work with the Chinese. Only the Chinese government has the clout to go toe to toe with the global corporations.

  11. MT_Wild

    Just an FYI on sheep. While they may not follow each other over a cliff, they still have a tendency to kill each other in mass panics.

    During lambing season sheep are usually confined to smaller pastures so they can be watched more closely. If the shepherd, guard dog/mule/llahma does its job this works out.

    But if for some reason a predator does get in with them and is not driven out, then the sheep will sometimes get pushed into a corner of the fence and start to trample each other in an attempt to escape. Not uncommon for 20-30 to get killed at a time.

    Stray dogs are a big culprit here, because they have a tendency to be in it for the chase. Coyotes grab a lamb and go.

    Not sure if there’s a good covid analogy here, other than don’t get caught in the rush for the door.

    1. John

      You beat me to it. Sheep are astonishing creative at individual and collective suicide without intense monitoring. Hiking in UK near Hadrian’s Wall I encountered a very fat sheep that had fallen over and was too fat to get back on all fours. They die of thirst if not found and set upright. Warning for obese Americans.

    2. albrt

      Doesn’t “Far from the Madding Crowd” start out with a herd of sheep running off a cliff?

      That’s all I got.

  12. Etrigan

    I had mono for a long time as a child. No one should go out of their way to end up with that level of fatigue. My exhaustion from a few days of being ill from vaccine 1 was so familiar it was triggering. Anyone who has experienced real fatigue should know Covid risks a return there and everyone who hasn’t should listen to people who have/do from long Covid or other conditions and be as precautious as possible to never, ever experience it! “Just fatigue” is such bullpocky.

  13. Biologist

    Preliminary data from an Imperial College London modelling study in the UK:
    Full pdf here:
    It came out yesterday, apologies if this was already posted somewhere.

    As I understand from a quick scan, they estimated (modeled) vaccine effectiveness using empirical data on neutralising antibody titres. In other words, they plugged in the empirical numbers of a) how much vaccine-induced antibodies are able to neutralise Omicron as compared to Delta in lab studies; b) how this depends on vaccines and boosters regimen; c) how much these antibodies decrease over time, based on 1st/2nd dose data; d) previous work showing that those titres are highly predictive of protection against mild or severe outcomes.
    This ignores T cell immunity, but they validate / calibrate their models against real-world data on infection, hospitalisation and death in the UK from Delta (and previous variants). It also assumes that clinically, Omicron is as mild/bad as Delta*.
    This in absence of empirical data on mild vs severe outcomes of Omicron (vs Delta) depending on vaccine, which given current transmission will of course be coming in very soon. Hence preliminary.

    From summary, my bold:

    Vaccines have played a central role in mitigating severe disease and death from COVID-19 in the past 12 months. However, efficacy wanes over time and this loss of protection will be compounded by the emergence of the Omicron variant. By fitting an immunological model to population-level vaccine effectiveness data, we estimate that neutralizing antibody titres for Omicron are reduced by 4.5-fold (95% CrI 3.1–7.1) compared to the Delta variant. This is predicted to result in a drop in vaccine efficacy against severe disease (hospitalisation) from 96.5% (95% CrI 96.1%–96.8%) against Delta to 80.1% (95% CrI 76.3%–83.2%) against Omicron for the Pfizer-BioNTech booster by 60 days post boost if NAT decay at the same rate following boosting as following the primary course, and from 97.6% (95% CrI 97.4%-97.9%) against Delta to 85.9% (95% CrI 83.1%-88.3%) against Omicron if NAT decay at half the rate observed after the primary course. Integrating this immunological model within a model of SARS-CoV-2 transmission, we show that booster doses will be critical to mitigate the impact of future Omicron waves in countries with high levels of circulating virus.

    That’s > 5-fold increase in risk of severe disease, 60 days after the booster – remember that boosters are the strategy that the UK and US are now betting the house on.

    It gets worse for non-boosted – estimated vaccine effectiveness of Pfizer against death drops from 95% at 3 months and 87% at 6 months for Delta to 74 and 50%. For Oxford / Astrazeneca it’s much worse – drop from 73% VE against Delta 6 months after vaccination to 29% against Omicron. That’s against death – against severe or mild disease it’s much worse. Remember that in UK more than 30% have not received their two doses, in the USA this number is larger I believe.

    As indicated in summary, boosters help but less for Omicron than for Delta

    There’s more detail in table 1 and figure 1.

    *) In a separate study, also from Imperial College, they looked at this question, and concluded it’s just as severe as Delta, based on proportion of cases seeking hospital attention. Didn’t read that study, some write-ups here: [paywalled]

    1. R

      This is the study SAGE are using that I referred to yesterday.

      The booster campaign in the UK is a Hail Mary pass. Everybody will have been infected before they are halfway. 1.5 day doubling time (although maths may be suspect)….

      Unless T cells can stop clinical progression, NHS overwhelming is already baked in.

    2. Objective Ace

      One thing that is being ignored–but shouldnt be based on how fast omicron is spreading is that the vaccines actually make you more susceptible to covid for the week or two it takes you to recover–then they offer the protection noted for 60 days.

      I’m not sure how that changes the models, and it surely differs by area. I would be much more comfortable getting a booster in rural kentucky then in NYC right now

  14. Bricky

    I think at this point the collective West has decided that it’s tired of Covid and that it is going to label Omicron as mild. And you know what, Omicron is mild compared to Ebola or SARS or whatever. You can frame a virus that kills 1 in 300 as responsible for deaths of 1 million Americans, or as “hey you only have a 1 in 300 chance of dying, but not really, if you are younger than 75 and not morbidly obese or already sick.”

    Under Trump, covid was among other things a way to hit him over the head and draw a line between good Americans and deplorables. Now that team Blue is in the White House the incentives have changed.

    I personally think SA has been “cooking its books”, you’re not supposed to say that but looking closely at their data there are things that don’t make sense. It’s perfectly understandable why SA would do that. But on the other hand, it legitimately doesn’t seem like SA’s hospital system has collapsed. There are no restrictions there and there doesn’t seem to be widespread death and chaos like say in India during their delta wave, or in NYC back in March-April 2020.

    The only way people will take Omicron seriously in NYC where I live is if systems start to buckle. This is not impossible, since Americans seem older, fatter, more diabetic, and generally more unhealthy than just about any other nationality in the developed world. I don’t think nearly as many people have previously caught covid as in SA, and there is a large unvaccinated population, so who knows what will happen. My personal best guess looking at the data is that omicron is par for the course with previous waves in terms of virulence, but clearly spreads more easily. Balanced by the fact that vaccination and/or previous infection will provide substantial protection against death (as it has in previous variants as well).

    1. Jen

      When I really feel like getting my blood pressure up I contemplate how much loss in workforce (even temporary) would it take to reach a point where nothing functions. 25%? 10%? 5%? 3%?

      I feel like our political class is at so much of a remove from what it takes to actually maintain a functioning economy that they can’t even conceive of the systemic risk. Think of Pelosi with her two 24K fridges full of ice cream, or Mayo Pete explaining that the supply chain problems will resolve when we all get our vaccines.

      So how many people have to be out of commission with covid for the system to buckle? I’d really rather not find out.

    2. Thuto

      Reporting from ground zero, Johannesburg, Gauteng, South Africa. It’s been a while since I last posted a comment here on NC owing to a health issue unrelated to Covid, which thankfully has responded to lots of rest and treatment and is getting much better. Let me hasten to add that It’s not my intention to add to the cheery commentary on Omicron because as Yves has pointed out in the last post (I think), context matters, e.g. SA on average is much younger than some Western countries which are currently in the early innings of dealing with the spread of Omicron. That being said, I have a close network of a few friends from varsity who are researchers at top scientific institutions and specialist physicians in multiple hospitals, the former pores over incoming data daily and the latter are in the trenches deep inside the healthcare system and the indications I’m getting from near daily conversations with them is that Omicron patients are indeed presenting with milder symptoms overall and deaths, even when compared to the same stages of the emergence and rapid spread of the Alpha and Delta variants, aren’t as yet trending upwards as had been feared.

      At the same stage during the last two waves of the pandemic, the hospital system was already starting to buckle under the weight of rapidly increasing hospitalizations, this is currently not the case with Omicron and my biokineticist and orthopedic surgeon, whom I visit on a bi-weekly basis at a hospital here in Joburg, confirm this.

      Closer to home, my own brother, who is in his mid-thirties and had a near fatal case of pneumonia pre-covid for which he was hospitalized for a month, recently got infected at work and we had feared that this would send him back into hospital but his case has thankfully been very mild. He completes his last day of self-isolation today.

      Admittedly, my comment is building off of largely anecdotal information that’s been shared with me by the medical practitioners attending to my health issue and my own “Covid brains trust” of friends with access to privileged information afforded to them by their day jobs, and I must say, in a strange kind of way, I trust this unvarnished data more than what’s coming from the media, private businesses or the state, who each have some sort of agenda to push and the attendant incentive to “cook the books”. That’s about as much typing as I can do but I thought i’d give some ground zero perspective to balance out what’s being gleaned from other sources, with the disclaimer of course that things may change, and other countries may, and likely will, fare differently from how we are faring down here in SA.

      1. PlutoniumKun

        Very good to have you back here, hope your recovery is going well.

        Its good to hear some confirmation that the news from South Africa isn’t quite as bad as feared.

        1. Thuto

          Thanks PK and everyone below for the kind words, the recovery is progressing very well and I’ll be back to my normal self in no time. In the meantime, stay safe. :-)

      2. HotFlash

        Thank you for this, Thuto. I, too, give more weight to ‘anecdotal’ evidence than to the polished narrative. In my experience, news from ‘on the ground’ has turned out to be more reliable. Thanks again.

        1. Thuto

          If by “repurposed drugs” you mean Ivermectin then yes, doctors have prescribed it although the MSM here tries to discredit it at every turn.

      3. GM

        The fear here is that this might turn out to be a India-in-2020 situation.

        Imagine that SARS-CoV-2 had come not out of Wuhan but out of Delhi. How would we have approached it in the rest of the world?

        In India the IFR in 2020, even accounting for excess deaths, was not much higher than 0.2%.

        There were a lot of hospitalized people and deaths, but they got to 60% seropositivity in places without society coming anywhere close to collapsing.

        Nobody really understands why the impact was so muted. but if all we had was that information, we might have ignored the whole problem.

        And yet the exact same virus was ravaging Europe and the US.

        And then of course Delta came and India itself collapsed.

      4. ChrisPacific

        Good to see you back. I always value your perspective as it’s so different from what we normally see in our USA-centric media. Take care and best wishes for continued recovery.

  15. Sully

    I live about 40 miles outside Albany NY. I tried to schedule a booster for my preferred covid vaccine for the last few weeks, the only booster I could get that way was 35 miles away & weeks away. I gave up on that, and tried to schedule in person at our local supermarket and CVS, both said I had to do it online. Looked online again, no appointments available at anything locally for any booster at any time. I was only given the choice to be scheduled 30-40 miles away weeks away, past a small city and many suburbs. I can’t believe there is not anything closer.

    I’m not quite 60 and pretty computer literate, I can’t imagine many of my neighbors are going to jump through all these hoops. I got a booster appointment yesterday about 10 miles away for January 5th, by walking into another local supermarket and asking if they were taking appointments (online it said they had none) I was happy to get it. Another woman, for another type booster, was scheduled for January 25th the next open date for her preferred booster.

    NY has mask mandates again, which I’m happy about, but just yesterday I got to witness a tantrum by a 70 year old man, who swore his way out of the store because a convience store worker reminded him of the NY mask mandate. I thanked her, and she said this happens multiple times a day. It is going to be a long winter.

    1. Soredemos

      The mask stuff will never cease to amaze me. We have a significant number of adult babies in this country; man- and woman-children who throw literal hissyfits for incredibly stupid reasons.

    2. bob

      They have to make this stuff much easier. The websites that don’t work and appointments that can only be made in person for 3 weeks away are not helping anyone.

      Saw this yesterday, good thread-

      “it’s insane how so much of testing and boosters is word of mouth and how useless the websites are like it’s all“yeah I know a van” “go to this corner” “they’re giving shots across from the deli next to that empty storefront””

    3. Punxsutawney

      Very similar to my experience. And why the heck was my medical provider (a major name) nationally not providing vaccines at most of their locations instead of just one office for 300,000 people.

  16. Wukchumni

    Got a Moderna booster yesterday on a walk-in @ our drug store in tiny town after my initial Pfizer twofer, and everybody was masked up and I feel a bit fatigued this morning from taking my shot…

    …then walked 100 feet to our market for ice cream as a just reward and nobody had a mask on aside from me

    Greatly reconsidering xmas plans, my sisters wanted to go out to a Mexican restaurant a few days before the hap-hap-happiest time of year, which seems awfully risky to me.

    Omicron has a little time to show itself in terms of what it can do, prey tell.

    Another thing in jeopardy is our over the hill gang skiing in Tahoe & Mammoth in early January. Just my luck on that one if Covid kept me away, my first time skiing in 2 years with 6 feet of snow on the ground and I can’t go, that would suck.

    1. diptherio

      Got myself on the waiting list for a Moderna booster a couple of days ago. Apparently my tiny town doesn’t have enough of the stuff to give to people who don’t fall into some high risk category (actually, I’m not certain they even have enough for those), and I’ve been told they’ll let me know when their supplies are up.

    1. Dean

      Here is a preprint of a study (Plasma neutralization properties of the SARS-CoV-2 Omicron variant, where the ability of 169 longitudinal convalescent plasma samples to neutralize pseudotypes bearing the original Wuhan spike, Omicron spike, or a highly mutated laboratory designed spike designated PMS 20.

      The convalescent plasma was 30 – 60 less potent in neutralizing Omicron vs Wuhan while plasma after 2 dose mRNA vaccine were 30 – 280 fold less able to neutralize Omicron.

      However neutralizing ability significantly increased in both convalescent and vaccinated individuals after an mRNA boost. From the summary:
      “Notably, previously infected or two-mRNA dose vaccinated individuals who received additional mRNA vaccine dose(s) had 38 to 154-fold and 35 to 214-fold increases in neutralizing activity against Omicron and PMS20 respectively.”

      Weather that neutralizing ability correlates with severe disease protection may remain open to question.

  17. Tom Stone

    Here in Sonoma County I’m seeing fewer people properly masked and a widespread belief the Omicron variant is”Mild”.
    No worse than the ‘flu,a nothingburger.
    And “Get Vaxxed, it will protect you”
    And the assumption that Omicron will be the last variant is pervasive.

    If Omicron does cause the “Health Care” system in the USA to collapse ( It’s on the ragged edge) and if there are other consequences to “Let ‘er Rip” that can’t be blamed on Bubba convincingly the rage will be incandescent.

    1. Blue Duck

      Witnessed a bar (its name might rhyme with “smell the beer”)in Santa Rosa last night that was packed to the gills – must have been 100 people, no ventilation what so ever. Not a single mask, not the bar staff nor the bouncers. Didn’t realize what we were walking into, and we turned straight around and walked out after we saw what was going on…

  18. LaRuse

    Anecdote from the Richmond Metro area of VA.
    Just picked my kid up from her Middle School because she has been sick with a cold all week and it seems to have progressed to an URI – but she’s COVID Negative for now. However, 10 kids had been checked out for early release before I got there at 1015 this morning. The ENTIRE cheer squad tested positive this morning for COVID. These are middle schoolers, so middling to low Vax rates most likely, but all of these kids were sick and there was a basketball game last night where the squad performed. Lots of yelling and heavy breathing. I think we are about to have an epic school age outbreak in my county a week before Christmas.
    January is going to be ugly.

  19. Kris Alman

    Here’s a snapshot of death rates (per 100k) of 6 countries (EU, US, Australia, Sweden, Denmark, Japan).

    Note how Denmark’s death rate started spiking late November. EU and US seem to mirror this spike. Omicron?

    1. Yves Smith Post author

      This is back to GM’s concern above, that whatever less bad results are being see in South Africa may not be observed elsewhere. For instance, with wild type, there was speculation that the BBG vaccine, which is a live vaccine, may have helped with immune responses. That was later supposedly debunked…but if not that, then what?

      South Africa had allowed use of Ivermectin on Covid since Jan 2020. Not sure how widely actually deployed:

      But that seems to have been reversed:

      Due to the state of Google, I can’t find good information about routine use. In some parts of Africa, ivermectin is administered 2x a month by mail for parasites. RSA does not appear to be one of those countries due to reports of use of animal Ivermectin for Covid:

      1. Anonymous 2

        My niece, when in South Africa in August, tried to buy IVM, which had been readily available until that point, but it had become unobtainable. My impression was that this was because there had been huge demand for it among South Africans and supplies had been almost exhausted rather than because of government prohibition.

      2. Objective Ace

        Just adding a another potential explanation for less bad outcomes: its summer in South Africa. More vitamin D uptake in everyone, and potentially more outside socializing (not sure about the levels of AC there)

      3. Basil Pesto

        I read this from NPR last night, suggests somewhat wide usage including black market (which may be counterfeit), but no data to go on.

        Due to the state of Google, I can’t find good information about routine use. In some parts of Africa, ivermectin is administered 2x a month by mail for parasites. RSA does not appear to be one of those countries due to reports of use of animal Ivermectin for Covid

        I did a similar check as I did with Zimbabwe last month and also couldn’t find anything conclusive suggesting RSA was part of the regular Ivermectin distribution programme. The countries that are seem to be in the equatorial part of Africa

  20. Hayek's Heelbiter

    The usual time to hospitalization is 8 days, but that is from onset of symptoms.

    Meta-analyses based on 18 randomized controlled treatment trials of ivermectin in COVID-19 have found large, statistically significant reductions in mortality, time to clinical recovery, and time to viral clearance. Furthermore, results from numerous controlled prophylaxis trials report significantly reduced risks of contracting COVID-19 with the regular use of ivermectin. Finally, the many examples of ivermectin distribution campaigns leading to rapid population-wide decreases in morbidity and mortality indicate that an oral agent effective in all phases of COVID-19 has been identified.

    Please note that the NCBI is hardly a left wing conspiracy theorist woo-woo database.

    Many Western governments and MSM suppress this information, spread disinformation, and go to the extent of forbidding doctors to prescribe ivermectin, even when this very cheap and remarkably safe drug has been proven to save lives.

    “Gross Negligence Manslaughter can occur when someone is killed by someone else’s extreme carelessness; that is, gross negligence. … The breach must have caused or significantly contributed to the death of the deceased. The breach must be characterised as gross negligence and therefore considered a crime.”

    As ivermectin does seem to save lives and reduce illness, does this mean that the the behaviour of western governments and the MSM make them de facto guilty of manslaughter?

    If carelessness can be considered a condition of manslaughter, does deliberate prevention of proven lifesaving treatments also rise to it?

    Would those who have a more finely honed legal mind please clarify this for me.


  21. C.O.

    In BC the restrictions are being awkwardly amped up while still claiming that only vax can save us – at one time Bonnie Henry was a big defence in depth proponent, now not so much.

    The link below is to a CBC article briefly noting the updated restrictions and the usual PR talking points. The latter read a bit strangely in such close proximity to the graph of weekly COVID-19 cases versus vaccine status. The graph makes me think of Lambert’s “Oopsie!” notation in the Water Cooler a couple of days ago. I don’t think that the now proportionately much lower number of people who have not had shots versus those who have can explain away the curves.

  22. Glen

    I received a Moderna booster along with the flu vaccine at the end of November. I was out of it for about three days after that (sore body/joints, slight fever).

    Have also noticed much less masking going on in my neck of the wood in the PNW.

  23. Ellery O'Farrell

    Just to mention a contrarian “lived experience”: here in my small corner of NYC (north of GWB, west of Broadway, south of Dyckman/Inwood), mask compliance on the primary subway, the A, is above 90% based on the counts of people I can see I take every time I ride it, all the way down to 42nd/59th (don’t ride the other train, the 1, as it’s a little scary while the A is basically safe). Mask compliance in my corner is north of 90% inside stores; if I happen to go to NYPresbyterian/Columbia, as I did yesterday, it’s 100%. Even people walking outside wear masks almost all the time (don’t have any counts, as there are too many of them, but I’d guess 75%–not including me, as I don’t wear one in the open, breezy to very windy, air right off the Hudson).
    My apartment complex, also very compliant with strict policies politely but rigorously enforced by doormen, security, and other residents, has had only 2 cases so far in going on 2 years. Something like 500+ apartments (hard to count because of combinations). Also, every single time I’ve casually mentioned to another resident that I’ve had my 3rd shot, they’ve replied that they have too; many have mentioned it to me without prompting, as something taken for granted.
    The larger neighborhood, Washington Heights, is a very different story both for compliance and case count. In the same zip code, my anecdotal evidence gets mixed with the rest and buried with data from only a quarter mile away.
    My theory is, and for many years has been, that NYC is a collection of tiny, often very different neighborhoods. Aggregating over even small but artificial areas, such as zip codes, is likely to distort the picture by homogenizing extremely different data. It’s part of what I like about New York…

  24. John Beech

    Just attended a dog and pony show in Daytona Beach (our product pays a role in their product so it was politic to be there). However, because there wasn’t a mask in sight (other than ours) and because I am high risk (asthmatic and overweight), this led us to split as quickly as we could once the outdoor part of things was about to head indoors (nothing like being in an enclosed area with 60 of your closest friends (and we didn’t really know a soul as communications are electronic for virtually everything these days). Anyway, very distressing to see masking being overlooked but there you have it. As for us, less than a mile down the road we stopped and horked our nasal cavities with Betadine 0.5% solution (in saline). Anyway, ran about 250ml through each of us (yes, we were prepared). This, despite the fact we were outdoors virtually the entire time (just prudent in my view since dead is a forever). So let’s pray Omicron is more mild than Delta. This, because ‘we the people’ need to catch a break and the news can’t always be bad, right?

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