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Waiting for Omicron

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December 14, 2021 9:34 p.m.

I want to give you another update on COVID. The outlook … well, it’s not good. Certainly not in the near-term. Here is a good summary of the emerging science of Omicron from Dr. Eric Topol. We now have at least ten lab studies that look at immune response to Omicron, specifically neutralization studies which broadly measure the body’s first line of defense against infection. The more studies we see the more they reinforce each other. Very limited protection against infection with a two dose mRNA regimen, though presumably still substantial protection against severe illness and death. A booster appears to get up towards the level of protection against infection two doses provided against Delta, though not quite as high. Two doses and prior infection also seems to produce fairly effective protection. Three doses and two doses plus infection seem to be in the same ballpark of protection.

It does seem like Omicron illness tends to be milder. But it’s important to understand why. Omicron’s big advantage is that it can reinfect people or break through vaccine protection more effectively. So the mildness doesn’t mean Omicron is a milder form of COVID. It’s that the cases are in people who already had a lot of immunity. It wasn’t enough to keep them from getting sick. But it was enough to limit the severity of illness.

Now the bad news. A lot of people are about to get sick. The growth numbers out of Europe and South Africa are so rapid they’re hard for me to make sense of. It seems like we’re talking about waves of infection that will dwarf all the earlier waves in the number of infections. I’m not going to repeat some of the estimates I’ve seen because I’m having a hard time making sense of what’s hyperbole and what’s not, what are true apples to apples comparisons with earlier waves. But it really seems like late December through January will be explosive in terms of numbers of infections.

It’s important to say that the cases this wave produces will on average be more mild because the overwhelming majority of people have had some exposure to COVID, either by infection or vaccination or both. Some now argue that the link between infections and severe disease has been broken sufficiently that infections are a misleading metric. But even if the percentage of severe cases is much lower, a sufficiently large wave will still produce severe disease in absolute numbers that will overwhelm hospitals.

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The one piece of advice remains the same: get a booster. Certainly if you are anything but young and healthy, get your booster. It’s not a marginal difference. It’s a big one. I would also seriously consider limiting obvious vectors of exposure: indoor activities in large groups, eating indoors, large crowds indoors or out. We all have our own levels of risk aversion and we can’t hide forever. But you should assume that your risk of being exposed to COVID is about to go up a lot. So plan accordingly.

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