State by state look

Cases. I sorted this chart by where cases are increasing the most. Texas and Florida lead the way with a WHOPPING +167% and +185% increase in 2 weeks. Goodness, friends. That’s a huge change and a scary situation in states with low vaccination rates.

Hospitalizations. If we sort states by hospitalization increases, here’s what we find. Remember that hospitalizations are always lagging behind cases. So, don’t believe the rhetoric that Texas or Florida are doing “just fine” (have you heard that like I have?) - we will see the effect of those case increases land in the hospitals in a few weeks. Letting COVID rip through states/communities is not a strategy. Never has been.

Is this Delta or Omicron?

Yes and yes. I think this surge will get steeper too. Omicron has a reproductive rate of 3 which is way higher than the other variants. I need to say that again. A reproductive rate of 3. Whoa. This means that cases due to Omicron are doubling every 3-4 days. Hang on, friends. This will likely be an explosion of cases on top of what we are already seeing with Delta. We are also seeing more breakthrough cases with Omicron. Vaccines+boosters continue to provide some protection, based on preliminary evidence, but is it enough? We don’t know yet.

You really need a booster against Omicron before the holidays

Preliminary evidence shows that vaccine effectiveness against Omicron after 2 mRNA shots of Pfizer was 30-40% - BUT, a booster increased that to 70-80%. Friends, that’s a huge increase! But only after a booster. I would anticipate we see the same with 2 doses Moderna + booster and 1 dose J&J + booster. Boosters boost. And, we need that protection against Omicron. Remember it takes time for the boosters to work. So, don’t get it on December 23rd and then pull-on-partay December 24th. Boosters need time - like good wine or cookies to cook.

Natural immunity is not enough.

I’ve posted about this already here. But, the data is coming in that brings this point home with Omicron from this recent study. Look at the pictures below: E, F, and G show how neutralizing antibodies respond to Omicron among those who were previously infected with COVID from the previous 3 variants - Alpha (panel E), Beta (panel F), and Delta (panel G). In those panels, look at the B.1.1.529 - that’s Omicron. The LOW numbers of IC50 in the red bar chart are the low responses based on neutralizing antibodies. This means that previous infections do NOT provide protection against Omicron with neutralizing antibodies.

Now look at Panel H. These are people who were infected and vaccinated. Check out the last bar (the red one with B.1.1.529). The neutralizing antibodies were much higher - which means more protection.

Moral of the study - Previous infections are not protective against Omicron. Vaccines are. We see this play out in real-time in South Africa where previously infected people are 3 to 8 times more likely to be reinfected than we saw with Delta. Please get a vaccine. Don’t rely on natural immunity to protect against Omicron.

The main takeaway is simple. We have to Omicron seriously. Coupled with very high daily cases, COVID fatigue, and the holidays, please pull back even more than you are. Mask up. Get those boosters and remember you need 2 weeks for those to take full effect. Do rapid testing if you’re doing any type of gathering.

For you clergy/church peeps, here’s specific guidance on church services during this surge.

And, take care of yourself. If you need to pull back from social media or gatherings or certain friends on certain news sites or fill-in-the-blank, that’s ok. We have been in this for a long time and we are going into another wave. So, pull back even more. Reach out to friends or a counselor if you need it. It’s ok to not be ok. For you healthcare workers, please know there are thousands of us doing our part to help you in your jobs. Thank you for all you’re doing.

Now, let’s breathe today when we can and remember what we can and can’t control. Masks and vaccines+boosters and distancing continue to be strong defenses. Solidarity, friends.

-FNE

Friendly Neighbor Epidemiologist

The winter surge and Omicron