This is why we need to take Omicron seriously - and guidance for the holidays

"Let it rip" is not a strategy

Hi everyone,

I really wish I could have written this post as a nice holiday reflection. But, it will be more of a warning of what is about to come to the US very quickly. To see what I mean by “quickly”, let’s look at what is happening in the UK - for the past 20 months, the UK has always been 2-3 weeks ahead of us like clockwork and with strikingly similar experiences in the US.

Daily cases in the UK are the highest they have EVER been in the entire pandemic. And, do not look like they are slowing down.

Why is this? The reproductive rate (so, the doubling time of infections) is a whopping 3-4. That’s more than double than the other variants. To put this into context, infections in the US during Delta double every weekish. So, it was an increase but a slower increase. This Omicron variant is double that of Delta! So, the increase is steeper. To think about the holidays, Christmas is 7 days away - that means Omicron will have 2 doubling cycles in the US. From an epidemiologic/community perspective, that’s a lot! In summary, this thing is about to take all of us by surprise.

Let’s go back to the UK to look at a visual of that reproductive rate compared to Delta. Do you see how the doubling time is so much more with Omicron and how that translates to cases?

Is Omicron milder? I’m not convinced of that yet at all!!! Why? Hospitalizations always lag a few weeks. If you look at the UK again, hospitalizations are increasing. Now that could be a result of the explosion of cases - so, proportionally we would expect an increase in hospitalizations too. To me, it doesn’t matter if it’s milder. What does matter is LOTS of people about to get sick - and, those with weakened immune systems and those who haven’t gotten their boosters will be greatly affected.

The “let it rip” mentality is short-sighted and selfish. I’ve heard, like you probably have too, that it’s a good thing that Omicron might be milder. From an individual perspective, maybe. From a community perspective, not at all. Why? The huge increase in cases means we will see PROPORTIONAL increases in already overwhelmed hospitalizations and deaths among those with weakened immune systems. Lots of people getting sick at the same time even with mild infections means those people stayed out of the hospital but could still get very sick. And what about long-COVID? We don’t know yet. The best article on this is from the incredible writer, Ed Yong. I would encourage you to go read his in-depth assessment on why ‘let it rip’ is a terrible strategy and excuse with Omicron.

Do our current vaccines work? Yes and kindof. Only with a booster! I wrote about that here in detail. But the take home point is that vaccines without a booster are only 30-40% effective against symptomatic infection. Yuk! That’s a huge reduction than what we saw with Delta. The good news is boosters will increase that to 70ish%. The bad news is many, many people have still not gotten their boosters. If you haven’t, please go get that. And, remember it takes 2 weeks for it to take into effect. So, you can’t get your booster Christmas Eve and then feel protected to get COVID or spread it if infected on Christmas Day at your family gathering. YOU NEED MORE TIME TO BUILD IMMUNITY.

What does that mean for the holidays? I wish I could speak to everyone’s situation here. But they are all so different and perspective. Things to keep in mind:

1. Will everyone be vaccinated and boosted? If not, you might consider going virtual this year. With Omicron being SO contagious and doubling in the US (and our awful testing strategies and sequencing capabilities), it’s pretty risky to do indoor activities right now. And cases continue to increase exponentially. 30-40% each week since Thanksgiving. That means there’s a lot of virus circulating nearly everywhere in the country right now. This, unfortunately, means we need to be extra cautious.

   

2. Do you have high-risk family members? With the reduction in vaccine efficacy, we will see more breakthrough infections occur. Will those be milder or have long-COVID? We don’t know yet. So, take into account your high-risk family members in terms of age, co-morbidities, immune systems, etc - especially if you will be around people who have not been boosted.

3. I’ve written about religious services here in detail. I would STRONGLY recommend requiring masks and any Christmas eve/day services and any church gatherings. By Christmas, remember we will have 2 doubling cycles for Omicron. So gatherings indoors with singing will be hotbed for virus transmission - especially in areas with low vaccination rates. Please take caution. If your church does not require masking at those services, I would encourage you to stay home and go virtual. Find some pretty candles and make that a special family time. We are not risking it this year since we are seeing our family the next day.

4. Lastly, I, like many of you, am frustrated that we are here again at the holidays. Ugh, friends. So, pull back as much as you can to enjoy what you can and control what you can. I do hope you all have a holiday that is full of times of peace and joy even if it looks different. And, a huge thank you to you healthcare workers who are weary and tired.

Take care, neighbors.

-FNE