This week we take on the Omicron variant and dive into the latest data that has emerged.
And now (drumroll), over the last few days that number has been ~4.6%! (Figure; the 7-day avg, seen on the chart [2.98%], is lagging since the rate is climbing so steeply.) This implies that the chance of an asymptomatic person in SF having Covid is now nearly 1 in 20.(12/25) pic.twitter.com/W4iRwC9zpR
— Bob Wachter (@Bob_Wachter) December 24, 2021
While data continues to emerge as we learn more, there are some compelling perspectives that suggest some good news on Omicron that imply it is less virulent than previous variants. We discuss the reasons why and what other confounding factors or explanations might exist and review the implications going forward.
And based on Fred’s hairspray experience we discuss masks effectiveness and choices
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick, I’m the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with Accountable Health here working with employers, payers and others on their population health improvement programs. So Nick, it’s been Omicron, omicron, omicron all the time. It’s, it’s pretty much nonstop. But understand we’re beginning to get some data about that specific variant of the virus. What are we seeing?
Nick van Terheyden
Yeah, so we definitely talked about this. And I think I’ve certainly been one of the folks that has said, Hold on, let’s see the data. We had data emerged from South Africa. Obviously, there was some confounding factors there that you go, Well, you can’t just lift up the data and say, Well, you know, that’s what would happen in the United States, although everything continues to progress in the same way in the South African data collections, that suggests that Omicron is less virulent causes less symptoms, you know, seems to be milder, let’s say. But here’s what’s interesting. I think we’re now several weeks in so if we were going to see data, we would have seen it now. And there’s still people saying, well, let’s wait for the data. And I’m I, I like to wait for the data. But at this point, I feel like I want to call for the same experience in the United States, as we’ve seen in South Africa. And it was specifically Bob walked out of California that looked at the San Francisco data. And he did something very elegant, that I think is worth exploring a little bit. So he’s been looking at a specific number, that was the measure of COVID positivity in patients that came into hospitals, because every patient that was coming in for anything had to be tested, because then you needed to know to be able to treat them, isolate them all of those things. And that rate, three, Delta was about naught point 2%, around December of this year at the beginning, so post Delta, but pre this Omicron surge was about naught point nine, and then went to 4.6, or something. And that tells us that there is a much higher incidence, because we’re positively testing that group. So it’s not just people presenting to be tested, they’re coming in for other reasons. It’s as random as you can get, you can’t get to perfect randomness. There’s probably some confounding selection criteria and all those things. So it’s imperfect in all sorts of ways. But it’s still pretty good. And yet we see flat hospitalization, so we’re not seeing the surge that we would have seen based on that increase rate. So that suggests that we are seeing lower impact of this disease in people, which is good news, that means that we’re having less of a clinical impact.
Fred Goldstein
And it appears to Nick, I guess, a couple of points, one, that’s due to the vaccines, apparently. So these are people who are showing up who are asymptomatic and getting hospitalized, which also raises an interesting point, if you think about that population, and you mentioned the idea that it may not be random, it probably not. But those are individuals who actually have comorbidities or other symptoms that are getting hospitalized. So perhaps they would have actually been a higher risk population than the not risk. And obviously, that’s a early conjecture. But clearly something to think about, it might not be a lower risk population in the sense. So it may be slightly better than you would think,
Nick van Terheyden
you know, that’s what I love about statistics, it’s, it’s very hard to see all of those potential confounding factors, you know, causality versus correlation. And there you are coming up with another point that, you know, just hadn’t occurred to me, you’re right, higher potential comorbid conditions coming in for treatment, and yet still not seeing that increased death rates. So that’s another positive. But I’m sure there are reasons to sort of suspect the data at least a little bit. But at this point, I’m feeling like it’s less virulent, it’s causing less disease, as you say, in the vaccinated the unvaccinated, and specifically children in this case, who have a specific problem in they were late to the party of vaccination, or at least available, I’m sure there’s still some that are unvaccinated. And also, that means they’re delayed in boosting because we want to spread out the boosters accordingly per the schedule. So they’re suffering increased rates because they don’t have the same level of protection from the vaccination.
Fred Goldstein
So obviously, as you look at this, some people could look at this and say to themselves, well, omicron is less variants of the letter rip, but the improvement is really potentially one it’s less very number two, because the vaccines are effective, particularly when you add that booster. So this isn’t something that you Say, we don’t need to worry anymore, but obviously continue to push vaccinations and boosters for people. Right?
Nick van Terheyden
Yeah, let’s be clear. This is not Oh, okay. No, that’s cool. And, you know, what’s important here is that it’s the holistic approach. It’s all the things that contribute to this and everything that we learn, we’re still messing some things up. I think, you know, if you follow me, and you see what I post about, I think we’re still making some mistakes in this process. Testing is one of them the availability of testing, free testing, importantly, and at for me, downstream negative consequences for testing and then saying, I have to take sick time and you know, the whole issue that predates COVID. But all of the things that contribute, to give us this overall protection and better outcome, but the underlying point here that’s important to make is a small percent of a very large number is still a very large number that can overwhelm our healthcare system. So if you have lots of people that are potentially more likely to be exposed and aren’t vaccinated, which you know, rates vary, then you’ve got a problem that’s going to present itself to our healthcare system and create some significant challenges for our healthcare workers who’ve been working their butts off for the last two plus years. And they can’t keep going like this.
Fred Goldstein
Absolutely. And one of the other things I think is important to make, we talked about the importance of vaccines, and obviously critical in this data is we’re seeing it, but also this concept of wearing a very good mask in in indoor settings or others. I mean, there have been some pretty substantial outbreaks. I mean, for the first time in my group of people that I know, I’m beginning to see individuals show up that get infected. And so obviously, omicron is much more contagious in terms of its ability to spread around and, and get to people. And so this idea of wearing a higher quality mask indoors, I think it’s critical.
Nick van Terheyden
Yeah, and I’ll just say that counterpoint to that one that I’ve certainly positioned behind any mask is better than no mask is my my key point here. You’re right. But wearing an N 95 as a whole thing, and people putting them on and just having them you know, like, chin straps, still not effective, right. And they’re harder to wear. So if you’ve got a choice between wearing a cloth mask on wearing an N 95 as a chin strap, I would say still wear the cloth mask because it’s giving you better results than not wearing anything, essentially. Yeah, we’ll
Fred Goldstein
see. Interestingly enough, I was wearing a KN 95 Last night getting my haircut. And when I went into the place, it was great. And I took it off for a second and suddenly I could smell the hairspray. Which I couldn’t smell with the mask on. Which was fascinating showed me the fit was pretty good there. So I felt the whole a whole lot better. So once again, Nick and
Nick van Terheyden
Fred, we just got to a point out I did not know you use hairspray. This is interesting. Oh,
Fred Goldstein
that was it for me. But thank you very much. actually did put something in my hair I believe. Great week next week, we’re gonna discuss hairspray and masks. Please join us. Red Gaussian with Accountable Health. Thanks again. Nick. If you’d like more information, please go to Accountable Health llc.com
Nick van Terheyden
I’m wishing everybody a Happy New Year. This is Dr. Nick on the incrementalist half. Wishing you happy new year better business better health.
