Friday, January 28, 2022

Is Omicron Really “Milder”?

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We’ve miscalculated the severity of Covid-19.

As the number of cases of Covid-19 in the United States reaches new highs, many people are hoping that the omicron variety, while contagious, will be less severe than the delta variant that came before it. Surviving omicron may confer some immunity against other versions, according to certain health care specialists. It’s a glimmer of hope in an already gloomy situation.

The problem is that it’s too early to tell how serious omicron is, and discussing particular symptoms isn’t necessarily the most effective approach to discuss severity. By ignoring preventative measures and putting the economy first, even if it means sending people back to work and school with active Covid infections, policymakers betting on the virus’s mildness risk upending the healthcare system as we know it—and allowing more death and disability to spread across the country.

At this point, we have more questions than answers about the omicron variation, which was only discovered six weeks ago: What does it indicate for future varieties, and how mild is it really? Does it mean we’re nearing the end of this phase of the pandemic?

The evidence supporting the “omicron is gentler” concept is as follows: The variation does not damage the lungs as violently as delta did, according to research with mice and hamsters. “So far, the omicron form seems to be less severe than the delta,” said Dr Anthony Fauci, the White House’s chief medical adviser, on January 5. However, he noted that the judgement is based on “several sources of now-preliminary data,” and that “more conclusive assessment of severity with longer-term follow-up” is needed.

Dr. David Martinez, a viral immunologist at the University of North Carolina at Chapel Hill, told me that it’s plausible that omicron is milder in people. “There are a lot of indications but I think we need to consider the intricacies and limitations of model systems, for example.” People aren’t mice or hamsters, after all, and animals are a poor proxy for how a virus moves through the human body.

But it’s also likely that the virus is picking up changes that make it more efficient in humans than in animals as it rips through millions of individuals, making predictions based on animal studies much riskier. “Will animal studies correctly replicate what happened in humans as the virus develops?” Martinez is perplexed. “If the animal data appears to be different, then you must consider why it appears to be different.”

Until now, other countries’ omicron experiences have been reassuring. For example, waves in South Africa and Europe began to recede almost as quickly as they surged, with significantly lower hospitalisation rates than earlier surges. However, the United States is exhibiting signals of substantially worse consequences, with hospitalizations rapidly increasing in response to rising cases—possibly due to an older, sicker population with poorer immunity. Vaccination also can’t completely compensate for flaws.

For someone who hasn’t been vaccinated or hasn’t seen Covid before, omicron might be just as devastating as the virus that wreaked havoc in 2020.

Severity is sometimes a matter of perspective. Omicron may be less severe than delta, but new research suggests that delta was more severe than prior variations. For someone who hasn’t been vaccinated or hasn’t seen Covid before, omicron might be just as devastating as the virus that wreaked havoc in 2020. “While omicron appears to be less severe than delta, especially in individuals who have been vaccinated, this does not mean it should be classified as mild,'” World Health Organization Director-General Tedros Adhanom Ghebreyesus warned on Thursday.

Even if it’s a gentler strain, the virus’s strong transmissibility negates any advantages. “If you do this every day, diseases can become enormous at times,” Martinez explained. “What will happen to our already-stressed health-care system, which appears to be dangling on a thread?”

Hospitalizations and fatalities are still the strongest indicators of severity among people, but they’re becoming increasingly difficult to track. Dr Rae Walker, associate professor and PhD programme director at the Elaine Marieb College of Nursing at the University of Massachusetts Amherst, told me, “We currently have a health care system that is actively crumbling, if not already collapsed, in many locations.” “Fumes power almost every health-care system.”

“You know how people always say that hospitals are a lagging sign of the illness severity?” Walker remarked. “We’ve seen all these case counts spike, but what we really need to look for is the number of hospitalizations to get a sense of how serious this is,” she says. But the reality is that many of these graphs have already reached their limit.” The local hospitals in Walker are already 20 to 30% full.

It’s not simply a paucity of hospital beds or ventilators; it’s also a lack of enough staff to care for everyone as cases and hospitalizations flood the country. Hospitals are also experiencing supply chain issues, with masks and other protective gear running low. “One hospital’s supplies of saline treatments had run out. The most fundamental tool required for I.V. therapy is saline flushes. “That’s like the most basic technology we have in health care,” Walker exclaimed, puzzled. “It’s a combination of human expertise and labourers, as well as the actual supplies.” And both of those substances are at such crucial low levels right now that I believe we would be extremely stressed even if we didn’t have omicron.”

Hospitals throughout the country are advising people not to visit the emergency room unless it is a serious emergency, since patients may have to wait hours or days to be seen. Patients are sent hundreds of kilometres away and ambulances are diverted due to overcrowding at hospitals.

This may cause omicron’s hospitalisation rates to fluctuate: “They can’t even count the number of admissions because those people can’t even get to the E.D.’s steps,” Walker explained. “What I’m worried about is that, as people are waiting to see if this idea of a further surge in hospitalizations or ICU admissions comes out, those figures may not play out because we’ve already reached the top of the graph,” they clarified, indicating that hospital capacity has been exceeded.

In the early stages of a pandemic, depending on hospitalisation statistics is akin to relying on test results: Due to a severe lack of capacity, the picture is fragmentary.

Simultaneously, the notion of what constitutes a case deserving of hospitalisation is evolving, according to Walker. When hospitals are overburdened, the sickest patients are given priority, which means that other patients who would normally be admitted quickly may have to wait days in the emergency department—a practise known as “boarding” that can put additional strain on capacity and negatively impact patient outcomes.

All of this adds up to a perplexing conclusion. Using hospitalisation data is similar to using test data early in a pandemic: it provides an incomplete picture because of a severe lack of capability. “Every time I see the word mild,’ it makes me sad because it feels like it’s part of a narrative created to convince us to keep our heads down and keep going,” Walker said.

Even if the diagnosis isn’t Covid, the pandemic is putting additional strain on the system: “We’re now getting to the point where there has been so much deferred care for so long, and so little capacity to make up for it,” Walker said. “We’re going to see a wave of acute health problem exacerbations that may require a higher level of care, such as hospitalisation.”

The idea that omicron is “mild” could be concealing a more concerning phenomenon: that omicron is harming the body in a different, subtler way—one that could nonetheless end in very serious consequences. “It’s making folks terribly sick in a different way,” tweeted Dr Craig Spencer, a New York emergency physician, with omicron appearing to “topple a delicate balance of an underlying condition.” Covid, in other words, could be putting vulnerable patients with chronic illnesses like heart disease or diabetes in danger, according to Dr Michael Warner, a Toronto physician. As a result, even if Covid isn’t the primary diagnosis, many hospitalizations may still be caused by it.

Long Covid, which can emerge following moderate or even asymptomatic occurrences of Covid, must be included in any consideration of disease severity. Long Covid is still being researched for causes and cures. “Even if it turns out to be a milder condition, which would be nice,” Martinez said, “We still have to be cautious.” “We can’t just let it run amok or burn through the people because it might still have catastrophic consequences.”

In the end, omicron could still be a severe hazard, and not just to the unvaccinated. It’s risky for vaccinated persons who are immune-compromised, over 65, or simply unlucky enough to suffer significant breakthrough infections. It’s also harmful to anyone who might need to go to the hospital in the coming month.

One thing is certain: Omicron will not be the final variation. It’s impossible to predict whether future viral versions will be milder or more severe. Omicron was unexpected, as it sprang from a strain of the virus that was widespread in summer 2020. It’s possible that the following one will develop from omicron, getting more or less severe, or it could appear out of nowhere. But, with millions of cases being filed every week in the United States alone, each with millions of potential outcomes, all we know is that there will be another, Martinez added. “We don’t know how different a future variant will be.”

Looking ahead can be a depressing exercise, especially when there is so much we don’t know. “However, the pandemic will come to an end at some point.” “This isn’t going to last forever, even if it feels like it,” Martinez informed me. “Once our health-care system isn’t as strained as it is right now,” he continued, the turning moment would most likely occur. The future will look brighter when hospitalizations begin to fall again, when effective therapies become more widely available, and when health workers can take a breather.

However, it is up to us to make it happen. Counting for a milder variant to emerge without taking any other necessary precautions to prepare and respond would be asking the virus that got us into this mess to get us out of it.

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