Bless you! I've been donating to MSF monthly for years plus frequent one-time donations for special needs. Was gonna add match-able dollars, but since your and James Gleick's have already been exceeded, it seems redundant to do so. Again, all blessings to you for your compassion!
The material attempting to separate the intrinsic properties of a particular variant from the context (always shifting) is especially valuable to me. I also appreciate the fundraising Doctors Without Borders. Few things are as frustrating as the tendency for those in the US to see only within our borders. It is especially concerning regarding Yemen where bombs I paid for are doing so much damage. Thank you.
In brief: "Covid denialism, like AIDS denialism, reveals that many of doctors’ assumptions are incorrect. We overestimate the value of reasoning and facts. We believe in our clinical authority. We expect patients to behave rationally. But we all develop our beliefs through interactions with other people — what you believe depends on whom you trust."
Thanks for sharing this. Thinking about a lot about the reasons behind anti-vax sentiment and it was nice to hear from a doctor what I thought are the core reasons behind it.
Thank you for the link to that article. Several years ago, in a long, meandering discussion with an outstanding doctor I know, we concluded that the institution of medicine has (partly intentionally, partly accidentally) oversold itself to society. It is no surprise that in the overlap between scientifically efficacious healing and miracle healing, there is likely trouble.
Zeynep, please publish some statistics on the current situation (Delta plus Omicron) and the statistical fate of us vaccinated or vaccinated + boosted elderly. and very elderly. You see a lot more data than I do, and I have quit spending 2-4 hours a day studying this issue because, life. Thank you very much.
That Civic is probably good for another 50,000 -100,000 miles.
As time goes on in Omicron hotspots, I wonder if we're using the wrong endpoints when talking about intrinsic severity. Outcomes like 'hospitalisation' are surely partly based on doctors' expectations of disease course and prognosis; if a lot of people are being hospitalised with Omicron but aren't even on cannula oxygen, I sort of wonder why they're being admitted in the first place.
In the Imperial study, Omicron cases had 25% lower hospitalisation than Delta, but 41% lower overnight admissions. How would it look if we measured Length of Stay, say, which is the big one for bed capacity planning. To be fair, the IC authors note this limitation:
_"It is quite possible that larger reductions in hospitalisation risk for Omicron vs Delta may be estimated for the endpoints of ICU admission and death, given that remaining immune protection against more severe outcomes of infection are expected to be much higher than those against milder endpoints."_
This isn't to dismiss the real concerns here and of course the impact of Omicron on CoV-naive populations, but the longer this wave continues, the longer it seems like if the health systems in highly-seropositive countries were going to collapse under the strain, we'd be seeing it already.
Yes, there is variability in types and severity, but really, is there any better metric to measure impact? We know that 'cases' vastly undercount, by at least 10x IMO, and can be massaged through greater or lesser testing. Example, Tompkins county, NY--home to Ithica--has both the highest % of vaxxinated adults, and the highest recent number of positive cases/100k in NY! Deaths are a stable measurement, you would think, but they have a lag in reporting, and can also be politically manipulated (my cousin in TX is still fighting to have her late husband's Covid death be labeled as such, to un-lock her benefits, and also bc, come on!
Still, I will say this again, that while hospital total capacity is important for hospitals and states for making decisions, daily new hospitalizations would be a much better, gold-standard indicator for epidemic severity. Wish more services used that figure.
I think there ARE better metrics for impact, for example "length of stay in hospital". There's been some anecdotal evidence of a massive difference in LoS between Omicron and Delta cases that do present at hospitals, and I'd be very interested to see if that's backed up by real data. But it's hard because we're still early in the Omicron wave so the signals are weak.
If (and I'm making these numbers up) 100 people are turning up at hospital every day but 50 go home that night, 40 go home the next day and 10 stay 2+ days, that's a VERY different picture in terms of health service load than if 30 go home, 70 go home the next day and 30 stay 2+ days.
The question I have over daily hospitalisations, though, is "Why are these people being hospitalised for Covid?".
Do they have 'severe Covid' by WHO definitions with low blood oxygen? In Israel, the Health Ministry treats new severe cases per day, rather than raw new admissions, as the relevant metric.
Are some admitted because of their perceived RISK of developing severe Covid based on doctors' experience over the course of the pandemic? If so, then it's *possible*, if Omicron has reduced severity and a different disease course, that those risk models are out of date for Omicron and we're seeing some over-admission of cases that are at lower risk for severe Covid than they look.
All good points, no argument here! Certainly, hospitals cannot control how many people come in through the front door. But they can control how fast they go back out, and who stays, and for how long. So I guess I should modify my notion to 'daily new admissions.'
Reporters, states, and health departments might be making better decisions if they stopped focusing their decisions and public communication on new positives and deaths. They have been very good at reporting the number of open ICU beds--which is super important, for obvious reasons--but are missing the stat that could give them the best real-time indication of trend lines for the pandemic.
How about number of non-covid related surgeries or procedures that have been cancelled? This would capture the severity and urgency of the covid patients and would not count incidental findings of covid for patients who are admitted for other reasons. I think it is more meaningful because it looks at the number of people that have been pushed out of the health care system and are waiting for care, a true social cost of covid itself.
If few people are waiting for surgeries, then one could argue that covid in its own right is not really a social problem, because there is hospital capacity to take care of ill patients.
I like that as it's own standalone metric for second order effect of covid on healthcare. Still thi k we shpuld measure disease pressure. Funny that NYT is fi ally decrying use of positive cases as misleading. Case counting really misses the point in a post-vaccination populace.
I like the recommendation to get a pulse ox! Is there any way to know what brands are most reliable? Are they all fine? I remember having a beast of a time trying figure it out last time I looked into this.
I think anything you buy at a pharmacy should be fine, and I've never heard of a counterfeit one online. They are pretty standard. I think any of the highly-rated ones here should be fine. https://www.amazon.com/pulse-oximeter/s?k=pulse+oximeter
I suspect that an Omicron breakthrough will be the equivalent of an Omicron-specific boost. That, plus vaccine against the original variant should be pretty good protection against any variant that we know about now, since there are a lot of shared mutations. I suspect also that antibodies directed against portions of Spike that don't change will be massively boosted. This is not worth intentional self-infection to get since an Omicron-specific booster should be around in a few months anyway, but with the rapid spread right now, lots of people will simply be unable to avoid breakthrough infections, and hopefully the overwhelming majority will be mild.
Covid spikes cast the long shadow of Long Covid into the future. Perhaps the next time you are looking for content, focus on Long Covid, particularly how children are damaged.
Yes, I would like to know what percent of cases have been long COVID, broken down by demographics if possible, and worst case for Omicron if that can be extrapolated.
This is what keeps us hunkered down. We have three-year-old twins and a two-month-old and we are BEYOND ready to get out of the house and into some indoor activities, but I’m really worried that the risk and severity of long covid is being underestimated and understudied. I have so many questions about it, and feel pessimistic that the data is being collected to answer those questions.
I am so excited! I just talked to an Amazon Customer service agent. When he said he was in Mumbai (I ask because I always want to know,. I told him about the Corbevax, and he said he is getting his vaccination *tomorrow!*
Thanks for the clarification. There was a trial, as noted in the WaPo. What you and I are missing is the detailed results. I agree that we should have this. Probably the best place to keep up to date is Wikipedia or the NYT vaccine tracker. I hoped to have time to track this down myself, but life keeps intervening.
Corbevax is being shared patent-free and it is easier to make and store than the ones we are using here. I have kept up with it because it was developed right here in Houston.
They have been hard to find. Usually I find information only in the press in India. I just saw this article and will search for more later today. Note that the WaPo didn't cite detailed information either.
I am also really interested in seeing the nitty gritty of independent comparative data on omicron health outcomes and severity for seropostive vs unvaccinated people. It feels like the media is glossing over the details.
I have seen some charts, omicron is worse for children than the previous variants. Have you looked into that ? Would you let a 4 year old go to kindergarten ?
Sincerely hoping covid has cycled into the pool of other well-known viruses that plague us year to year. I fear we're approaching a point where vaccinated and well-intentioned people are ready to revolt at more restrictions.
It's such a long time since you wrote "This must be your first" and I have seen precious few references to Jan 6 as an attempted coup. There must be more nuance to what's happening to prevent another, successful, attempt than only the Jan 6 committee investigation. What's the landscape and how likely are we to survive as an actual democracy?
And thanks for your sponsorship of DWB, that's amazing!
Any insight as to whether those infected with O are contagious for a shorter period? I think we're going to see a huge uptick in those who test + and fail to isolate for 10 days (or avoid testing to avoid isolation). The combination of >> transmissibility and potential < severity of O -- plus the CDC lowering isolation days for HCP - could be driving people to decide the costs of isolation don't outweigh the benefit of avoiding infecting others.
What are your thoughts on boosters for healthy, young, vaccinated individuals? I have both shots of Pfizer plus a breakthrough infection from September and I'm trying to determine whether or not it makes sense to get a booster.
I’m 32, pretty healthy, and got vaccinated in April. I got my booster in October, just a few days past six months after getting my second dose. My reasoning — and my GP supported it — was to minimize the risks of a breakthrough infection that I might pass on to my family. Our three-year-old twins are too young to be vaccinated and our third child was born the day I got my booster (she came two weeks early — surprise!). So, with a wife recovering from a c-section, twin toddlers, and a newborn, I wanted to do everything I could to stay healthy for them.
Morally, I know that me getting a booster is less important for public health than getting those vaccines to countries without enough access to them. But I also know that regardless of whether I got it or not, that dose was not going to magically be made available to someone else who needs it in another country. So, rather than guilt myself for the policy failures of my government, I did what I could to protect myself and my family.
I’m not a doctor or expert by any means, but to my knowledge there really isn’t any known downsides to boosting. Rare side effects like myocarditis are much likely to occur from an actual covid infection than from vaccination, so it was a pretty simple decision for me.
Still super-rare—and what ER doctors call a “mild” case still can really suck—but the booster vaccines may actually have higher myocarditis risk than a SARS-COV-2 infection itself. All the usual disclaimers about just one study, etc. of course apply.
I’m 38, male, and happily got a booster. If I had an eighteen-year-old son, though, I’d be on the fence. For young men, one shot or two spaced six months apart are looking increasingly like the two ideal spots on the Pareto frontier of COVID risk vs. side-effect risk.
Bless you! I've been donating to MSF monthly for years plus frequent one-time donations for special needs. Was gonna add match-able dollars, but since your and James Gleick's have already been exceeded, it seems redundant to do so. Again, all blessings to you for your compassion!
Thank you!
The material attempting to separate the intrinsic properties of a particular variant from the context (always shifting) is especially valuable to me. I also appreciate the fundraising Doctors Without Borders. Few things are as frustrating as the tendency for those in the US to see only within our borders. It is especially concerning regarding Yemen where bombs I paid for are doing so much damage. Thank you.
Thank you for the kind words!
Dear Zeynep...you are one of the few bright lights out there...I came across this article today, and thought of you: https://www.nejm.org/doi/full/10.1056/NEJMp2115832?query=WB
In brief: "Covid denialism, like AIDS denialism, reveals that many of doctors’ assumptions are incorrect. We overestimate the value of reasoning and facts. We believe in our clinical authority. We expect patients to behave rationally. But we all develop our beliefs through interactions with other people — what you believe depends on whom you trust."
Take care, and stay well.
Thanks for sharing this. Thinking about a lot about the reasons behind anti-vax sentiment and it was nice to hear from a doctor what I thought are the core reasons behind it.
Thank you for the link to that article. Several years ago, in a long, meandering discussion with an outstanding doctor I know, we concluded that the institution of medicine has (partly intentionally, partly accidentally) oversold itself to society. It is no surprise that in the overlap between scientifically efficacious healing and miracle healing, there is likely trouble.
Zeynep, please publish some statistics on the current situation (Delta plus Omicron) and the statistical fate of us vaccinated or vaccinated + boosted elderly. and very elderly. You see a lot more data than I do, and I have quit spending 2-4 hours a day studying this issue because, life. Thank you very much.
That Civic is probably good for another 50,000 -100,000 miles.
As time goes on in Omicron hotspots, I wonder if we're using the wrong endpoints when talking about intrinsic severity. Outcomes like 'hospitalisation' are surely partly based on doctors' expectations of disease course and prognosis; if a lot of people are being hospitalised with Omicron but aren't even on cannula oxygen, I sort of wonder why they're being admitted in the first place.
In the Imperial study, Omicron cases had 25% lower hospitalisation than Delta, but 41% lower overnight admissions. How would it look if we measured Length of Stay, say, which is the big one for bed capacity planning. To be fair, the IC authors note this limitation:
_"It is quite possible that larger reductions in hospitalisation risk for Omicron vs Delta may be estimated for the endpoints of ICU admission and death, given that remaining immune protection against more severe outcomes of infection are expected to be much higher than those against milder endpoints."_
This isn't to dismiss the real concerns here and of course the impact of Omicron on CoV-naive populations, but the longer this wave continues, the longer it seems like if the health systems in highly-seropositive countries were going to collapse under the strain, we'd be seeing it already.
Yes, there is variability in types and severity, but really, is there any better metric to measure impact? We know that 'cases' vastly undercount, by at least 10x IMO, and can be massaged through greater or lesser testing. Example, Tompkins county, NY--home to Ithica--has both the highest % of vaxxinated adults, and the highest recent number of positive cases/100k in NY! Deaths are a stable measurement, you would think, but they have a lag in reporting, and can also be politically manipulated (my cousin in TX is still fighting to have her late husband's Covid death be labeled as such, to un-lock her benefits, and also bc, come on!
Still, I will say this again, that while hospital total capacity is important for hospitals and states for making decisions, daily new hospitalizations would be a much better, gold-standard indicator for epidemic severity. Wish more services used that figure.
I think there ARE better metrics for impact, for example "length of stay in hospital". There's been some anecdotal evidence of a massive difference in LoS between Omicron and Delta cases that do present at hospitals, and I'd be very interested to see if that's backed up by real data. But it's hard because we're still early in the Omicron wave so the signals are weak.
If (and I'm making these numbers up) 100 people are turning up at hospital every day but 50 go home that night, 40 go home the next day and 10 stay 2+ days, that's a VERY different picture in terms of health service load than if 30 go home, 70 go home the next day and 30 stay 2+ days.
The question I have over daily hospitalisations, though, is "Why are these people being hospitalised for Covid?".
Do they have 'severe Covid' by WHO definitions with low blood oxygen? In Israel, the Health Ministry treats new severe cases per day, rather than raw new admissions, as the relevant metric.
Are some admitted because of their perceived RISK of developing severe Covid based on doctors' experience over the course of the pandemic? If so, then it's *possible*, if Omicron has reduced severity and a different disease course, that those risk models are out of date for Omicron and we're seeing some over-admission of cases that are at lower risk for severe Covid than they look.
All good points, no argument here! Certainly, hospitals cannot control how many people come in through the front door. But they can control how fast they go back out, and who stays, and for how long. So I guess I should modify my notion to 'daily new admissions.'
Reporters, states, and health departments might be making better decisions if they stopped focusing their decisions and public communication on new positives and deaths. They have been very good at reporting the number of open ICU beds--which is super important, for obvious reasons--but are missing the stat that could give them the best real-time indication of trend lines for the pandemic.
Thanks for reporting, BTW, keep up the good work!
How about number of non-covid related surgeries or procedures that have been cancelled? This would capture the severity and urgency of the covid patients and would not count incidental findings of covid for patients who are admitted for other reasons. I think it is more meaningful because it looks at the number of people that have been pushed out of the health care system and are waiting for care, a true social cost of covid itself.
If few people are waiting for surgeries, then one could argue that covid in its own right is not really a social problem, because there is hospital capacity to take care of ill patients.
I like that as it's own standalone metric for second order effect of covid on healthcare. Still thi k we shpuld measure disease pressure. Funny that NYT is fi ally decrying use of positive cases as misleading. Case counting really misses the point in a post-vaccination populace.
I like the recommendation to get a pulse ox! Is there any way to know what brands are most reliable? Are they all fine? I remember having a beast of a time trying figure it out last time I looked into this.
I think anything you buy at a pharmacy should be fine, and I've never heard of a counterfeit one online. They are pretty standard. I think any of the highly-rated ones here should be fine. https://www.amazon.com/pulse-oximeter/s?k=pulse+oximeter
Any evidence that breakthrough infection after vaccine adds further super-powers to the immune system?
I suspect that an Omicron breakthrough will be the equivalent of an Omicron-specific boost. That, plus vaccine against the original variant should be pretty good protection against any variant that we know about now, since there are a lot of shared mutations. I suspect also that antibodies directed against portions of Spike that don't change will be massively boosted. This is not worth intentional self-infection to get since an Omicron-specific booster should be around in a few months anyway, but with the rapid spread right now, lots of people will simply be unable to avoid breakthrough infections, and hopefully the overwhelming majority will be mild.
That makes sense. I'm a nurse and so far have avoided infection, but worry my luck may be about to change with omicron.
Covid spikes cast the long shadow of Long Covid into the future. Perhaps the next time you are looking for content, focus on Long Covid, particularly how children are damaged.
Yes, I would like to know what percent of cases have been long COVID, broken down by demographics if possible, and worst case for Omicron if that can be extrapolated.
This is what keeps us hunkered down. We have three-year-old twins and a two-month-old and we are BEYOND ready to get out of the house and into some indoor activities, but I’m really worried that the risk and severity of long covid is being underestimated and understudied. I have so many questions about it, and feel pessimistic that the data is being collected to answer those questions.
I too worry about long COVID.
I am so excited! I just talked to an Amazon Customer service agent. When he said he was in Mumbai (I ask because I always want to know,. I told him about the Corbevax, and he said he is getting his vaccination *tomorrow!*
That is so worrying, given there is no trial data! Yikes. We would never permit this in a wealthy country.
(I hope they get the data released before starting shots!)
Thanks for the clarification. There was a trial, as noted in the WaPo. What you and I are missing is the detailed results. I agree that we should have this. Probably the best place to keep up to date is Wikipedia or the NYT vaccine tracker. I hoped to have time to track this down myself, but life keeps intervening.
I have reported a few times on Corbevax. There is a story out today that it is approved for use in India!https://www.washingtonpost.com/world/2021/12/30/corbevax-texas-childrens-covid-vaccine/
Corbevax is being shared patent-free and it is easier to make and store than the ones we are using here. I have kept up with it because it was developed right here in Houston.
Thank you! Could you clarify something for me? I don't see any trial results. Do you know where these are available?
They have been hard to find. Usually I find information only in the press in India. I just saw this article and will search for more later today. Note that the WaPo didn't cite detailed information either.
I am also really interested in seeing the nitty gritty of independent comparative data on omicron health outcomes and severity for seropostive vs unvaccinated people. It feels like the media is glossing over the details.
I have seen some charts, omicron is worse for children than the previous variants. Have you looked into that ? Would you let a 4 year old go to kindergarten ?
This chart: https://mobile.twitter.com/jburnmurdoch/status/1467270479912357889
Thank you. That chart does indeed get the point across.
Sincerely hoping covid has cycled into the pool of other well-known viruses that plague us year to year. I fear we're approaching a point where vaccinated and well-intentioned people are ready to revolt at more restrictions.
It's such a long time since you wrote "This must be your first" and I have seen precious few references to Jan 6 as an attempted coup. There must be more nuance to what's happening to prevent another, successful, attempt than only the Jan 6 committee investigation. What's the landscape and how likely are we to survive as an actual democracy?
And thanks for your sponsorship of DWB, that's amazing!
Any insight as to whether those infected with O are contagious for a shorter period? I think we're going to see a huge uptick in those who test + and fail to isolate for 10 days (or avoid testing to avoid isolation). The combination of >> transmissibility and potential < severity of O -- plus the CDC lowering isolation days for HCP - could be driving people to decide the costs of isolation don't outweigh the benefit of avoiding infecting others.
What are your thoughts on boosters for healthy, young, vaccinated individuals? I have both shots of Pfizer plus a breakthrough infection from September and I'm trying to determine whether or not it makes sense to get a booster.
I’m 32, pretty healthy, and got vaccinated in April. I got my booster in October, just a few days past six months after getting my second dose. My reasoning — and my GP supported it — was to minimize the risks of a breakthrough infection that I might pass on to my family. Our three-year-old twins are too young to be vaccinated and our third child was born the day I got my booster (she came two weeks early — surprise!). So, with a wife recovering from a c-section, twin toddlers, and a newborn, I wanted to do everything I could to stay healthy for them.
Morally, I know that me getting a booster is less important for public health than getting those vaccines to countries without enough access to them. But I also know that regardless of whether I got it or not, that dose was not going to magically be made available to someone else who needs it in another country. So, rather than guilt myself for the policy failures of my government, I did what I could to protect myself and my family.
Is that the only reason NOT to get a booster?
I’m not a doctor or expert by any means, but to my knowledge there really isn’t any known downsides to boosting. Rare side effects like myocarditis are much likely to occur from an actual covid infection than from vaccination, so it was a pretty simple decision for me.
Interestingly, that might not be true any more. Check out this study: https://vinayprasadmdmph.substack.com/p/uk-now-reports-myocarditis-stratified
Still super-rare—and what ER doctors call a “mild” case still can really suck—but the booster vaccines may actually have higher myocarditis risk than a SARS-COV-2 infection itself. All the usual disclaimers about just one study, etc. of course apply.
I’m 38, male, and happily got a booster. If I had an eighteen-year-old son, though, I’d be on the fence. For young men, one shot or two spaced six months apart are looking increasingly like the two ideal spots on the Pareto frontier of COVID risk vs. side-effect risk.