That is a problem then certainly. My back-of-the-fag-packet calculation suggest an unvaccinated over 50’s population of something north of 30 million and an unboosted population of 60+ million.
Even a slightly milder omicron is going to cause serious fallout when the numbers are that big.
Dec 3: 306
Dec 11: 485
Dec 12: 586
Dec 13: 804
Dec 14: 1360
Dec 15: 1742 (Exceeded the previous highest amount of cases)
Dec 16: 2213 (192 cases admitted to hospital, 26 in ICU)
Dec 17: 2482 (215 cases admitted to hospital, 24 in ICU)
Dec 18: 2566 (206 cases admitted to hospital, 26 in ICU)
Dec 19: 2501 (227 cases admitted to hospital, 28 in ICU)
Dec 20: 2482 (261 cases admitted to hospital, 33 in ICU)
Dec 21: 3033 (284 cases admitted to hospital, 39 in ICU)
Dec 22: 3763 (302 cases admitted to hospital, 40 in ICU)
Dec 23: 5715 (347 cases admitted to hospital, 45 in ICU)
Jan 4th: 23,131 cases, 2 deaths (1,344 cases admitted to hospital, 105 in ICU)
Jan 5th: 35,054 cases, 8 deaths (1491 cases admitted to hospital, 119 in ICU)
Jan 6th: 34,994 cases, 6 deaths (1609 in hospital, 131 in ICU)
Jan 7th: 38,625 cases, 11 deaths (1738 in hospital, 134 in ICU)
Jan 8th: 45,098 cases, 9 deaths (1795 in hospital, 145 in iCU)
Today’s Update.
Jan 9th: 30,062 cases, 16 deaths (1927 in hospital, 151 in ICU)
The lower case numbers can possibly be attributed to several things: yesterday was a Saturday and testing tends to be lower, many testing stations are closed, queues are long. And the number doesn’t include rapid tests: NSW doesn’t even have a system to log and report them yet (they hope to launch one next week. Queensland, which launched its recording system this week, saw its numbers surge dramatically when they launched its online system yesterday.)
Some other numbers from the NSW Citizen Covid Dashboard:
5,218 Healthcare workers in isolation
13,784 patients in “Hospital at Home”
253,998 “low risk” cases in self-management
Just talked to my mom, who’s in another state. She and a friend drove from pharmacy to pharmacy looking for tests for the friend’s daughter’s family for four. The two adults in that family already tested positive, but the kids are sick. And there are no tests in sight. So there are now two people who have been confirmed with COVID that haven’t been reported to the state, and two kids with presumed COVID that haven’t been and can’t be tested at all.
Furthermore, mom reported that our relatives are in the same situation. Whole family is sick, only some are tested, so the others are obviously also positive but have no tests.
For now, the numbers mean nothing in at least three US states. And that’s just what I personally, anecdotally know about.
The Australia numbers are interesting as they seem to mirror what is happening elsewhere in the world as omicron moves through vaccinated populations.
Very rapid expansion (even with high rates of vaccination) but nowhere near the death rates that much smaller case numbers of other variants were causing previously.
The initial drop in cases seen for one day is not necessarily significant but if the omicron pattern is maintained then at some point it should follow a steep peak as well as a steep decline.
What isn’t known yet is to what degree/or indeed if, large death numbers will lag hospitalisations in same way they did for other strains.
Covid should be treated as an endemic virus similar to flu, and ministers should end mass-vaccination after the booster campaign, the former chairman of the UK’s vaccine taskforce has said.
Dix was instrumental in helping pharmaceutical firms create the Covid vaccines that have transformed the risk to most people. He said he supported the current booster campaign, but a “new targeted strategy” was needed to get the UK to a position of “managing Covid”. He added: “We should consider when we stop testing and let individuals isolate when they are not well and return to work when they feel ready, in the same way we do in a bad influenza season.”
He made a very relevant point about understanding which vaccines/regimes promote the best cellular response. That, rather than antibodies alone, gives the longest lasting protection against severe disease and against multiple variants.
That is the sort of data that only comes with time and the focus in the early days has understandably been on antibody protection against infection but it’ll be very interesting to so the output of that.
Testing cellular immunity is more expensive, and takes more time, but it’s being done. This study, for instance:
Cheers for the link, A small and limited study it may be but you can already see the difference in antibody v cellular over that 8 month period. In some cases the cellular response is increasing over time, not sure what is going on there.
The limited nature of that study is that it only looks at three vaccines, with a small cohort and (as far as I can tell) no different vaccination regimes (i.e. times between doses, boosters etc.).
It’ll be fascinating to watch the picture develop for this.
Here’s another study, also small, out of the same lab. It’s interesting because it includes omicron
It found almost no neutralizing antibodies to Omicron after 8 months, but a robust cellular immune response in most participants. That’s consistent with immunized people being able to catch and transmit omicron, but (mostly) not getting seriously ill.
The three vaccines in the first study are all the vaccines approved in the US, so it’s fairly complete (but very small) for a US study. While of course some people delayed getting shots for various reasons, there was only one timing of initial doses approved in the US, so any studies looking at different schedules of dosing is going to have to be done somewhere else.
The second one (linked in this post) only looked at Pfizer and J&J. The principal investigator of that lab is one of the developers of the j&j vaccine, so he has an interest in it.
As a starting point that’s good news. And it is also consistent with what’s being seen in the real world
yes, it’s always nice when the theory matches what people are seeing in real life. But it does suggest that some of the observed “omicron is milder” stuff is due to a large fraction of the population having prior exposure to covid, either via vaccines or a previous infection.
Also “mild” means “not hospitalized “. It can still be nasty and have long term side effects.
There’s a doctor in Boston who has been posting publicly (I see her posts shared on FB from friends) about COVID since the beginning. She calls herself “Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid” and specifically says her content is sharable, so I want to share her most recent post in it’s entirety, which includes comments from doctors, nurses and hospital admins across Boston. I apologize for the long post, but it really gives you a sense of how overwhelmed the healthcare system is right now. And this is from Boston, arguably the healthcare capital of the US.
-11,000 cases/day in June in the US.
-650,000 cases yesterday (plus a gabillion unreported at-home tests).
Things are unbelievably terrible out there. Forget anything you’ve heard about Omicron being “mild.” It is HORRIFIC how it is ravaging our society and our hospitals and our health care workers. Please do everything you can to not get Omicron this month.
Get boosted. (Get vaccinated!) Wear a good mask everywhere. Hunker down. Don’t congregate inside with unmasked people. Don’t eat inside with strangers. Minimize travel. Do what you can to not get hurt or sick or quarantine-stranded.
Our hospital systems are beyond stressed: the ER’s hallways are full of patients, the ICUs are full up, the Urgent Cares have lines around the block, the PCPs are getting pounded, the pediatricians have exploding clinics.
In addition, if you get seriously ill right now, there are essentially no drugs to help you out. They simply haven’t been manufactured and distributed in bulk yet; they do not exist. There are almost no monoclonal antibodies available, and the antivirals like Paxlovid will not be readily available until February or March. There are no real out-patient treatments except Tylenol. Please do everything you can to not get Omicron this month.
Here’s some perspective from the trenches:
Quotes from Massachusetts friends and colleagues
—Emergency Room doc: “It is horrendous. I can’t even get to the bottom of how horrendous it is here. The rooms, hallways, waiting room are all filled with COVID patients. Patients sit out in the waiting room for hours just waiting to be evaluated because there are not enough nurses. There are no beds in the hospital. Covid positive psych patients might actually stay the entire five quarantine days in the Emergency Department. Patients who are homeless have nowhere to go, no shelters, no hotels, no hospital beds. Some sit in the waiting room. Some go out into the cold. Some get lucky and stay in our hallways. We are a ship on an ocean of chaos and disaster with no lifeboats, no land in sight, no coast guard. That is how it feels.”
—Emergency Room Doc (different ER): “My last shift in the ER we started with eight nurses instead of fourteen. Two nurses cried while they were working and one actually walked out and quit. We also had no secretary. So I had to answer the phone, draw my own bloods, transport patients. I have patients with no nurses for their entire visit, including one patient who had had a stroke. I found a patient who sat in their feces in the hallway for four hours. On top of that, I come in day after day and I’m surrounded by the same patients because the hospital is full to the brink and nobody is getting beds. We have 40 beds in our ER that are currently holding 50 patients waiting for medicine hospital beds and 20 patients waiting for psych beds. It’s a literal war zone. I cry after every shift. We are beyond drowning, we have drowned. The house of cards has collapsed.”
—Hospitalist: “COVID admissions are through the roof. No ICU beds so only patients on ventilators or drips are being put in the unit. Patients still seem surprised by how sick they are. COVID+ family members asking why they aren’t allowed to visit. Then I open social media and see anti-vax and anti-mask posts in our local town groups. It’s emotionally exhausting.”
— Hospitalist: “30-40% of my admissions have COVID and the unvaccinated can get very sick. I sent two patients to the ICU, one of whom was only 30. Many staff out sick, being told they have to return after 5 days and mask (you do not want to be in the hospital unless you absolutely have to since your doctor or nurse may be recovering from COVID while they care for you). Our whole hospital only got four doses of the monoclonal Sotrovimab this week and two are already used up; no idea when we’ll get more from the state. The National Guard has come here to help but the ER may have to close for lack of staff……On the personal side, I just have to say it has been really hard. Like “question why you went into medicine” hard. Random outbursts of crying, hard. …I count myself lucky with supportive family and friends, amazing colleagues, I’ve started therapy, etc, but the repeated trauma is exhausting. Normally, I’m a calm, balanced, resilient person, but this has turned me into someone I don’t recognize.”
—Hospitalist (from another hospital): “We had eight National Guardsmen come help out at the hospital. All now have Covid!”
—Pediatric ER: “We usually have two nurse practitioners who follow up on Covid tests. It’s been taking 12 hours a day for them to call back all the patients. Now one is on vacation and the other one is sick. So now the docs are trying to do this on top of working in the ER. Every patient is “shocked” to hear they or their child has COVID.”
—Neonatologist: “The sheer number of covid positive laboring women this week is insane - thankfully so far most are asymptomatic or mildly symptomatic.”
— Family medicine: “I was on call over NYE weekend. Starting from 9am Friday it was call after call, 90% COVID related. Busiest call I’ve had in the seven years with my group. My husband joked that he’d build me a desk for the toilet so I could chart and pee.”
—Psychiatry: “Our staff shortages are so terrible that we have had to start combining group homes meaning we have to move people with major developmental delays and things like schizophrenia from one house to another. It’s a nightmare. We are already paying staff extra & allowing asymptomatic COVID+ staff to work. On a personal level, I have developed hives & shingles from the stress."
—Community psychiatrist: “I came back from vacation (where I covered myself for refills and urgent messages) and covered for three nurse practitioners, two sick, one with Covid. Other support staff out sick too. Widespread staffing shortages before the pandemic, now just ridiculous. Raging mental health and opioid crises. Kids out of school 3 of 5 days.”
—Cancer surgeon: “I am a cancer surgeon and today I had to tell a woman with liver metastases that I cannot operate on her this month to remove her tumors because the hospital is full. She sat in my office and sobbed.”
—Cancer surgeon: “I’m vaxed/boosted, came down with Covid this week and now my kids have it. OR time is so restricted I had to spend the whole week trying to get coverage for the week’s cases. Cried this morning because my rapid is still positive and so I can’t go back and I’m now trying to find coverage for next week’s cases too. These are cancer patients! I can’t take care of them, I can’t take care of my kids, I can’t take care of me.”
—Rheumatology: “My immunosuppressed patients have been so careful but I had half a dozen immunosuppressed patients turn positive in the last few days and I was only able to secure monoclonal antibodies for those on Rituxan. Everyone else is out of luck.”
— Internist: “We just got urgent instructions today to reduce in person visits and switch to telemed because of a staffing shortage. Our patients who get infusions are also getting bumped.”
— Hematologist: “We have a bunch of patients who need blood transfusions every three weeks and we had to cancel some last week because there was no blood and we had to cancel some this week because there is no staff. The shock and horror — from us, from them — is just unbearable.”
— Family Med. “We typically have four medical assistants. Two have Covid, two others didn’t come in. We usually have four people at the front desk. Three have quit because they get yelled at too much. I have patients arguing with all of us about their positive results saying, “Why are you testing me for Covid, I just need antibiotics,” and “I can’t have Covid.””
— Family medicine - “Our triage nurse and two out of three secretaries were out. Tons of Covid patients. Every day I was in the office late returning calls. My husband tested positive and isolated so I had to do everything for the kids who have been remote this week. This weekend I’m working on 50+notes.”
— Family Med: “40+ positives a day in our practice, can’t stay on top of all the phone calls. I have said over and over: there are no monoclonals, no antivirals, no treatments available, it’s unfortunate you didn’t get the vaccine, buy an oximeter and … good luck.”
—Family Med: “Call after call, message after message of people with symptoms, exposure or both. All wanting to know how they can get tested (wait a week for an appointment through us or try your chances refreshing over and over online for an appointment, waiting in 6 hour lines, or going to an overwhelmed urgent care facility — several of which are closed due to staffing shortages) and how they can get monoclonal antibodies (sorry, none available except for the absolutely highest risk immunocompromised patients). I have nothing to offer anybody other than tylenol and instructing them on when to go to the ED.”
—Family med: “I felt so badly this week-end for my COPDers who were calling to get monoclonal antibodies, and I had to say it was unlikely they would get them.”
—Family Medicine: “So many people are out I’m now working seven days a week… Exhausted…And the patients who refuse to wear their masks! They say, ”There is no way, I don’t have covid" but the next day: positive. They don’t seem to care if they make me sick.”
— Family medicine: This week every day I had people newly positive. Everyone. Young (40 and under), older, kids, pregnant women. Half of our labor floor was COVID positive. There are new treatments but they aren’t actually available. So I’m left to tell people that there is nothing I can offer except symptomatic treatment. Over and over and over again.”
— Family medicine: “Was on call over NYE: it was an absolute horror story. On Friday I think of all the patients I saw, all but two had covid. I had to send four kids under two to the ER and one we had to send one out with ALS (advanced life support) for ICU care. Came in the afternoon after the storm: every sick patient I saw had Covid while my staff was out with kids at home with Covid. I started answering my pages and phone calls with, “Hi, this is Dr. Covid, I mean…” Not only physically exhausted, and my autoimmune diseases flaring from the stress…. I miss my family. My husband got a breakthrough covid infection — he found out when he tested on Christmas Eve to be safe before visiting family. Positive: another Zoom Christmas. … Despite all of the above, I’m happy to do this. Just… so… tired…”
—Family medicine: “I did a well-check on a toddler last week. Her father told me flat out that no one in his family would ever be getting a covid vaccine because “I am not afraid of covid, I am not afraid of my kids getting covid…” and the hardest to hear of all “I don’t care about anyone else." It took every fiber of my being to remain professional. So on top of the physical exhaustion, there’s that moral/ethical exhaustion for the gut punch when you’re already down…”
—Internal medicine: Friday we had to convert everything to Telehealth (or cancel them if their insurance wouldn’t allow) because each day of the week I lost a staff member who got sick with Covid. On Monday I had four staff, Tuesday there were three, Wed and Thursday we had two people and Friday I was the last one standing. Three people in my house have Covid. What on earth is going to happen tomorrow?
It is going to stay very bad in terms of staff and cases for the next few weeks. Please do everything you can to not get Omicron this month.
Perhaps you should have. Or maybe I just lack rational common sense.
Geez, are you still so upset about a comment I made nearly 3 weeks ago – in the context of studies showing that omicron was milder? 
Omicron is milder. There is no disagreement about that now.
A good, balanced article by an ER doctor in New York City:
Now a question for you.
Why are certain parts of the US experiencing a hospital crisis, while most other parts of the US and most other countries are not, or not nearly to the same extent? (Honest question. I don’t know the answer.)
A big part of it may have to do with how burnt out the health care staff are from dealing with Covid for the past two years. Many doctors and nurses are also getting sick themselves. That’s an issue where I live (Alberta, Canada).
It is milder, but iirc you confidently predicted that it was so much milder it wouldn’t cause problems with the hospitals.
I expect most of the US to see issues with healthcare. Our hospitals are ordinarily staffed not-much-over-expected-capacity, because healthcare workers are expensive and extra staff are a drain on finances. We actually have regulations preventing new hospital beds being opened in areas that don’t “need them”. (Probably due to political lobbying, but I’m not certain of the history.)
Omicron puts a lot of people in the hospital. We have a huge population that’s both unvaccinated and insured. And of course, it’s not only the unvaccinated who get seriously ill. Immune compromised people and the unlucky do, too.
And even they guy who falls off his bike but happens to have covid puts extra strain on the system due to having covid. He needs to be isolated from covid-negative patients.
Additionally, a lot of our doctors are out with covid. That hasn’t happened since the supply chain produced enough masks. But omicron is far more contagious. I took my mom for an antibody infusion, and the nurse who gave it to her usually works in GI. He was dragged into the covid ward because most of the staff there were out sick. The nurse who discharged her was a covid nurse, but he was there because he had already recovered, having caught it over Christmas.
I’m not certain what parts of the US aren’t struggling at least some. Same with Europe. I live in a highly vaccinated part of the US, and our hospitals aren’t totally without capacity (based on the state’s dashboard) but the staff are pretty fried and I’m reading articles about how bad everything is.
I concede that I didn’t expect the level of crisis that we are seeing in many US hospitals. Your analysis seems to put it down to systemic problems in the US healthcare system.
From the NYT data of “How cases, hospitalizations and deaths are trending”, it looks like several states are not doing too badly with hospitalizations, notably California, Oregon, Washington, and Hawaii.
Much of the pressure seems to be coming from staff being off work due to testing positive.
Quick question - what’s the significance of “insured” here? (Hey, I’m British - I don’t know these things).
What I was actually stopping by to post:
Daily People Tested Positive in the UK per this govt website.
5 Jan -193 207
6 Jan - 148 138
7 Jan - (incomplete)
8 Jan - 146 390
9 Jan - 141 4723
10 Jan - 142 114
11 Jan - 120 821
(I just posted the last week of data because that’s clear of any potential reporting issues over the xmas/new year period.)
All the graphs (on the website) are now trending downwards. Hospitals are still struggling, and hospital admissions & deaths will lag behind cases, but for the longer term - fingers crossed but looking good.
j
Insured = able to access medical care without paying cash up front (barring a small access fee [“co-pay”] of maybe the equivalent of £10–20), and therefore reasonably likely to see a doctor when ill. May well have a GP or doctor’s surgery to go to.
Uninsured: the opposite of free at the point of service, and therefore less likely to seek medical care when there are alternatives such as hoping it will go away on its own or hoping it’s not that bad. Likely to need to approach a hospital’s emergency room as the first point of contact with a healthcare provider.
A lot of this varies by individual, and by state, and there’s a lot of ground between “no insurance at all” and “fully and comprehensively covered.”