Andy Larsen: Omicron will result in a lot of sickness — but not a lot of death

This wave is going to be less bad than it could have been.

(Matt Dunham | AP) People pass through during the morning rush hour at Waterloo railway station in London, Tuesday, Dec. 14, 2021. As of Monday in England, people were urged to work from home if possible, with long lines forming at vaccination centers for people to get booster shots to protect themselves against the coronavirus omicron variant.

I am really encouraged by the recent news and research from other countries about the omicron variant.

No, this recent news doesn’t mean omicron is a “nothingburger” that was hyped by the “fake news” media to get clicks, though I’m sure critics will take a victory lap. Omicron still will have a significant impact on our lives in a number of ways. It still will stress our heath care system, significantly, and our population. It has caused a substantial percentage of America to all get sick at the same time — and higher percentages are likely coming, especially in Utah.

It is a big deal and will be an even bigger deal in the weeks to come.

But I think we’re going to be able to avoid huge tallies in deaths: It’s going to be less bad than it could have been. From the evidence we have now, omicron looks like a fast-traveling hurricane — yes, we’re still experiencing a hurricane, but it’s not going to park over us and cause devastating flooding.

Let me show you what I mean.

A shorter wave?

Here’s the data from South Africa. Cases are in blue, deaths are in red.

First, that case wave is starting to head downward. It’s been a higher, quicker wave than the others, but it doesn’t look like it’s going to continue to grow exponentially upward like we had worried.

Why is it stopping? South Africa’s top infectious disease specialist, Salim Abdool Karim, explained that “in South Africa, variants, even highly mutated ones, will run out of people pretty quickly,” he said. “Pretty much by the end of last week it was running out of steam; there just aren’t enough people left to infect.” He estimated that 70% of those in his country had been infected by a previous variant; roughly 26% of South Africans have been vaccinated.

While those two numbers have some overlap, it drastically reduces the amount of susceptible targets omicron can still infect — even though omicron can escape immunity in some people. Further, there’s no doubt that hundreds of thousands more South Africans got the omicron variant, yet had an asymptomatic case.

Will that happen in America? Well, it’s probably true that 70% of America hasn’t had COVID-19 at this point, but it’s also true that a much higher percentage of Americans have gotten vaccinated — about 62%. The result is still a hugely significant population of our country that has some degree of immunity to COVID — computational biologist Trevor Bedford estimates around 80% to 90%. Utah’s had middling vaccination rates (ranking 26th), but pretty high infection rates (ranking seventh).

Just like South Africa, it’s probably wise to expect a massive jump in cases that will result in more people being sick than at any time during the pandemic. Indeed, In New York state, we already see that — and there’s no reason to believe Utah and the rest of the U.S. won’t follow. But I would be surprised if case totals are still that high by the end of January.

Deaths and cases decoupled?

And thanks to that level of immunity, we also are seeing a decoupling of deaths and cases. Look back at the South African graph. In those previous waves, you see there’s a pretty clear correlation: You see a rise in cases, and then pretty quickly thereafter, you’d see a rise in deaths.

If you’re reading online, you can move your mouse or press your finger over the individual dates, to see approximately when that death count grows after the case count does. It’s usually about a couple of weeks. We’d expect to start to see a bigger rise in South Africa’s COVID deaths by now, but we just haven’t.

That’s being borne out by data in other countries, too. In the United Kingdom, Imperial College analyzed the data and estimated a 15% to 20% reduced risk of any hospitalization once you adjust for all of the factors, including age, vaccination status and history of previous infection — not too dissimilar from the 29% the South Africans found in the study we discussed last week.

Over the population as a whole, (i.e., not adjusting for the fact that more people have immunity of some sort), you see significantly lower hospitalization numbers: 60% to 90% lower, in fact.

Even that number isn’t enough to explain why deaths have stayed nearly flat while cases jumped. More than that, the Imperial College researchers also found a 40% to 45% reduced risk of a hospitalization that resulted in an overnight stay. In other words, when people go to the hospital, they’re almost twice as likely to leave quickly. Take a look at the London data: The spike in cases has caused a rise in COVID patients going to the hospital, there’s no doubt. But it has caused only a tiny rise in people on ventilators; and those are frequently the hardcore cases in which death is a concern.

If this trend follows in Utah, it’s going to be a literal lifesaver. Right now, 95% of intensive care unit beds in Utah are full, but non-ICU beds are 60% full. There’s just much more capacity in our standard hospital units.

Now, look, I haven’t ever heard anyone who went to a hospital for any reason then say what they faced was “mild.” If you’re going to the hospital, you’re likely facing some rough symptoms. And I certainly don’t want to minimize the stress that our health care workers will go through in the next few weeks — especially because they will be working short-shifted, as some will get omicron themselves and have to miss time. Even for those who don’t end up getting the virus but just want to know they have good care available if something goes wrong, this remains a significant problem.

But in terms of deaths caused and severe illness, the above data is incredibly good news: We’re going to see significantly fewer funerals than last year in this wave.

Good and bad news on treatments

One especially notable reason that it’s good news that omicron is less severe than previous coronavirus variants is that our tools to fight it have been significantly weakened. In particular, the majority of our monoclonal antibody treatments straight up do not work against omicron, including the most famous of them, Regeneron.

What about the Paxlovid pill you may have heard about? After all, it just got a thumbs-up from the Food and Drug Administration this week, right?

The good news is the Pfizer’s pill to fight COVID will work against omicron, and prevent a further estimated 80% to 90% of hospitalizations for people who take it within five days of symptom onset but before they get to the hospital. The bad news is that we have only a tiny amount of it: Utah’s first shipment is only 440 units of the medicine, to give to 440 people. We’ll get about 2,500 courses of the pill in January. That’s not enough.

That means that we’ll have to ration Paxlovid treatments to those who are most likely to die. Those risk factors haven’t changed: the elderly, those with comorbidities, and those who haven’t gotten COVID before. Don’t expect to go to a doctor and get Paxlovid unless you fit at least one of those criteria; even then, you might have to be lucky. If I hear a story about one of these pill courses going to a young, healthy and wealthy person here in Utah, I might lose my marbles.

For everyone else, the best course of action is the much the same as it was. If you’re healthy, get boosted immediately. Your previous infection from another variant or one- or two-dose vaccination looks unlikely to protect you from infection, whereas with three doses, you have good odds to avoid it.

If you test positive, stay home. And everyone, sick or not, should be very aware of their behaviors before interacting with the high-risk while omicron rages, especially with those folks who don’t have antibodies.

Omicron certainly isn’t a good thing, but it appears that we’re going to escape the worst of the potential storm we feared.

Andy Larsen is a data columnist for The Salt Lake Tribune. You can reach him at alarsen@sltrib.com.