Andy Larsen: What you need to know to wade through this omicron wave

Cases are rising rapidly, so here’s vital information on testing and what comes next.

(Francisco Kjolseth | The Salt Lake Tribune) Long lines of cars snake around the Maverik Center in West Valley City on Tuesday, Jan. 4, 2022, as people wait for COVID-19 testing.

It’s omicron madness.

As predicted, the omicron wave has hit Utah, and hard. We’re now seeing daily case counts that are double what we’ve seen at any point in the pandemic, and our systems are significantly stressed as a result.

In this article, let’s discuss some of the recent findings about omicron, what they mean moving forward, and some tips for Utahns dealing with the height of sickness in our community.

How high can Utah go?

First, let’s look at the case growth in the state. It’s pretty striking.

But, of course, these are only the cases that get reported to the Utah Department of Health. Many, many cases aren’t being reported: People who test positive on at-home tests generally go unreported, as do those who can’t access a test because they’re sick, people who just figure they’re sick and don’t ask further, and even asymptomatic cases.

The Centers for Disease Control and Prevention estimates that from February 2020 to September 2021, only 1 in 4 coronavirus cases was detected and taken into account in the official figures. But, with omicron, there’s reason to believe that the number of undetected cases has risen greatly — tests are scarce and the virus itself tends to be mild. It may well be that only 1 in 10 cases is counted now.

Dr. Michelle Hofmann, deputy director of the Utah Department of Health, expects daily case counts to reach about 12,000 a day in Utah by month’s end — an estimate that seems reasonable but somewhat conservative to me.

If you look at what’s happening on the East Coast, those states are currently getting about 3,000 coronavirus cases a day per million residents on average, with spikes up to 5,000 or 6,000 on good testing days. Those states have more vaccination immunity than Utah but generally less history of previous infection. Have those states peaked? It’s unclear, but their curve is beginning to flatten somewhat.

It’s worth noting that Utah is, ahem, ahead of omicron’s curve when compared to most of their Western neighbors. Utah has averaged about 1,500 cases per million residents over the past week, whereas Idaho, Arizona, New Mexico, Wyoming and Montana are between 500 and 1,000 cases per million residents. It would be nice to have a more comparable Western state that was further along in the curve to get a better idea of what to expect, but no such luck. We’re leading the way among our state peers.

Cross-variant protection

You may have noticed how many people who were previously infected with a different COVID-19 are now getting omicron. As we discussed earlier, people are between two and five times more likely to become reinfected as a result of the omicron variant than previous variants.

A study from Qatar, in fact, estimated how well prior infection protects. Against alpha, beta and delta variants, having a previous infection protects the unvaccinated between 85% and 92% of the time. Against omicron, though, previous infection prevents 56% of symptomatic infections.

But how well does it work the other way around? Does omicron infection protect you from delta and the other variants?

If not, that would be a real problem: Essentially, we’d have the same delta wave that we had before, just with a startling omicron growth on top of it. And delta would be able to find a resurgence once omicron’s waters receded.

Well, we have good news from South African scientists: Infection with omicron does indeed give your immune system a boost in preventing delta — especially for vaccinated folks.

An explanation for lower severity

And that cross-immunity is a good thing, especially because omicron is different than delta.

As you’ve heard by now, there’s little doubt that omicron cases are, on average, less severe than previous coronavirus variants. Indeed, we know that the decrease is not just due to lots of people having some degree of immunity to coronaviruses by now, but also because omicron is inherently weaker.

We didn’t really have great explanations as to why, until recently. This Nature article does a good job of explaining the process of our studies into the matter; naturally, we first start with studying how omicron attacks the animal kingdom.

In particular, omicron’s changes to the coronavirus’s spike protein make it harder for it to enter lung cells. Omicron infects the tissue in noses and throats especially well, leading to obvious upper respiratory symptoms like sore throats, sneezing and headaches. But your lung tissue is more resilient to this than other variants, leading to less damage.

Note that “more resilient” doesn’t mean “completely resilient.” It certainly is still possible for lung cells to be infected by omicron. Omicron is not the “common cold,” as so many are so eager to say. But you’re more likely to have more working lung cells after an omicron infection than a delta infection, which is certainly good news.

Tests and where to find them

Everyone wants a test right now, and there are tens of different manufacturers of at-home COVID tests from which to choose. I would love to give you a breakdown of which tests are most effective against omicron, but the truth is that the data isn’t very informative. There haven’t really been conclusive apples-to-apples studies on omicron sensitivity across these various tests.

But there are things we do know about the at-home tests. First, at-home tests have been shown to have disappointing reliability in the early days of infection — especially before symptoms show up. In one study of 30 people who were being tested by both PCR and rapid daily for their jobs, the rapid test didn’t test positive until one or two days after the PCR test did. Those people were transmitting the virus in the gap during the time between the two tests.

Many of the leading manufacturers of at-home COVID tests report that their tests worked identically in identifying omicron cases to delta cases — picking up positives about 85% of the the time compared to PCR, just as they did before. However, the Food and Drug Administration’s data suggested that the at-home tests “may have reduced sensitivity” to omicron. Australian researchers found comparable results, and the FDA hasn’t released its data.

We also have pretty good data that says PCR tests are more effective more quickly with throat and saliva samples than nasal ones with omicron — perhaps a function of where it’s most likely to reproduce. Most of the at-home tests still ask you to swab just your nose. And despite the research, the FDA has asked people to still follow the nose directions, because they don’t have any data on how the tests work with the other samples. I’ve talked before about how I wish the FDA would adopt the clear direction of scientific studies earlier, and this is one such example, though I understand that it’s tricky to do with the multiples of tests out there.

What would my advice be in getting tested? First, if the situation is mission critical, it’s still best to do a PCR test at a testing facility, a list of which you can find at coronavirus.utah.gov. Right now, many of those facilities are experiencing delays in both appointment and turnaround times, so don’t be afraid to call around and ask what the current status is at each location to get results as quickly as possible.

One option that cuts off the appointment-scheduling wait is Intermountain Healthcare’s self-serve tests. Essentially, you pick up the PCR test, swab yourself at your home or in your car, then drop off the sample at an Intermountain facility. Intermountain then emails you the results. Those results still may take over 24 hours to receive, but it may be the quickest or most convenient option for people who can’t make an appointment work.

If results will just take too long on those tests, then rapid tests may be your only choice. Those have been difficult to find recently.

Online product trackers like NowInStock track when online retailers have various tests in stock to ship to your door. I recommend watching that site and stocking a couple of them in advance of getting sick. Then you’ll have the tests when you need them.

What if you can’t wait for them to be shipped? I recommend going to the websites of big retailers like Walmart, Target and CVS to see what stores have which tests in stock on shelves. As of this writing, Walmart and Target had no tests in stock, and CVS didn’t have any tests available close to me in Salt Lake City — but if I drove out to their West Valley City or West Jordan locations, they had them on shelves.

Of course, in-store stock tracking is never perfect, and please be nice to the employees at pharmacies, retail stores and testing facilities if they aren’t able to meet your needs. To be sure, the lack of testing availability is a huge bungling of mismanagement in the face of extremely predictable demand — but not by the actual workers at those places.

Those are just normal folks, doing the best that they can in the face of unprecedented levels of sickness in our community. And boy, do most of us know that feeling.

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