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Still think omicron is “mild”?
Low severity of disease ≠ mild impact
While the virulence of omicron is seemingly less severe on an individual scale and especially in those who are vaccinated, the impact of omicron on the healthcare system, schools, businesses, economy etc. has been far from mild. Notably, higher vaccination coverage during the omicron surge likely led to less severe disease for many. Yet, according to an MMWR report from the CDC, we still saw some of the highest daily case counts, hospitalizations, and emergency visits during the omicron wave. Over a 3-week period, there were more cases of omicron compared to delta and 17% higher deaths.
The narrative that the media espoused was that omicron is a milder variant, but mild compared to what? Compared to COVID when we didn’t have vaccines available? Additionally, as the recent NY Times piece “the pandemic of the forgotten” pointed out, this narrative doesn’t take into account vulnerable populations such as the 7 million immunocompromised Americans. We do not know how well the vaccines work in this population and many of these Americans continue to live in fear for their lives while the rest of us learn to “live with the virus.” Similarly, we are neglecting to address the racial inequities and socioeconomic inequities in vaccination.
Impact on the economy, healthcare system and schools
According to the Census Bureau survey, 8.8 million people did not work between the end of December and the beginning of January as they had to care for themselves or someone else with COVID symptoms. In a survey of small business leaders, 71% of responders said their revenue was negatively affected due to the increase in COVID-19 cases and 37% had to close their business or scale back.
With regard to schools, omicron caused disruptions in learning whether children were attending in person instruction or doing virtual learning. Many schools had to close temporarily and if they remained open, there were staffing shortages and child absences due to illness or quarantine, making it difficult to maintain a consistent learning environment.
Of course, the healthcare system has been overwhelmed in a multitude of ways with 80% of hospitals are under “high or extreme stress,” record hospitalizations, extreme burnout amongst healthcare staff and staffing shortages.
Will the next variant be less severe?
The second narrative being pushed by the media is that the next variant will be even less severe. There is no certainty that this will be the case. Even if it is the case, less severe cases of COVID can still cause long COVID. Data also shows that even a less severe case of COVID-19 can increase a person’s risk of cardiovascular problems for at least a year after diagnosis. The rates of conditions such as heart failure and stroke are much higher in people who have recovered from COVID-19 than in those who never had COVID-19.
What comes next?
Well that depends on our level of preparedness. With less than two-thirds of Americans fully vaccinated and only one-fourth of Americans having received a booster shot, we still have a long way to go in our vaccination efforts. Recent data shows that a third dose of the mRNA vaccines was highly effective at preventing Covid-19 associated emergency room and urgent care visits by 94% during the Delta wave and 82% during the omicron wave. The risk of hospitalization was also decreased by 94% for Delta and 90% for omicron after a third shot.
Additionally, as I’ve mentioned before, masking is a low cost, effective tool and sadly, it is being politicized. While I don’t think we will need to mask forever, we have still not vaccinated a large enough percentage of the population, only 24% of children ages 5-11 are vaccinated and children under 5 cannot be vaccinated so masking is still essential.
I also just want to remind everyone that the goal was never to eradicate COVID (although that would be nice), the goal was to mitigate its effects on our health, hospital systems, schools and our economy. Vaccination is effective in preventing deaths, reducing hospitalizations and reducing the severity of disease. The next time someone describes omicron as mild, it needs to be taken into context that vaccination has allowed it to be viewed as mild, yet the impact on our society has not been mild whatsoever. We need to focus on increasing vaccination efforts AND promoting masking until we have successfully vaccinated a majority of our population and taken care of our most vulnerable.
Iuliano AD, Brunkard JM, Boehmer TK, et al. Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods — United States, December 2020–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:146–152. DOI: http://dx.doi.org/10.15585/mmwr.mm7104e4external icon.
https://www.census.gov/data/tables/2021/demo/hhp/hhp41.html
https://www.theguardian.com/society/2022/feb/03/us-coronavirus-healthcare-system-providers
Anindit Chhibber, Aditi Kharat, Khanh Duong, Richard E. Nelson, Matthew H. Samore, Fernando A. Wilson, Nathorn Chaiyakunapruk,Strategies to minimize inequity in COVID-19 vaccine access in the US: Implications for future vaccine rollouts, The Lancet Regional Health – Americas, Volume 7, 2022, 100138, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2021.100138.
(https://www.sciencedirect.com/science/article/pii/S2667193X21001344)https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html
https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e3.htm
COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler: Looking for Clarity in the Haze of the PandemicYong Huang, Melissa D. Pinto, Jessica L. Borelli, Milad Asgari Mehrabadi, Heather Abrihim, Nikil Dutt, Natalie Lambert, Erika L. Nurmi, Rana Chakraborty, Amir M. Rahmani, Charles A. DownsmedRxiv 2021.03.03.21252086; doi: https://doi.org/10.1101/2021.03.03.21252086
Xie, Y., Xu, E., Bowe, B. & Al-Aly, Z. Nature Med. https://www.nature.com/articles/s41591-022-01689-3 (2022).
Johnson AG, Amin AB, Ali AR, et al. COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence — 25 U.S. Jurisdictions, April 4–December 25, 2021. MMWR Morb Mortal Wkly Rep 2022;71:132–138. DOI: http://dx.doi.org/10.15585/mmwr.mm7104e2
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The Science is in Again: Masks STILL Work
As states prematurely end mask mandates, mounting evidence continues to show that masks do indeed work! Despite the clear evidence that masks are effective at reducing COVID-19 transmission, political leaders are moving to downplay the importance of masks and choosing politics over public health. What’s especially troublesome is bolstering the idea that mask mandates may no longer be necessary in public schools (some states have already moved to end mandates in schools) again going against the strong evidence that masking in schools reduces transmission of COVID-19 as discussed in previous posts.
The data on the effectiveness of masks is clear (I have presented it before) and more data since has come out reaffirming this fact. Let’s review the most recent study delineating just how essential masking is AND once again highlighting that not all masks are created equal (refer to my prior post on the best masks). Here are some major findings of this study:
- Use of a face mask or respirator indoors was associated with a lower chance of infection with SARS-CoV-2 (the virus that causes COVID-19)
- Protection against SARS-COV-2 was highest in those who reported wearing a face mask or respirator all the time
- Infection was also lowest amongst those who usually wore an N95/KN95 respirator
- The group with the second lowest infection rate was those wearing surgical masks
- Cloth masks offered the least protections
Of course, every study including this one has limitations, which you can read about in the discussion section, but the overall message remains clear. I ask political leaders and the public to consider these points before making swift decisions that will impact our most vulnerable populations:
- Children under 5 years old are still not yet eligible for vaccination
- Only 50% of those eligible for booster shots in the US have received them (recent data highlights the necessity of a booster shot in light of omicron)
- Vaccine inequity is a major issue (recent data shows how low-income workers are disproportionately affected)
- The US has the highest death rate of high-income countries surpassing a death toll of 900,000 and a lower percentage of people vaccinated compared to many European countries that are relaxing protections (many of these countries also have paid sick leave, universal healthcare etc.) thus, parallels cannot be drawn
While many states are ending their mask mandates, the responsibility to protect ourselves, our loved ones and the society we inhabit falls on each of us. Community is an important aspect of the fight against COVID-19 and has been since the beginning. Until protection is widespread and equitable, defeating COVID-19 will be an insurmountable feat. Please mask up and take care of each other.
References:
https://abcnews.go.com/Health/dozen-states-move-end-masking-mandates-covid-19/story?id=82806903
Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021. MMWR Morb Mortal Wkly Rep 2022;71:212–216. DOI: http://dx.doi.org/10.15585/mmwr.mm7106e1external icon.
Budzyn SE, Panaggio MJ, Parks SE, et al. Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements – United States, July 1-September 4, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(39):1377-1378. Published 2021 Oct 1. doi:10.15585/mmwr.mm7039e3
Brooks JT, Butler JC. Effectiveness of mask wearing to control community spread of SARS-CoV-2. JAMA 2021;325:998–9. https://doi.org/10.1001/jama.2021.1505external icon PMID:33566056external icon
Chughtai AA, Seale H, Macintyre CR. Effectiveness of cloth masks for protection against severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis 2020;26:e200948. https://doi.org/10.3201/eid2610.200948external icon PMID:32639930external icon
Andrejko KL, Pry J, Myers JF, et al.; California COVID-19 Case-Control Study Team. Predictors of SARS-CoV-2 infection following high-risk exposure. Clin Infect Dis . Epub December 21, 2021. https://doi.org/10.1093/cid/ciab1040external icon PMID:34932817external icon
Thompson MG, Natarajan K, Irving SA, et al. Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:139–145. DOI: http://dx.doi.org/10.15585/mmwr.mm7104e3external icon.