11 January 2022: "Everybody Has It"

Despite a Los Angeles Times headline blaring “Nearly 250,000 new coronavirus cases in 8 days: Where is LA County Omicron surge heading?”, I found a patient’s comment to be more compelling:

“It seems like everybody has it.”

Mathematically, that isn’t exactly right – “only” 29.8% of Los Angeles County residents are currently infected but that estimate (termed prevalence) suffers from about a two week lag and will undoubtedly go higher. Plotting prevalence over the course of this now 22 month pandemic shows that Omicron has been massively impactful. The figure below shows prevalence rates absolutely skyrocketing, surpassing the entire 2020/2021 surge in a huge two week jump. That number will only go higher.

Unsurprisingly, incident case rates (new infections per unit time and population) also show no sign of slowing down and have absolutely dwarfed the summer impact of the delta variant (Figure below).

The good news?  Mortality rates continue to decline in the County – this despite the massive, unprecedented and widespread impact of Omicron. The figure below shows just how much has changed, especially when compared to our 2020/2021 surge that preceded the widespread availability of boosters.

The continued “decoupling” of cases and mortality is better represented in the figure below.

A completely new phenomenon is developing now among the patients we see in clinic – overlapping exposures. With now 30% plus of the County currently infected, patients are having multiple exposures at once or in sequence. No longer are people simply waiting 5-7 days to retest and clear after being exposed to a known case, but they might have to test several times over the course of 2 weeks to be sure that they have not been infected.

In this environment, it is absolutely crazy that there are still no restrictions on congregate setting such as indoor dining. In the absence of decent public health leadership and guidance, it is useful to remember the 30% prevalence rate presented above. When you walk into a restaurant and see a dozen unmasked people eating – remind yourself that 30% of them, statistically, are infected and can pass it on to you. The same for a concert, a bar, a sporting event, your friends and a crowded elevator. 

So not everybody has it, but soon enough, everybody will.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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