29 December 2021 Blog Post: Flooded with Omicron

Like so much of the country and the world, our office here in Santa Monica has been inundated with testing requests from patients with symptoms as well as known exposure to a COVID-19 case. For me personally, this is my second day post-exposure from a known COVID case with whom I spent 45 minutes in an examination room (with an N95 mask). They did not develop symptoms until later in the day and tested positive the following day. This places me in effective quarantine, although I’m fortunate to be able to do large swathes of my job by telemedicine and video medicine modalities.

Our public health system has, again, broken under the strain. There is no available monoclonal antibodies (although their efficacy is debatable for Omicron, they are effective for Delta), novel antivirals have not come to market, rapid antigen tests are now largely unavailable (I too am having difficulty), and booster shot appointments are hard to come by here in LA County. A holiday surge was inevitable but I don’t think anybody expected one of this magnitude.

Case rates have risen exponentially in the last two weeks, now essentially at Delta’s midsummer peak (note that data published by LA County still lags badly nearly 2 years into the pandemic, at least a week if not two weeks behind). 

A more noisy plot of daily rates shows that we have likely surpassed delta’s surge by about twofold but still remain far below the peak we experienced last Winter (November 2020-January 2021).

Prevalence rates (the number of current infections at a point in time rather than the number of new infections) are another way to look at these data – but this too suffers from a reporting lag on the order of two weeks. At this point Omicron barely appears as a blip on the far right of the graph – but we know from practical experience that this is not true. My estimate is that 10-15% of the County is currently infected with the virus.

The piece of very good news in all of this is that mortality has not increased whatsoever and currently (for the week ending 12/21/2021 at least) stands at 0.09 daily deaths per 100,000 population.

This graph below is a bit busy but plots case rates and mortality rates together.  I’ve started it at our local minimum of cases in late May 2021 for comparison of Delta in the summer and Omicron now.

We can see at the far left an uptick in cases from 14.79 to 30.83 but a decrease in mortality from 0.11 to 0.09 (both expressed as daily events per 100,000 population).

And last, but not least, to address the refrain of ‘we are seeing more positive tests because we are testing more’ – that actually doesn’t seem to be the case.

There was a sharp rise in testing coinciding with the start of the school year moving as high as 1481 daily tests per 100,000 population in early September. This is in sharp contrast to the summer when rates were as low as 375 daily tests per 100,000 population. The obvious crater in late November corresponds to school being out of session and while testing rates have picked up, they still are not at the 1655 maximum we saw in early November. If you think case rates are high now, just wait to see what happens when kids return to school and in-school testing resumes.

Bottom line, it is a mess out there. I have seen cases in every possible clinic stratum at this point: unvaccinated, vaccinated, vaccinated and boosted, previously infected and unvaccinated, as well as previously infected and vaccinated. The only group I have not yet seen an infection or breakthrough infection in → previously infected, vaccinated and boosted. I have no doubt that domino will soon fall.

By a stroke of good fortune, mortality rates have not budged and I’m hopeful that they do not. However, we must all on some level must recognize that the more times we expose our most vulnerable (elderly, immunocompromised and those who cannot establish vaccine-induced immunity) to COVID-19, we are playing viral Russian roulette. I overheard a conversation yesterday where somebody referencing Omicron said ‘well, yeah, but people aren’t dying of it.” I hope he is right – but do we really want to test that theory?

My advice? 

  1. Cancel New Years plans (sorry). 
  2. Upgrade to an N95 or KN95 (we have them in the office if you need). 
  3. Test immediately before family gatherings. 
  4. Test 5 days after family gatherings. 
  5. Get boosted if you have not already (aim for spike protein antibody levels >2500 which are attainable with boosters). 
  6. Wash your hands (it is just good hygeine).
  7. If you are in a congregate work setting, increase ventilation, or add a HEPA filter to the room.

If you have been exposed to a known COVID-19 case, isolate and then get tested with a rapid antigen test and/or PCR 5 to 7 days after exposure. If you test negative, resume your daily life. 

If you are infected, stay home for at least 5 days after your positive test – even better 7 days and employ a ‘test in’ strategy. Do not test with PCR (can stay positive for days, weeks, months after recovery) but instead use a rapid antigen test. If you are positive at Day 5, then you are still infectious!  Stay home. Once negative, you can resume your daily activities.

Optimally, we should all test before returning to work and school after the Holidays.

Outbreaks that spike exponentially also tend to burn themselves out quickly. I’m hopeful that things will look very different in a few weeks’ time.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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