It was a very Omicron Christmas for many of us. As cases soar (70,000 at the end of October; over 200,000 today), I had countless friends and relatives who suddenly had to cancel, adjust, or scale down their celebrations because of people finding out they were positive on Thursday or Friday or even in the car on the way over to open presents.
The ripple effect of having so many people get Covid and needing to isolate for 5, 7, or 10 days (recommendations are evolving) is happening as we speak: schools and daycares closing because not enough teachers, flights cancelled because not enough crew, restaurants shuttering because not enough staff, church/temples cancelling in-person services because the leaders are sick.
And most importantly, hospitals forced to limit access because so many staff can’t come in. Even today, several Boston-area Urgent Cares and testing centers closed early because they were over capacity. Hospitals are already cancelling any non-urgent surgery requiring admission. There aren’t enough blood donations so transplant surgeries are at risk. Many in-person clinics may need to close; some already have.
We’ve even had to bring in the National Guard to Boston to help out at our hospitals.
It also looks like it will be, unfortunately, be A Very Omicron New Year’s Eve.
What do we know this week?
Is Omicron infecting vaccinated people? Yes. Usually their disease is milder.
Is Omicron infecting previously infected people? Yes. Usually their disease is likewise milder.
Is Omicron infecting boosted people? Not as often but sometimes. Boosters definitely help decrease your chance of getting it. If you do get Covid anyways, your illness is usually milder.
Is Omicron infecting unvaccinated people? Yes, like crazy. Unvaccinated people are the ones who are more likely to end up in the hospital, have severe disease, go to the ICU, and possibly die. This is worse in older people but is definitely happening with people under 65. The vast majority under 50 who are dying of Covid are unvaccinated.
New: Is Omicron faster? Yes, it appears you turn positive faster after exposure than with Delta — it has a “shorter incubation period” — so 2–3 days after a Christmas gathering, if you have any symptoms at all, get tested. If you make it to 5 days after Christmas and are still negative, you are probably good.
New: Is Omicron hospitalizing children? Unfortunately, yes. This is something we were concerned about in South Africa; now our suspicions have been confirmed in New York City where there’s been a sharp uptick in kids sick enough to require hospitalization. Many of these children could have been vaccinated but weren’t. We don’t yet know whether this is going to be a major issue.
Is Omicron more “mild”? We don’t know yet. Maybe. Maybe it’s not going to make more people die per infection.
But, still, there’s nothing “mild” about 10 gajillion cases disrupting society’s functions and 10 gazillion hospitalized people disrupting regular medical care and bringing our health care workers one step closer to quitting (as did thirteen of my colleagues and family in December).
New: Do we have medicines that work against Omicron? Some. There’s evolving good news and bad.
— Two out of three monoclonal antibody concoctions don’t work against Omicron
— The one that does work (sotrovimab) is very tightly rationed
— The new PREVENTION monoclonal — Evusheld — for profoundly immunosuppressed people DOES seem to work against Omicron which is fantastic news. This is an intramuscular shot (butt or thigh). Also currently rationed.
— The older antiviral IV infusion drug Remdesivir seems to help outpatients and seems to work against Omicron (good news)
— The new oral antiviral drugs from Pfizer and Merck (Paxlovid and Molnupiravir, respectively, notice the alliteration, I don’t think it’s a coincidence) are promising but are not going to be an instantaneous miracle cure for us.
— First off, they are not yet available. For example, there’s no deliveries of Paxlovid until next week, and then tiny numbers until March. Too bad, because we really need them right this minute.
— Secondly, they haven’t yet figured out exactly how to distribute them or get the prescriptions to contagious people.
— Thirdly (this is new), there will be a bunch of medical limitations on who can take them.
On the ground and out of the lab:
Today I got a ton of emails and texts from colleagues who worked this week-end. Here’s a sample:
- “I just finished 3 days in the ER. It’s like a war zone. Say “boo” to me and I will break down and cry. …I just can’t believe what is going on here. There is nowhere to even sit in the waiting room. It is literally standing room only… and every single patient has COVID …It’s just so surreal … I have been an ER doc for 28 years. I have never seen anything like this.“
- And: “Tons of staff out with COVID. Those who are working almost all have someone at home with COVID. Lots of children and babies showing up to the hospital with symptomatic COVID. Some babies in the NICU can’t have their parents come in to visit because the parents have COVID. It’s literally everywhere.”
- And: “I’m on call today for primary care. As if you don’t already know: Everyone. Has. Covid. Literally everyone.”
- And “I worked OB…It was all covid, all the time. Numerous laboring patients came back positive for covid during routine admission screening, many of them asymptomatic. One intubated covid positive postpartum mom in the ICU… an emergency gyn patient turned out to be Covid positive and symptomatic.. … So much covid, everywhere one turned.”
- And: “I’m on call this weekend. 85% of my calls have paged with header of “patient tested positive for COVID, not sure what to do.”
- And: “I spent Christmas balancing sick patients in the ICU while waiting to hear if my daughter’s Covid test was positive.”
- And: “We have 1/3 of our vaccinated office staff out positive, so we will need to do Telehealth care until the end of the year.”
- And: “It was the most calls I’ve gotten in a 48 hr period in my 20 years as a primary care doc.
- And: Every call I got was Covid, except one “breath of fresh air” call about foot pain. But if you had a sore throat — Covid. Or a slight sniffle- Covid. Or a “low grade fever” — Covid. Or I saw someone Monday who tested positive Tuesday — Covid. And also, sadly, lots of adults positive and really worried about small kids at home — then they had Covid, too.”
- And: “Waiting for my one year old’s Covid test from a daycare exposure. Wondering what’s going to happen if I have to cancel 20+ patients tomorrow.”
- And: “Worked Xmas eve. 13 of my 14 ICU beds were covid. 11 of 13 unvaccinated.”
- And: “My work week is so difficult. Step into the abyss Monday and come out Thursday. I love medicine but hate this pandemic.”
- And: “The weekend was beyond belief to me. Almost every single patient has COVID. Some very sick and terrified — some less acutely ill, but no less terrified. As physicians, we felt like we were getting pummeled — I think my residents felt smaller and smaller with each call, just because it was so overwhelming. The exhaustion is just indescribable at this point. I didn’t take off my N95 for 13 hours STRAIGHT yesterday.”
So what should you do about your New Years’ Eve plans?
Journalists will tell you to look for the most vulnerable person in your group. Is there someone particularly susceptible to getting Covid? Is there someone most likely to get bad Covid? Is everybody boosted? Can people who turn positive a few days after New Years easily isolate for a week to ten days?
But for those of us surrounded by people on the front lines, the answer is written in their suffering — the suffering in our hospitals and in the homes of our patients and our health care workers.
We’re in the middle of a gigantic surge of a worldwide pandemic of a wildly infectious variant, wee don’t yet have the drugs to treat it, and we’re running out of people to manage it.
We can’t outrun Covid’s biology this time. Omicron is here and has created a perfect variant storm. Our only shelter right now is to stay home, cancel the party this year, delay the plans, and wait until it’s safe to come out again.
It will be safe again. This will pass. But it is not safe now.