Trying to understand the Numbers Game: Coronavirus infection isn’t what it once was. Studies suggest that, compared with Delta, Omicron is a third to half as likely to send someone to the hospital; by some estimates, the chance that an older, vaccinated person will die of COVID is now lower than the risk posed by the seasonal flu. And yet the variant is exacting a punishing toll—medical, social, economic. (Omicron still presents a major threat to people who are unvaccinated.) The United States is recording, on average, more than eight hundred thousand coronavirus cases a day, three times last winter’s peak.
Should we be focused on case counts at all? Some experts, including Anthony Fauci, argue that hospitalizations are now the more relevant marker of viral damage. More than a hundred and fifty thousand Americans are currently hospitalized with the coronavirus—a higher number than at any other point in the pandemic. But that figure, too, is not quite what it seems. Many hospitalized COVID patients have no respiratory symptoms; they were admitted for other reasons—a heart attack, a broken hip, cancer surgery—and happened to test positive for the virus. There are no nationwide estimates of the proportion of hospitalized patients with “incidental COVID,” but in New York State some forty per cent of hospitalized patients with COVID are thought to have been admitted for other reasons. The Los Angeles County Department of Health Services reported that incidental infections accounted for roughly two-thirds of COVID admissions at its hospitals.
Clarifying the distinction between a virus that drives illness and one that’s simply along for the ride is more than an academic exercise. If we tally asymptomatic or minimally symptomatic infections as COVID hospitalizations, we risk exaggerating the toll of the virus, with all the attendant social and economic ramifications. If we overstate the degree of incidental COVID, we risk promoting a misguided sense of security. Currently, the U.S. has no data-collection practices or unified framework for separating one type of hospitalization from another.
Complicating all this is the fact that it’s sometimes hard to distinguish a person hospitalized “with COVID” from one hospitalized “for COVID.” For some patients, a coronavirus infection can aggravate a seemingly unrelated condition—a COVID fever tips an elderly woman with a urinary-tract infection into delirium; a bout of diarrhea dehydrates a man admitted with sickle-cell disease. In such cases, COVID isn’t an innocent bystander, nor does it start the fire—it adds just enough tinder to push a manageable problem into a crisis.
Prevention (CDC) director Dr. Rochelle Walensky noted that the “overwhelming number of deaths” from COVID-19 among the vaccinated “occurred in people who had at least four comorbidities.”
“The overwhelming number of deaths, over 77.8%, occurred in people who had at least four comorbidities, so really these are people who were unwell to begin with,” Walensky said
With Alpha and Delta, almost all COVID hospitalizations were related to the infection. The situation is different with Omicron—a function both of its diminished ability to replicate in the lungs and of its superior capacity to infect people who’ve been vaccinated or previously contracted the virus.
Omicron Symptoms: Sore throat is a "really important" symptom. This is then followed by
Headache (65 percent), Fatigue 65 (65 percent), Runny nose (65 percent), Sneezing (55 percent).
Booster Numbers: About 73 million people, or 35% of the 207 million people who’ve received a primary vaccine series, have received a booster, according to federal data.
The Pennsylvania Department of Health reports 17.3 million vaccine doses have been administered in Pennsylvania. 74.5% of Pennsylvanians age 18 and older are fully vaccinated.
Omicron is "inherently milder" than Delta among children under 5, new study shows Researchers analyzed electronic health records for about 80,000 children under the age of 5 who were infected with COVID-19 for the first time in the United States. They found that the Omicron coronavirus variant is “inherently milder” among children under 5, with infection leading to “significantly less severe outcomes” than the Delta variant, according to a preprint study published Thursday.
The study also showed about 70% reduction in hospitalizations, intensive care unit admissions and mechanical ventilation among children infected with Omicron compared with those infected with Delta. They also found a 29% reduction in visits to the emergency room. Data on deaths was not included, as there were so few reported.
About 1% of children infected with Omicron were hospitalized, compared with about 3% of children with Delta.
Is it possible to get COVID twice? Yes, it is possible to get COVID multiple times, particularly now the Omicron variant has become dominant. Analysis by the UK Health Security Agency (UKHSA) published in December showed that around one in 10 people with the Omicron variant in England had previously contracted COVID-19.
UK studies into Omicron have suggested that previous COVID infection provides poor protection against the new strain. Researchers at Imperial College London found that the Omicron variant largely evades immunity from past COVID infection or two vaccine doses.
At present there is not enough data to tell whether people can get reinfected with Omicron. This is because most public health bodies define reinfection as two positive test results for the same individual 90 or more days apart.
Residual signs of COVID infection can show for up to three months on a PCR test, so the only reliable way of talking about reinfection is to include a 90-day window between positive tests.
Pfizer and Moderna are working to develop an Omicron-specific vaccine. Pfizer reportedly plans to begin human studies of its new vaccine before the end of January, while Moderna is working on its vaccine for the fall.
But with Omicron spreading at such a rapid rate and with more positive COVID-19 infections than ever, is it too late for an Omicron-specific vaccine to be effective? A vaccine that targets the Omicron variant could prevent mild infection and severe disease, which the original vaccine has against previous strains, including Delta.
Dr. Roy Gulick, chief of the Division of Infectious Diseases at New York-Presbyterian/Weill Cornell Medical Center and professor of medicine at Weill Cornell Medicine, said it is unclear how helpful these vaccines will be if they are released in the spring.
He noted that current data shows that the original vaccines still work against many variants, including Omicron. But Omicron is responsible for an increase in breakthrough infections, though those infections in the vaccinated and boosted tend to be milder.
The second line of thinking is that Omicron, although currently associated with the highest number of cases, has surged and then receded very quickly in South Africa, where it was discovered in November.
According to Gulick, this raises the question, “Do we want to be recommending a vaccine for a variant that may quickly disappear from the scene? The answer is we honestly don’t know.”
Breakthrough infections are happening, but those who are vaccinated and boosted are experiencing mild symptoms and, by and large, are being kept out of the hospitals. According to the New York Department of Health, new hospitalizations are 14 times higher among the unvaccinated.
COVID-19 and Pregnancy: Pregnant women that are not vaccinated against COVID-19 are at an increased risk for severe symptoms and newborn death should they contract the virus during pregnancy, according to a new study published in the monthly journal Nature Medicine.
The peer-reviewed study, which assessed over 144,000 pregnancy records in Scotland dating back to March 2020, focused largely on data from December 2020 to October 2021, when vaccines were made accessible to the public.
The data showed that around 77% of the infected pregnant women were unvaccinated. Those without the vaccine were more likely to be hospitalized with COVID-19 than pregnant women that were fully inoculated.
About 91% of COVID-19 hospitalizations and 98% of critical care admissions and "all baby deaths" in pregnant women were among those unvaccinated upon contracting the virus, according to the study.
Fourth Booster: This week, people who are especially vulnerable to COVID-19 infection will be able to get a fourth dose of vaccine to help protect them from the virus. People who are eligible for the fourth dose are part of the same group eligible for the third primary shot, which is different from the third booster dose available to most people.
According to CDC recommendations updated Friday, immunocompromised people should receive the regular two doses of either the Moderna or Pfizer BioNTech mRNA vaccines as well as a third shot.
Eligible individuals could fall in the following moderate to severely immunocompromised categories: those who have been receiving active cancer treatment for tumors or cancers of the blood, those who have received an organ transplant and are taking medicine to suppress the immune system, those who have received a stem cell transplant within the last two years or are taking medicine to suppress the immune system, those with moderate or severe primary immunodeficiency such as DiGeorge syndrome or Wiskott-Aldrich syndrome, those with advanced or untreated HIV infection and those who are being treated with high-dose corticosteroids or other drugs that may suppress immune response.
For immunocompromised people who received a single shot of the viral vector Johnson & Johnson COVID-19 vaccine, the CDC advises a booster shot of the Moderna or Pfizer-BioNTech vaccines two months after the first dose. People who are not in one of the moderate to severely immunocompromised categories are not yet eligible for a fourth shot – and may not need one in the future. People who are eligible and have received a three-dose series of primary mRNA shots should get a fourth booster shot five months after their third dose, says the CDC.
Omicron: Could it be as effective as a vaccine? Anecdotal reports from South Africa have consistently shown the Omicron variant only causes mild symptoms. Now, scientists and leading health experts are in agreement that Omicron may actually be a blessing in disguise and could even be more effective than a vaccine. Experts have dubbed it a natural vaccine due to its high levels of antibodies without the debilitating symptoms.
Researchers found that the virus loses 90% of its contagion capacity 20 minutes after becoming airborne and that most of that loss happens in the first five minutes of it reaching the air, according to the study, that simulates how the virus behaves after exhaling. The findings indicate viral particles rapidly dry out after they leave the moist and carbon dioxide-rich environment of the lungs, curbing their ability to infect other people.
Large-Scale Study Finds Omicron Unlikely to Cause Severe Disease: A study that evaluated more than 69,000 patients with SARS-CoV-2 infections in Southern California found that the Omicron variant caused much less severe health outcomes than the Delta variant. The researchers—one from the University of California at Berkeley; two from Kaiser Permanente, the healthcare system through which the patients received treatment; and three from the COVID-19 Response Team at the United States Centers for Disease Control and Prevention—looked at 52,297 cases caused by the Omicron variant and 16,982 cases of the Delta variant between November 30, 2021 and January 1, 2022. None of the patients with the Omicron variant required medical intubation while 11 patients with the Delta variant needed ventilators. In addition, the length of stay for those patients requiring hospitalization was 69% shorter for individuals with Omicron compared to those with the Delta variant.
Caution: Paxlovid Interacts With Many Heart Meds: Patients with hypertension, coronary artery disease, atrial fibrillation (Afib), and hyperlipidemia should pay close attention to what follows if they are considering starting the drug, as they likely will need to stop or modify their cardiac medications and monitor their blood pressure and heart rates closely while taking it.
Pfizer's new oral COVID-19 drug ritonavir-nirmatrelvir (Paxlovid) interacts with Cardiac patients taking antiarrhythmics such as ranolazine, amiodarone, dronedarone, flecainide, propafenone, quinidine, bepridil, and systemic lidocaine. Statin Drugs like lovastatin, simvastatin, atorvastatin, and rosuvastatin as also being influenced by ritonavir-nirmatrelvir. Calcium channel blockers as are the Blood thinners like warfarin, Xarelto is the only one that should be stopped, according to the FDA.
Eliquis. Caution is recommended if a patient is on the antiplatelet drug clopidogrel (Plavix) and ticagrelor (Brilinta) is contraindicated.