A message from The Center for Closing the Health Gap
By Clyde E. Henderson, MD
Cincinnati Medical Association
The Omicron variant of this COVID-19 virus has now become the dominant strain in the US constituting over 98% of the virus’ infections in our country. The increased contagiousness of this variant has been one of its predicted characteristics. This is being borne out by the record 1.4 million cases recorded today, Jan. 11, 2022. The seven-day average test positivity rate also surged to an all time high 26.3% compared to the previous high of 23% seen on April 3, 2020. The conventional wisdom still remains that Omicron infection results in less severe disease even though COVID-19 hospitalizations in the US reached 142,388 yesterday, also a record high. This is likely not going to be the last hospitalization record considering that hospitalization peaks lag behind case number by about 2 weeks. Be reminded that the death peaks generally occur one to two weeks later than hospitalization peaks. Currently, the seven-day daily death average is 1,653, up 35% compared to two weeks ago. The good news is that the hospital stays are on average 50% shorter than during the peak of the Delta wave.
The answer to why hospitalization and death numbers are up, if indeed the Omicron variant is milder, can be found in a number of scenarios. First a smaller percentage of a hugely larger number of cases is a larger absolute number of severe cases, hospitalizations, and deaths. What is more significant is that the number of infections being reported probably severely underestimates the actual number of cases considering the unknown number of positive home tests. There are also a large number of untested asymptomatic or mildly symptomatic people. It is estimated that when all these are added to the mix, there may well be up to three million cases today.
It remains the case that if you have been fully vaccinated and boosted then you are less likely to suffer severe illness, hospitalization, or death from COVID-19. Without being vaccinated you are ten times as likely to be hospitalized and thirteen times as likely to die from this virus. There remains 38% of eligible Americans who are not vaccinated and 65% of eligible Americans have not gotten their boosters. The Omicron variant will find and infect these folks and this level of community spread results in breakthrough infections in the vaccinated. A cautionary note is that this astronomical level of replication WILL result in future mutations. Will one of these future mutations be more contagious and more virulent?
This surge of COVID-19 is not only overwhelming our hospitals in many areas, but it is resulting in tremendous disruptions in our children’s health and education. Childhood hospitalizations are at a pandemic high. A substantial percentage of these sick children are under 5 years of age and thus not eligible for vaccination. They can only be protected from COVID-19 by being surrounded by fully vaccinated adults and eligible siblings, and by appropriate pandemic mitigation measures. From an education standpoint, schools are grappling with how to educate children in the face of severe staff shortages in a raging pandemic surge. The case positivity rate is twice as high in Hamilton County compared to any time in the pandemic. Cincinnati Public Schools have decided to return to remote learning for two weeks. It is widely accepted that remote learning is associated with losses in both educational advancement and socialization. Yet instruction can’t proceed without instructors. Getting our kids back into functional and safe schools ASAP is essential. Our K-12 students need not only vaccinated instructors and school staff, but on-site and at home COVID-19 testing, proper fitting protective masks, and rooms with adequate space and ventilation.
All of the human statistics that we have used over the last 20 or so months to follow the impact of this disease are likely to worsen over the next few weeks. Yet, we the people are not powerless. We must encourage COVID-19 vaccination and boosters. This continues to be a pandemic fueled by the unvaccinated. We will emerge out of this crisis better and sooner if we wear the best quality mask that we can tolerate and afford, wash our hands, stay home when sick, and maintain six feet of distance when out in public.