Omicron Post #4

Previous Omicron updates: #1, #2, #3. Last weekly non-Omicron update.

An introductory word: Thanks to Dominic Cummings, I have a lot of new readers, many from the United Kingdom, so I want to welcome all of you, and I hope at least some of you will stay when I turn to non-Covid questions. I am American so these posts focus on the United States, but I keep an eye elsewhere too, and mostly we’re all in this one together and the same conclusions apply. If you have good news sources and follows to keep a better eye on the UK or Europe for Covid purposes, or data sources anywhere I may not have noticed, I invite you to share them in the comments.

The constant refrain from all sources is ‘we will know more soon.’ Soon is continuously arriving. The new information we are learning hasn’t completely ruled out many possibilities, but it is broadly consistent with Omicron spreading fast and having a high degree of immune erosion/escape in terms of infection but not protection against severe disease.

Thus, to headline the core takeaways at the top, here’s broadly where I’m at as of now (probability estimates at the end, as before). I’d be surprised if any of these were wrong.

  1. Omicron spreads far more rapidly than Delta and is going to take over.
  2. This will come at us fast. Omicron will be the majority strain by the end of January. This happening by end of year is on the table.
  3. Omicron re-infects those who have already been sick, or breaks through to those who have been vaccinated, much more than Delta.
  4. Previous infection continues to protect against severe disease, hospitalization and death.
  5. Omicron doesn’t cause substantially more severe disease than Delta when it infects you, but we don’t know if it causes less severe disease yet, our evidence is ambiguous.
  6. Omicron cases on average are much more mild because there will be a much higher percentage of re-infections and breakthrough cases, which are highly protected against severe disease.
  7. The big peak is probably within a few months, so you don’t have time to wait for an Omicron-targeted shot. The current shots will still work against severe disease, so strongly consider getting vaccinated or boosted if you can.
  8. The best thing we can do to minimize the harm Omicron causes is to ramp up production of therapeutics, especially Paxlovid, as rapidly as possible, along with the necessary tests and other logistics to get the treatments to people in time to matter. The goal is mitigation at this point, not prevention.
  9. There is going to be a period early in 2022 when there are quite a lot of Omicron cases, such that it will be difficult to remain uninfected and it will likely be difficult to get any kind of medical treatment at a hospital. Be ready.
  10. Also be ready in case of lockdowns and other government restrictions, especially if you live in Europe where they’ve shown a willingness to use them. And if you’re immunocompromised or otherwise at high enough risk you need to be sure to not get Omicron, then the price of success is getting super paranoid soon and lock down hard, for at least several months.

In Search of Bayesian Evidence

How rapidly does Omicron spread? How far has it spread already?

Any given infection or reported group of infections, or even piece of data, is unlikely to be conclusive. But each one does have a likelihood ratio of how common it is to witness it in worlds where Omicron will spread extremely rapidly in the West, versus worlds where Omicron doesn’t do that. Similarly, they have ratios for how often how much of that comes from immune escape versus baseline infectiousness, how much protection remains against severe disease and death, and what the baseline severity of Omicron is.

Then we need to consider what we saw relative to what we expected to see. In general, no news is good news. If ‘nothing happens’ regarding Omicron, that continuously makes us less worried, whereas most news will make us more worried. Getting a constant string of bad news is expected, but how much of it did we get, how fast and how bad?

A lot of that depends on the extent to which various jurisdictions are looking for news. Taking a Trump-like approach of ‘if you didn’t run the tests you wouldn’t have that many cases’ does successfully postpone the bad news for at least a few days, and sometimes several weeks. All reports need to be adjusted for the amount of effort being put into finding data and generating reports.

The South African Study

Title and link: Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa.

This preprint was the first study about Omicron, and it doesn’t hold back. Author has a thread here.

Here’s the results section.

35,670 suspected reinfections were identified among 2,796,982 individuals with laboratory-confirmed SARS-CoV-2 who had a positive test result at least 90 days prior to 27 November 2021. The number of reinfections observed through the end of the third wave was consistent with the null model of no change in reinfection risk (approach 1).

Although increases in the hazard of primary infection were observed following the introduction of both the Beta and Delta variants, no corresponding increase was observed in the reinfection hazard (approach 2). Contrary to expectation, the estimated hazard ratio for reinfection versus primary infection was lower during waves driven by the Beta and Delta variants than for the first wave (relative hazard ratio for wave 2 versus wave 1: 0.75 (CI95: 0.59–0.97); for wave 3 versus wave 1: 0.71 (CI95: 0.56–0.92)).

In contrast, the recent spread of the Omicron variant has been associated with a decrease in the hazard coefficient for primary infection and an increase in reinfection hazard coefficient. The estimated hazard ratio for reinfection versus primary infection for the period from 1 November 2021 to 27 November 2021 versus wave 1 was 2.39 (CI95: 1.88–3.11).

Extending the period back to 1 November is going to decrease the magnitude of this effect somewhat, although case numbers in the earlier pre-mostly-Omicron period of November were low.

The study notes that it is studying reinfection risk rather than vaccine breakthrough risk, but the two should be highly correlated.

It looks like the study’s method was to match IDs of current infections to previous infections.

One worry is that this might fail to control for immunity declining over time since infection, beyond the 90-day window where reinfection risk is assumed to be zero. Given that they calculated no additional reinfection risk for Delta up through October, presumably this effect can’t be anything like big enough to explain the results.

Another note is this only counts infections that were detected on both occasions, which could have some interesting effects. Mostly I think this should undercount the rise in reinfections, because more of the control group were actually previously infected without knowing it, which is effectively a multiplier effect on the real odds ratio.

Here’s the key chart:

This is naked-eye obvious. The population at risk for (known) reinfection is roughly double what it was before, yet the ratio of reinfections to other infections is clearly much higher than that.

Also note that this finding rules out the possibility that most South Africans were already infected. If that was true, then being known to have been infected wouldn’t provide much additional protection.

They give us numbers that should be easy to work with, file under Huge If True:

The mean ratio of reinfection hazard to primary infection hazard decreased slightly with each subsequent wave, from 0.15 in wave 1 to 0.12 in wave 2 and 0.09 in wave 3.

The mean ratio of reinfection hazard to primary infection hazard for the period from 01 November 2021 to 27 November 2021 is 0.25.

Note that protection from an Omicron infection, for a future second Omicron infection, would probably still return to previous levels.

I am inclined to mostly believe this result, as it is broadly consistent with other findings.

Denmark

Link is to Washington Post report on Denmark’s huge jump in sequenced Omicron cases. Denmark does a lot of sequencing, so them finding a lot of cases first is a sign things are far along.

The number of confirmed cases in the country rose from 18 on Friday to 183 on Sunday, reflecting both the speed at which the variant has spreadand the sensitivityof Denmark’s virus surveillance system.

The northern European country is a leader in the sequencing of variants, acting as an early-warning system for the continent.

Health authorities in the country of 5.8 million perform more than 200,000 polymerase chain reaction, or PCR, tests per day — one of the highest rates of tests per capita in the world. Positive tests are submitted for special PCR tests that detect variants. For those that come back positive, scientists sequence the whole genome. Denmark sequences 25,000 strains per week, Lillebaek said.

Danish media reported that some of the infections were traced back to a concert in late November and a Christmas lunch involving 150 guests.

Britain also reported a sizable uptick in omicron cases: 86 new cases on Sunday, bringing the total number there to 246.

Attempts to trace Omicron cases are helpful, but in terms of knowing where we stand they can also corrupt the data. If Denmark was about as likely to catch an Omicron case of a given severity as a Delta case, and was sequencing all its 4300 tests a day (its 7-day average of positive tests), and got back 183 positive cases in a day, that would mean 4% of cases were already Omicron, and given what that would be saying about exponential growth, we’d expect to cross 50% within two weeks.

The question is, if we hadn’t been doing this extra tracking of Omicron cases, how many of the Omicron cases we did find would have been missed? If we don’t discount those, we’re going to get an overestimate, and of course Saturday could have been an outlier due to timing of data collection. If we catch every Omicron case, then we’d have to discount by the percentage of Delta cases that get missed, which is unknown, in addition to adjusting for exact timing. Even with a lot of testing I’d presume 50%+ of cases are missed, and plausibly 75%+. Denmark’s cumulative case rate is only 8.8% for the entire pandemic, so this ratio could be quite high.

What we do know is that up until a few days ago, they sequenced every positive test and found zero Omicron cases. Now they’ve suddenly found 183 in a single day, 4% of average daily positive tests.

Superspreader events are a thing, so it’s possible that this is luck, but there aren’t a bunch of other Denmark-like countries that also do all this sequencing, so there was only one ‘shot’ at this happening in this way. It’s a sign of very rapid spread.

Hopefully we will also track outcomes from the group, to help us learn about severity. The numbers are starting to get big enough that they’ll tell us something, but that still requires time for cases to develop.

Anime NYC

The Omicron timeline needs to be moved up substantially, because the case that we found in Minnesota was a case of community spread, probably at a large Anime convention in NYC, and on November 19-21, which predates the identification of Omicron.

The case was not only vaccinated but boosted, and a majority of the friend group later tested positive. Things are escalating quickly, and we’re not making that much effort to find cases. This was identified as Omicron as part of a random sampling rather than any reason to suspect the case, which is also worrisome, and there was still an 8-day delay involved. Ouch.

Our awful mayor issued this statement afterwards, along with others who urged those in attendance to get tested.

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But look at the timing. They’d all already been infected over a week ago. What’s the point?

Boston

This is a graph of the amount of Covid found in the wastewater in Boston. If you have links to similar other measurements taken regularly, share them in the comments.

That spike on the right has two of the three highest single-day measurements, and they were the last two days of data reported. This can’t represent Delta cases alone unless it’s a data error, because the rise is too rapid given what we know about conditions. If it’s Omicron and the measurements are what they superficially look like, it means Omicron is already primary in Boston, and there’s a huge spike in infections already, that hasn’t been matched with a surge in hospitalizations or positive tests.

There are other outlier measurements on the graph, so probably these are outlier measurements. But if they hold up over the next few days, then what would that mean?

If they hold up and there isn’t a wave of new hospitalizations quickly, then this is the best of all possible worlds. Omicron would be spreading like wildfire, but be much milder than previous waves. We’d be able to get through it quickly, and have no realistic way to prevent it, so all we could do would be to shield the vulnerable to the extent we could, use what treatments we have that we can get to be legal, and come out the other side.

If they hold up and then the hospitalizations follow then things are quite bad, it’s hitting us now and we’re in a crisis situation. There will be pressure to do very foolish things to try and stop something that will be utterly impossible to stop, and Paxlovid will arrive too late to make much difference.

If they don’t hold up, that’s mostly what I expect. Either it’s bad or weird data, or Omicron somehow puts a ton more virus into the wastewater, and then there’s nothing to see here. That’s what I mostly expect, but note that the measurement happened in both the north and south sections, which didn’t happen on the previous big fluke measurement.

Here’s a graph in Missouri that doesn’t yet show a similar spike, but is updated less often and is from a less internationally connected area. As you’d expect, no spike.

There’s also this Dutch source, which shows no spike yet.

Unfortunately that was the only other ones I found so far. There’s implications in the next section’s threads that such data is available for the UK but I’m not sure where to find it.

SGTF in the UK

Oops. As of December 3.

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Too Little, Too Late

Scott Gottlieb warns us not to act prematurely, despite it already being too late:

Noting that companies, including Pfizer, were doing so, Gottlieb said, “This is going to be a really critical decision because what we’ve seen in the past, for example, when we engineered a vaccine to specifically target 1351, the old South African variant, was that vaccine worked well or appeared to work well against 1351 but didn’t appear to provide as good coverage against all the other variants.”

“And there’s reason to believe that as you develop vaccines that are very specific to some of these new variants, they may not work as well against the full complement of different variants that we’ve seen. So you wanted to try to stick with the ancestral strain, the Wuhan strain, in the vaccine, I think, as long as possible,” Gottlieb continued.

I don’t want to pick on Gottlieb because he’s better than most, but this is emblematic of a system that never acts in time when it matters. Given the logistical timelines involved, even if we made a full best effort starting today, we’d largely be too late getting the new Omicron vaccines to those who need them. Waiting until Omicron is already dominant or far enough on its way to make it the kind of obvious being looked for here is a way for exponential growth to laugh in your face every single time.

Exponential growth doesn’t permit one the luxury of being exactly on time. Either you’re too early or you’re too late. You either move now and have some chance to do some good, or you’re way too late.

Here’s another Washington Post headline showing the extent to which we will get there too late and with too little.

New coronavirus vaccine may eventually be needed for omicron variant, BioNTech CEO says

“I believe, in principle, we will at a certain time point need a new vaccine against this new variant. The question is how urgent this needs to be available,” CEO Ugur Sahin told a conference hosted by Reuters.

He also said the current vaccine could be adapted “relatively quickly” if needed to combat the omicron variant, but cautioned that more research was still required.

If that’s the attitude of the CEO of BioNTech, that should both put to bed any rumors that the vaccine companies are trying to trick us into taking extra vaccines to make them more money (which was already absurd, and no doubt will never be put to bed no matter the evidence, but shrug) and also put to bed the hopes that the new doses could arrive in time. This essentially indicates that the serious push will only begin after Omicron is a large share of cases and then it will be far, far too late.

Similarly, here’s the head of the CDC saying true things that complete miss the point and the urgency.

“We know we have several dozen cases and we’re following them closely. And we are every day hearing about more and more probable cases so that number is likely to rise,” Walensky said on “This Week.”

If something is certain, it is also probable.

“We have about 90 to 100,000 cases a day right now in the United States, and 99.9% of them are the delta variant,” Walensky said.

This is probably true, although I think there’s a non-trivial chance Omicron is already over 0.1% of cases, but it won’t stay true for long and isn’t all that relevant.

South Africa

Gauteng hospitalizations:

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The person linking to this thought it was bad news, but given the rate at which cases are increasing, it looks to me like good news. Not easy to interpret, but the hospitalization rate per infection is what matters here. Note also that positive test rate is now >20%, which means a higher percentage of cases are being missed than before.

Here’s some South African data by province:

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If I’m reading both charts correctly, the ratio here seems quite good, actually.

The December 2 version of the summary graph from Gauteng.

The thread that was in gives some caveats on the hospital numbers, they get revised upwards later and lag cases, but still.

Then here’s the chart from December 4.

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Preliminarily it looks good, but I still don’t feel we can conclude anything.

Here is a summary of patient profiles from Gauteng. In general, the patients are healthier than one would expect, even accounting for age. I found this especially interesting:

In summary, the first impression on examination of the 166 patients admitted since the Omicron variant made an appearance, together with the snapshot of the clinical profile of 42 patients currently in the COVID wards at the SBAH/TDH complex, is that the majority of hospital admissions are for diagnoses unrelated to COVID-19. The SARS-CoV-2 positivity is an incidental finding in these patients and is largely driven by hospital policy requiring testing of all patients requiring admission to the hospital.

Think about what this implies. If a majority of the cases that have Covid-19 were admitted to the hospital for unrelated reasons, then either Covid is somehow causing all these ‘unrelated reasons’ without making the patients sick with Covid in an obvious way, or the chance of hospitalization in the window when you have Covid less than doubles. You’re more likely to be admitted to the hospital and happen to have Covid, then for Covid to send you to the hospital.

If that’s true, then that seems like a very mild disease indeed. Anyone else want to take a shot at interpreting the data here?

Case Numbers Going Up

There was a superspreader event in Oslo.

OSLO (AFP) – Norway introduced new anti-Covid measures in greater Oslo on Thursday (Dec 2) after a suspected cluster of Omicron cases emerged among dozens of vaccinated people.

Face masks will be mandatory in public transport, shopping centers, shops and taxis when social distancing is not possible.

People will have to work from home if possible and the number allowed to gather at private indoor events will be limited to 100, the government said.

The announcement came after the Omicron variant was detected in at least one of “50 to 60” people who tested positive for Covid-19 after a Christmas dinner in Oslo last week.

That represents about half of the 120 people – all vaccinated – who attended the event organized by solar energy producer Scatec.

Superspreader events are outliers by definition but that’s almost half of the people attending all of whom were vaccinated. I do not believe that is a thing that could have plausibly happened under Delta. They haven’t officially confirmed these were all Omicron cases yet, but it seems unlikely they aren’t mostly or entirely Omicron.

The response of tightening restrictions in the area seems unlikely to accomplish much.

Other Threads and News

Noah Smith’s second summary thread. I intentionally read this last. It’s solid, but doesn’t contain much additional information.

Thread illustrating the range of possible properties of Omicron, and how its infectiousness interacts with its immune escape properties. Correctly suggests that any efforts need to start now to have any chance of arriving in time. Doesn’t think Omicron is likely to be less infectious, but that seems like it was mostly priors.

Jose Caballero thread from December 2.

Trevor Bradford thread estimating potential properties, concludes this is likely going to spread very fast.

Poll claiming that Americans are quite open to additional measures against Omicron.

Note how crazy it is that there are 68% of people support mandatory vaccination but only 70% (2% more!) people support encouraging booster shots. There are almost no people with the ‘encourage people to do useful things but don’t force them to do those things’ position. Sigh.

Bad news on monoclonal antibodies (WSJ), but isn’t surprising given what else we know.

An attempt to synthesize what we know while incorporating Metaculus predictions, from December 2. Included for completeness, but nothing new or surprising.

Probability Updates

Chance that Omicron has a 100% or bigger transmission advantage in practice versus Delta: 35% → 65%.

Note that I am interpreting this as ‘in practice in the United States of America,’ or in Europe, rather than the transmission advantage in an immunologically naïve person.

We have the growth in cases in Denmark and around the world, the paper from South Africa, the continued case growth in South Africa, the wastewater in Boston (even if I’m not sure if this is ‘real’ yet) and the superspreader events in Oslo and at Anime NY. We have cases being found within a few days, in multiples, from nothing, across most countries that checks for cases.

After a certain number of exponential curves, it’s hard to deny what you are looking at. I’m not willing to go super high on this yet because 100% is a very high threshold, and variants often have large advantages when they are first spreading that don’t carry over to later on, but this seems more likely than that.

Chance that Omicron will displace Delta as most common strain: 85% → 95%.

With the extent of immune escape we’ve seen and the rapid growth in cases, I don’t see a plausible path to this not happening. The likelihood ratios this week were very high, and model or systematic error is the reason I’m not going higher than this.

Chance that Omicron is importantly more virulent than Delta: 8% → 5%.

Chance that Omicron is importantly less virulent than Delta: 35% → 50%.

If Omicron were more virulent than Delta that would make our observations so far very unlikely. It’s not impossible that this is the case and the huge number of young people infected and number of breakthrough infections and reinfections are disguising it, but this becomes less likely over time.

With respect to being less virulent than Delta, there’s a bunch of suggestive findings that have cases or implied cases rising without a rise in hospitalization. I am increasingly hopeful that we did indeed get lucky on this and anyone saying ‘no evidence’ here has very little leg to stand on.

However, I still think this is only a coin flip, because the data we have is too confounded by too many factors, as discussed above.

Chance that Omicron is importantly immune erosive, reducing effectiveness of vaccines and natural immunity: 80% → 95%.

Will the CDC label Omicron a variant of high concern before 2022? 15% → 13%.

The data on immune erosion seems very clear. There’s enough uncertainty it’s not fully over (and I am moving fast enough that I admit I’m not being all that principled or accurate in my various 5% chances here in terms of exact percentage) but I don’t see how we get the data we’re getting without this being the case.

As for the label of high concern, that’s a question of how and how fast the CDC works and I grow increasingly skeptical that they will ever do anything with speed, and the prediction market on this has been up for longer as the deadline grows closer.

Chance that Omicron means the vaccinated and previously infected are no longer effectively protected against severe disease until they get an Omicron-targeted booster shot: 3% → 2.5%.

The data doesn’t make sense if this is false but I don’t want to get too confident too quickly.

Chance we will be getting boosters modified for Omicron within 6 months of our previous booster shot: 30% → 30%.

It looks like it will take three months to complete the whole process and get the new vaccine formulations approved, at which point boosters will become available, and by the time any given person can in practice get a shot, it will likely be more than 6 months after their last shot unless they delayed on the booster quite a bit, which likely means they’re not high priority. So my guess is in practice this won’t happen, but the whole thing is odd and ambiguous. I should likely formulate a more precise question that better answers what we care about.

Chance that Omicron is less vulnerable to non-antibody treatments like Paxlovid or Fluvoxamine: 3% → 3%.

No new information.

Chance we are broadly looking at a future crisis situation with widely overwhelmed American hospitals, new large American lockdowns and things like that: 12% → 17% (EDIT: Should have been at least 25%).

I’m going back up on this based on a higher certainty that Omicron is the real deal, and the higher chance it’s a very fast version of the real deal that is likely to peak quite high and overwhelm the hospitals temporarily. If that happens, there’s going to be a lot of pressure for extreme measures. What’s keeping this from rising more is the possibility the cases will remain mild.

EDIT: Commenters pointed out that while this seemed like a big adjustment, it definitely wasn’t enough and the other updates implied a bigger change, to at least 25%, depending on the exact definition and how many components need to apply. 

Will Omicron be >1% of all cases by the end of the year? 70% → 93%.

The market on this is trading too low. There’s very little chance this does not happen given the new timelines. There’s still some uncertainty here, but it’s declining rapidly, and it’s mostly model uncertainty.

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91 Responses to Omicron Post #4

  1. shacklesburst says:

    Small formal correction: Ugur Sahin is the CEO of BioNTech, not Pfizer. BioNTech are the actual developers of Comirnaty who partnered with Pfizer for production, logistics and trials. They’re not a Pfizer subsidiary. However, the bigger brand recognition of Pfizer obviously means that the vaccine is mostly known as the “Pfizer vaccine” outside of Germany.
    Your point still stands, obviously, maybe even more so than if the actual CEO of Pfizer (Albert Bourla) had made it.

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  3. CP says:

    British referral from Cummings here, though from some time before covid, in fact.

    I’m very limited in my ability to understand all this beyond the very basics (ask me one on sport, as my old Grandad used to say), but I understand South Africa tests all in-patients. You go in with a broken leg, they test you, you test positive. Without your broken leg, you’d not be in hospital and there’s a good chance that positive test never exists. I’m sure I’ve seen the figure 76% of people in hospital in Gauteng with a positive test aren’t in for anything related to covid. Which may be me clutching at straws but seems terrific news…

    • TheZvi says:

      I didn’t think it was that high, more like 50%, but yes that’s my understanding and I reasoned about it explicitly a bit.

      Another possible explanation is: You test positive several days before you show Covid symptoms, so if things are growing super fast, then most of them haven’t had time to show symptoms yet (and if we tracked them carefully, we’d learn something!)

      • jhfgliwh says:

        In the patient profiles page[1], they use breathing room air as a proxy for incidental covid admissions, and the various hospitals report 66 – 83% on room air.

        [1]: https://www.samrc.ac.za/news/tshwane-district-omicron-variant-patient-profile-early-features

      • Aristophanes says:

        I’ve also seen the 76% incidental hospitalisation number (think it was in a SA Health report). FWIW this is also consistent with the age profile of hospitalisations being dramatically younger with Omicron, which has also been reported in the data. This is a positive thing – the easiest way to get a flatter age profile is if most hospitalisations are incidental

        This strikes me as a exceptionally important number. There’s a few pieces of evidence that are weakly suggestive that Omicron is less virulent than other variants etc, but the issues of lags (both real and in reporting) remain. E.g. daily hospitalisations and deaths seem low relative to cases “at comparable points in previous waves” but if you misestimate reporting lags by a few days you get a 2x error.

        However, the incidental hospitalisation number should be pretty reliable and substantially less sensitive to reporting lags (both “true” and incidental hospitalisation reporting will lag, so the ratio lags less).

        I think the way to think about the incidental hospitalisation numbers is as follows.
        – For every n people who are infected with Covid, you get an incidental hospitalisation. (This is pretty constant over time and variants, because it just tells you the multiple of “how often do people go to hospital for unrelated stuff” and “how long do you test positive for”)
        – For every j people infected with variant J, you get a “true” hospitalisation.
        – Thus you get a incidental hospitalisation rate of 1/n / (1/n + 1/j) = j/(j+n)

        Thus the incidental hospitalisation rate is very informative about j. Note how non-linear it is – this is a case where the odds ratio is relevant. An incidiental hospitalisation rate of 76% means you get 3 incidentals for each real. By comparison, (making up numbers out of thin air*), if the incidental hospitalisation rate for Delta was ~10%, you get 9 reals for each incidental. That would make j(Omicron) 27 times larger than j(Delta) i.e. Omicron 27 times less likely to put someone in hospital.

        Now, to be clear, the 10% is a made up number (although it seems plausible – would Twitter ban someone who said “20% of Delta hospitalisations are incidental”?) and the 76% might prove too optimistic. And the rising share of cases that have some form of protection from vaccine or (more likely in SA) prior infection will be increasing over time, which will be contributing. But that leaves a large wedge to explain.

        * There are various studies/ reports that suggest for kids, about 50% are incidental up to and including Delta. Presumably much lower for older age groups. 10% is a semi-randomly plucked number for illustration.

  4. dannymo says:

    Great post as always, Zvi. Advice request: My wife and I are expecting our second child the last week of December, and were planning to do a hospital birth (in the Bay Area). Are we at “induce early” levels of concern for hospital overwhelmed-ness? And is there any real data on the danger Omicron poses for newborns? Thanks in advance!

    • dannymo says:

      I should mention, my wife and I are both vaccinated/boostered, and our 6-year old is also fully vaccinated.

    • TheZvi says:

      There’s no data on Omicron vs. Delta for newborns but it’s probably similar. I’d be much more worried about lack of hospital resources due to overload, which happens faster, than the risk of infection for you or your newborn, but I can imagine scenarios where moving up things one week is a good idea, if the doctors will allow it. Basically if Omicron is at 10% you don’t want to wait another week…

  5. Dan Sacks says:

    On interpreting the hospitalization data: in the US at least, some states define a COVID hospitalization as “admitted to the hospital” and “has a positive COVID tests.” So for example if you are admitted for labor and delivery, tested for covid as part of the routine standard of care, and turn out to be covid positive but totally asymptomatic, some states will count that as a hospitalization. (About 60% of states in mid 2020 used confirmed cases only, not covid symptoms, to count covid hospitalizations.)

    One implication is that, for hospitalizations measured this way, if Omicron is extremely widespread and also relatively mild (especially among vaccinated/prior infected folks), then we’ll see lots of non-severe covid hospitalizations.

  6. jhfgliwh says:

    It’s a messy datasource, but I think wastewater data from Tshwane, Gauteng tells an interesting story as well [1] (bottom chart of page 6). It has already increased to delta peaks, and could even be starting to slow (or at least seemingly not continuing to increase exponentially, but not enough data points to tell). Far ahead of where it was at a similar case count in the delta wave. Confounding factors like viral load/case obviously, but might be another weak signal that case counts are being undercounted relative to prior waves, implying milder/asymptomatic cases that folks aren’t bother to test for covid.

    [1]: https://www.nicd.ac.za/wp-content/uploads/2021/12/Wastewater-based-epidemiology-for-SARS-CoV-2-surveillance-in-South-Africa-week-47.pdf

    Link for future reports: https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/surveillance-reports/weekly-reports/wastewater-based-epidemiology-for-sars-cov-2-in-south-africa/

    • TheZvi says:

      For now website isn’t loading, but that sounds like a great source once that gets fixed.

      If things are already peaking, that’s exceptionally good news – the exception to no news is good news is that at some point the wave always stops in its tracks for no obvious reason, and we’re saved, and we never quite know why.

      • jhfgliwh says:

        Their website has been having a lot of outages over the last 24 hours, I imagine a large amount of recent interest in their datasets. FWIW it’s still responding for me so may need to just try a couple more times.

        I think anecdotal evidence like 60/500 testing positive on the two SA flights to holland, ~4% of a festival testing positive at entrance testing, 70-80% of covid hospital admissions being incidental, are also weak signals in that same direction of there being quite a dramatic attack rate already, at least in some parts of SA.

  7. Schub says:

    Wasterwater data from Switzerland can be found at https://www.eawag.ch/en/department/sww/projects/sars-cov2-in-wastewater/ e.g. specifically from Zurich area (large, urban, long time data set) https://sensors-eawag.ch/sars/zurich.html

  8. robryk says:

    https://sensors-eawag.ch/sars/overview.html is the site of Swiss wastewater monitoring. Red lines represent wastewater counts, blue line is the count of positive tests in the area served by the plant in question. You can get CSV files with daily values from the per-plant pages. Note that all the values in the graph are per-capita. https://sensors-eawag.ch/sars/zurich.html and https://sensors-eawag.ch/sars/geneve.html are the two plants that serve ~500k each, the rest are smaller.

    https://www.covid19.admin.ch/en/overview is the website that provides positive test counts, hospitalization counts, death counts, vaccination counts for Switzerland in general (and for each Kanton separately).

  9. John Schilling says:

    Discussion of Omicron virulence seems to universally note that the young age of the infectees is an important cofounder. That was certainly the case a week or two, when we were first trying to understand this new variant – South Africa does skew young. But Omicron has in hindsight been circulating in Africa for a month or longer; they do have *some* old people there, and I haven’t heard that they sealed them all in iso-pods for the duration. And now we’re seeing significant numbers of cases in Denmark, Norway, Minnesota…

    Is it still the case that all the outbreaks we have data for skew towards a younger-than-normal distribution? If so, is it possible that this might not be a coincidence and that Omicron, in evolving for greater transmissibility and/or immune escape, might have developed features that directly or indirectly make it preferentially infect the young?

    • Ariel says:

      I think that Omicron didn’t have enough time to mix through the population, so most cases today are among people that travel, which skew young. I remember that sort of behavior in the earlier waves in Israel, where superspreader events among the 12-30yo cosmopolitan group seed each outbreak, which becomes more uniformly spread a few weeks afterwards.

  10. JM says:

    Since we are talking about wastewater surveillance so much, it seems worth noting that higher viral load is one component of what could increase infectiousness in addition to immune escape etc. So we should probably expect some multiplier on the wastewater/case ratio by default if more virus is being produced. You mention it in passing but wanted to point out that this wouldn’t be a surprising effect, and would make it challenging to determine prevalence using this measure.

  11. Chris Lawnsby says:

    Thank you so much for doing these posts– they are the absolute best.

  12. Ariel says:

    Funny thing – Omicron seems to be spreading about as fast today in today’s populations (doubling every 3.5 days or so) as classic COVID is spreading in naive unprotected populations back in February 2020.

    If the current theater measures are orthogonal with lockdowns, which I strongly suspect, then a 2020-style lockdown will give us 2020-style results – allowing us to keep R below 1 for about half a year, which should be enough for a vaccine. The sooner we do this, the less omicron cases we’ll have to suffer.

  13. axis says:

    Why doesn’t anyone mention the possibility that Omicron infection doesn’t protect you against Delta?
    If Omicron were really as fast spreading and mild as many hope, that still doesn’t necessarily mean it ends the pandemic right there unless it protects you against other strains – ie you could have Omicron and Delta spreading simultaneously as if they were two separate diseases

    • Daniel says:

      This is possible, but seems much less likely (at any important level) than infection by Delta failing to protect against infection by Omicron. In one case there’s strong selection pressure, while in the other case you just have to get lucky. And I suspect the immune response is too complicated for us to expect a simple symmetry where the amount of cross-immunity between two viruses is just a function of how different they are or something like that.

    • A1987dM says:

      On the other hand, the societal control systems act to keep the *overall* R(t) close to 1, meaning that any strain non-negligibly less transmissible than the dominant one will have R(t) non-negligibly less than 1 and be driven to extinction. There were no major influenza epidemics in the southern-hemisphere winter of 2020 or in the northern-hemisphere winter of 2020/21 even though COVID and influenza don’t give any immunity against each other.

  14. Ariel says:

    Funny thing – Omicron COVID seems to spread about as fast in today’s populations (doubling per 3.5 days-ish) as COVID classic in February 2020’s naive unlockdowned populations.

    This means that if we do a March 2020-style lockdown, we can probably keep R below 1 (supposing I’m not double-counting interventions that we’re doing today and we also did in March 2020, but I can’t think of many) for a while, enough to get the booster rolling.

    Not sure that would be the wisest idea – I’m mostly sure the die have been cast in early 2021, when vaccines have slashed the severe disease/infection rate and COVID has became normalized enough to the person on the street they aren’t scared of its effects.

    Also, Long COVID seems less worse than in late 2020 as we both gained more experience with it, that ONS study has been cut to half, and it seems vaccination cuts it by another half.

  15. Anonymous says:

    This is a local wastewater graph.
    https://datastudio.google.com/u/0/reporting/6594f63b-b894-4baa-aa36-23ecb0abce65/page/p_smkfgnxulc

    It looks “real”, in that this is far outside the apparent variation in previous results, but I have no idea how it could be real if the wastewater:case ratio isn’t significantly inflated for some reason with Omicron. Exponential growth is fast, but it shouldn’t be that freaking fast.

  16. dearieme says:

    Niall Ferguson – the historian, not the Astrologer Royal – is fearful that omicron will sicken children.
    https://www.bloomberg.com/opinion/articles/2021-12-05/omicron-sounds-death-knell-for-globalization-2-0?srnd=premium&sref=ZMFHsM5Z

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  18. Brett Bellmore says:

    News that Omicron didn’t seem to be blocked by prior Covid infections pushed my estimated cost/benefit ratio into favorable territory, (Especially given that my bout is approaching a year ago.) so an hour ago I got the Moderna shot.

    We’ll see if I’m regretting that decision by tomorrow.

  19. Humphrey Appleby says:

    What is your best guess on Omicron and children (under 5)?

    • TheZvi says:

      Same as Delta, and I’m confused why it’s a question.

      • Dave Kasten says:

        Probably 2 sources:
        1. People just imagining the “what could be worse than the previous waves” and tacking this on — especially since anyone who read a book about influenza knows that kids get hit hard by pandemic flus
        2. For those more tuned in, there was some worrisome early reporting from South Africa about the number of kids with COVID in the hospital, before it turned out that the vast majority of those cases were the “they’re in for something else, we tested them as per protocol and discovered incidentally they have a very mild case of Omicron” as you describe

  20. Robert Rounthwaite says:

    It seems that you are using the term “virulent” to mean harmful, irrespective of its communicability. Unfortunately, that term is kind of ambiguous, at least to normal folks like me — here are two definitions: “(of a disease or poison) extremely severe or harmful in its effects.” but “(of a pathogen, especially a virus) highly infective.”

    • A1987dM says:

      “Virulent” comes from the *Latin* “virus”, which meant “poison” not “replicator”, and long predates the English “virus” which wasn’t used with its modern meaning until the 20th century.

  21. Daniel says:

    Regarding virulence: It looks to me like there’s a real risk of a Simpson’s Paradox here. It seems that people infected by Omicron are disproportionately vaccinated or previously-exposed, relative to people infected by Delta. The death rate within each subgroup could be much higher for Omicron than for Delta even if the overall death rate goes down. To estimate the magnitude of this effect, we can start by assuming essentially all deaths occur in immune-naive populations. Does anyone have an estimate for how the fraction of infected individuals who are immune-naive differs between our Gauteng Omicron data and our Delta data?

  22. Craken says:

    I don’t yet have much confidence in the virulence level and only lean slightly toward optimism. It’s difficult to tell in the early days, for many reasons you note, especially given that people with Covid immune protection have quite low mortality (~0.1%). Many thousands of well characterized infections may be needed to distinguish between 0.05%, 0.1%, 0.2% mortality. I’d guess more virulent at 15% chance and less at 25%–and 60% about the same.

    Otherwise, I generally agree with your predictions and the overall consistency amongst them looks solid except for these two: the chance of Omicron being >100% more infective and the likelihood of an Omicron crisis in America. You make the first 65% and the second 25%. I think the likelihood of the second hinges significantly on the likelihood of the first: an ultra-infective strain among vaccinated/previously infected could increase absolute infection numbers to an intolerable peak, even assuming it’s half as virulent as Delta. Everyone is apparently exposed to infection again, unlike the Delta wave when most had significant immune protection from infection. And this is happening at the worst time of the year. My doubts about the timeliness of Paxlovid have also increased. I’d guess 70% hyperinfectious chance, 50% crisis. I give even odds that Omicron will be 10% of cases by year end, with crises declared in January and an Omicron monopoly by February.

  23. Kevin Puetz says:

    Wastewater data for Des Moines, IA is at https://dmmwra.org/CivicAlerts.aspx?AID=46. Bi-weekly (Mon/Wed) though the most recent data is Dec 1 right now.

  24. shakeddown says:

    Minor positive data point: Israeli cases are still steady (up to about 527 nationwide from 456 a month ago), and still mostly hitting the mostly-unvaccinated under-20 age bracket, and hospitalizations are still falling. We wouldn’t really expect enough Omicron cases to substantially move this (either the total case numbers or a higher rate of infections hitting the already-vaxxed older population) yet, so not updating on it much so far, but we do know Israel already had some omicron cases so seeing if this changes should give good information.
    (source https://datadashboard.health.gov.il/COVID-19/general)

  25. Vin says:

    I wonder if the probability that omicron fully takes over from delta may be too high: cross-immunity backwards from omicron to delta may also be low, in which case omicron will temporarily dominate as it surges, and then there may be a long-term delta/omicron competition based mostly on intrinsic transmissibility, not so much competitive evasion. So yes on your probability in the short term, but not so clear in the medium term (and the medium terms comes quickly with omicron).

  26. martinz says:

    Isn’t the most likely reason that symptoms appear milder in SA that the vast majority of people in SA have some protection from vaccination or prior infection? In other words, perhaps the data is consistent with Omicron being no less virulent than delta for a person without antibodies – it’s just that it has some escape so people are being infected who would not get delta.

  27. Basil Marte says:

    > “I believe, in principle, we will at a certain time point need a new vaccine against this new variant. The question is how urgent this needs to be available,” CEO Ugur Sahin told a conference hosted by Reuters.
    He also said the current vaccine could be adapted “relatively quickly” if needed to combat the omicron variant, but cautioned that more research was still required.

    I might be naive, but I’d expect the CEO of BioNTech to be competent in *some* fashion, and I’m wondering whether the above partially corresponds to “the boat ride” tweets. Half the text is a pretense that “it is not known” to him or anyone else whether updated vaccines will be necessary. However, it seems compatible with:
    – they are already working on updating it;
    – this quote will make calls for updated vaccines more sayable;
    – they expect that when (if) tribal consensus flips to updated vaccines being “necessary”, they will be able to unveil the results of having already started working on it by now, conditional on not running into problems.

  28. RM says:

    > Also note that this finding rules out the possibility that most South Africans were already infected. If that was true, then being known to have been infected wouldn’t provide much additional protection.

    I don’t get what this means? Can someone explain this more slowly to me?

    • TheZvi says:

      Assume we exclude the vaccinated and then have three categories:
      X – known to have been infected previously
      Y – infected previously but not known
      Z – never infected

      If X has a big edge over (Y+Z) then (Y+Z) must be largely Z rather than Y. If Y is most of (Y+Z) then both groups are mostly already infected, and so there wouldn’t be much difference.

  29. Egg Syntax says:

    Hi Zvi (& hi lots of British people), can you clarify this? I can interpret it in two opposite ways:

    “Note that protection from an Omicron infection, for a future second Omicron infection, would probably still return to previous levels.”

    • TheZvi says:

      I simply meant that Omicron can reinfect if you had Delta or an old vaccine, but once you recover from Omicron you would presumably be as immune to that as you would be to a second delta infection.

      • Egg Syntax says:

        Makes sense. So I think our current understanding is as follows, where X => Y means “a past infection with strain X provides this amount of protection against strain Y”, and the point you were making above is #3. By all means let me know if you think I have this wrong!

        1. Delta => Delta : very good, ~ comparable with vaccination.
        2. Delta => Omicron : evidence increasingly suggests worse than #1.
        3. Omicron => Omicron : very good, you currently think.
        4. Omicron => Delta : very unknown; if v. good than Omicron may be great news.

      • Egg Syntax says:

        Heh, after all the time I spent carefully lining that up into table format, WP eats my extra whitespace ;P

      • TheZvi says:

        Yeah basically. My assumption is O->D and D->O are both ‘some protection against infection, strong protection against severe disease’ and O->O = D->D.

    • jp1 says:

      trying a version of the table in a pre:

       1  ->  2  after strain 1, protection vs 2     
      -----------------------------------------------
       d  ->  d  strong, like vaccine                
       d  ->  o  weak vs infection, strong vs severe 
       o  ->  o  strong, like vaccine                
       o  ->  d  weak vs infection, strong vs severe 
      
      • jp1 says:

        I posted at the second level of comments for width. wordpress.com themes are obsessed with narrowness.

        WordPress also filters out html elements unpredictably. “pre” seems to be allowed, this time at least.

      • jp1 says:

        … and as an html table below, it got filtered, making a mess.

        Sorry. Please delete that recent comment “… and as a table in html:”.

        I first tried it in a comment on a wordpress site with defaults, and it came out well. Your settings here are different.

    • jp1 says:

      … and as a table in html:

      1
      ->
      2
      after strain 1, protection vs 2

      d
      ->
      d
      strong, like vaccine

      d
      ->
      o
      weak vs infection, strong vs severe

      o
      ->
      o
      strong, like vaccine

      o
      ->
      d
      weak vs infection, strong vs severe

  30. Seb says:

    Wildly off topic, but did you see Flores just called you the greatest deck designer of all time? Or, at least claims you’re “widely considered” as such.

    • TheZvi says:

      I consider this an uncontroversial position for the time period I was active, so to me the question is whether things happened after I stopped and there’s a new champion. Flores (and Chapin) in particular have held this position explicitly for a while.

      • Seb says:

        Well, as he’s still saying it in print now, I’m going to assume nothing significant enough has happened in the intervening years to take that crown from you, so kudos!

  31. Ginger & Honey says:

    Hey Zvi! I was double-vaccinated with Pfizer in July 2021; I think that young men like me (30) might be at a higher risk of cardiovascular complications from the vaccines that it is admitted by the mainstream, though not as much as typical anti-vaxers claim.

    It seems that omicron will replace delta due to its high infectiousness. Given that:

    – it seems to pose less health risks (milder infections),
    – that the infection might be unavoidable even with the strict measures,
    – that the combination of paxlovid/fluvoxamine might become universally accessible,
    – and that my young age (plus some remaining vaccine-related immunity) may provide a large degree of protection,

    then maybe it’s good to outwait the delta wave without a booster (in my case, 5% infection risk before April 2022), and consider late Spring 2022 as a proper time to drop out all the safety measures and act as if the virus does not exist?

    • TheZvi says:

      I’d get the booster anyway. If you don’t get the booster, I would still not see spending several months isolated as a worthwhile sacrifice, but some degree of caution isn’t crazy. And if hospitals are about to get overwhelmed for a bit, that’s a good time to use a relatively high amount of caution, of course.

      • Ginger & Honey says:

        Yes, my local healthcare is currently under a significant strain, plus the pandemic made me adopt a rather isolated lifestyle. It’s cold and smoggy outside, all cool people are far away/online, I can ship most of the groceries to my house, locals encountered on a daily basis seem way more abrasive and hostile than before 2020.

        I worry that this constitutes a major and possibly irreversible mental shift, and that everyday life will never feel the same. :(

      • TheZvi says:

        Look, the pandemic sucks, getting Covid isn’t great, but what matters in life is still what matters in life. You gotta get out there, see people, live. If you can’t do it wherever you are, I’d urge you to do it someplace else instead. Yeah, people are harder to get to know now, but you gotta push through that, it’s your life and it’s ending one minute at a time and all that.

    • Dave says:

      Why not get a J&J booster?

  32. Jeff Kaufman says:

    I think the Boston growth really can be just Delta. Wrote this up: https://www.jefftk.com/p/interpreting-the-biobot-spike

    • Anon says:

      Agreed, I live in Boston, and universities like MIT and Harvard are doing a ton of surveillance testing and a fair bit of sequencing from what I understand. It would be shocking if there was this level of Omicron spread without the universities realizing it, and the current high case rates are consistent with just a lot of Delta spread.

  33. Kat says:

    If omicron is very likely more infectious and very likely less severe, and its global domination is just a matter of time, shouldn’t we actually encourage quick omicron transmission (at least passively, by removing/opposing restrictions regarding omicron hotspots) in order to save more lives?

    • TheZvi says:

      Not until we’re as ready as we’re going to be, and Omicron vaccines and Paxlovid both need more time. Also you want it to hit under better weather. So for now postponing is good.

  34. Ninety-Three says:

    “Note how crazy it is that there are 68% of people support mandatory vaccination but only 70% (2% more!) people support encouraging booster shots.”
    If you poll people on abortion you will find *more* support for “legal at any point” than “legal in the third trimester”. My read of this Covid stat isn’t that no one believes in non-mandatory encouragement, it’s that people treat these polls like a mood affiliation survey rather than a series of statements about the physical world.

  35. So I’ve been really puzzled about 2 things (well, way more than 2, but these 2 in particular):

    (1) Why hasn’t there been an official FDA endorsement of the EUA for molnupiravir, and if the CDC is required to weigh in, why hasn’t that happened?

    (2) Why isn’t the hearing for paxlovid on the FDA AMBAC calendar of upcoming meetings?

    Now, (1) is still a puzzle, unless everybody is just lackadaisical because of the “wobbly” efficacy. But (2) might have an answer, based on a news report today:

    S Kimball, “Pfizer will submit full data on Covid treatment pill to the FDA in a few days, CEO says“, CNBC, 2021-Dec-08.

    Summary: It appears the submission Pfizer made last month was a submission of part of the clinical trial data, a step in what’s called “rolling submissions” where they continuously update the FDA until either they’re done or the FDA says “Please stop, that’s plenty.” The absolute, definitive, director’s cut version will be submitted “in coming days”. Everybody’s treating this with a “high degree of urgency”.

    So, suppose submission happens by Friday 2021-Dec-10. Then you have to give the FDA a week to look it over, re-run all the analyses, check everything, write up a formal report — if that takes a week, people will be burning the midnight oil. So that would be 2021-Dec-17. That means the AMDAC committee meeting might happen the next week, say Monday 2021-Dec-20, by my count.

    If the FDA acts quickly on their recommendation, that means an EUA the week of the 20th.

    That’s all extrapolation on my part, based on Albert Bourla’s claim of submission “in the coming days”, so it’s a bit of skating on thin ice.

      • [Sorry for the delay in answering. Life intervenes: yoga class, holiday gathering with the vax’d and mask’d, get a pizza to take home for dinner… the usual.]

        First, I try very hard not to give medical or financial advice ex familia, other than to express an opinion… or two… or three.

        Second, as far as wagers in general and prediction markets in particular: I’m at least a generation older than you, and grew up in small-town Midwest which is worth at least another generation. Back in those days, “gambling” had more significant social stigma, which results in me having all sorts of inhibitions I’m disinclined to wrestle with. Also, I’m acutely aware that I would have no idea what I’m talking about. So I will respect the pseudo-proverb I learned in about 1970: “it is better to be silent and be thought a fool, than to open one’s mouth and remove all doubt”.

        With that out of the way as prolegomena, I do know one or two things about drug research, development, and regulatory submissions (though this is also a rebuttable assumption, since I am a research guy, not clinical development or regulatory.).

        The process I outlined above is the best possible timeline that I can imagine. I assumed there are absolutely no surprises in the data, that Pfizer and the FDA will re-analyze it independently and find no differences, that both Pfizer and the FDA will assign a team of 10-20 highly experienced hands to prepare the submission documents & slide decks without interruption, that the AMDAC members could be rapidly convened with short notice on the verge of the year-end holidays, and that FDA administration will accept an EUA verdict immediately. (NB: they still haven’t formally accepted molnupiravir yet.)

        That could happen, if everybody were totally focused on the task, and absolutely nobody dug in their heels or tried to be disruptive. (No “Joe Manchin” or “Kristen Sinema” syndrome, if you can stand the irony of that.)

        Even if something goes wrong, there’s about 1 week of slack until the end of the year to apply pressure to the sticking point and still make it by the end of the year.

        What are the chances? My WAG (wild-ass guess): 50% chance it goes perfectly because the data is good and everybody knows this is important so they’re in the spotlight; bump up to 60% if we allow for a screw-up and take another week?

        I am not at all confident in those numbers, so see what you think yourself. Sorry that’s vague; best I’ve got.

    • Martin Z says:

      There are reasons to be concerned about molnupanavir, for example:

      • Oh yes, absolutely!

        I blogged about the FDA AMBAC hearings on molnupiravir, and about how much drastically worse the second half of the trial had to be to knock the efficacy down from 50% to 30% (the second half had to have a negative efficacy of -32% to make that happen!).

        Either the first half of the trial and the second half of the trial were 2 drastically different populations and we don’t have a biomarker to tell who is who (which would be very troublesome, since the treatment was not only ineffective in one population but had some small chance of being actively harmful), or there was something hinky with the randomization or blinding of the trial (which would be worse).

        There were all sorts of worries in the tox section of the meeting about mutagenicity in pregnancy. If there is eventually an EUA, it will probably require a negative pregnancy test before being prescribed to women.

        Everybody’s hoping paxlovid will look a lot better (89% efficacy!) and more consistent (interim analysis and final analysis consistent). That’s why I was noodling around so much, looking for when the FDA hearing for EUA would be.

    • jp1 says:

      a nice overview, but old and inaccurate.

      A search of “obesity” gives “(diabetes, obesity etc)” in small faint text, only under BAME populations. It’s not a factor in the graphs.

      Risk of “see your doctor” and “library/museum” is grouped with “beach”. “older kid playdates” is shown lower.

  36. Carol says:

    1. What could be the IFR and % of severe cases caused by delta vs. omicron?

    2. What would be your estimates for the effectiveness of mRNA vaccines (e.g. two shots of Pfizer), taken 10-12 months ago, against the omicron variant? I wonder about the risk reduction for a) any infection, b) non-asymptomatic mild course, c) severe course, d) long Covid, e) death.

    3. Could there be any truth to the claims suggesting that the vaccine-related deaths had an uneven distribution, and were likely associated with faulty batches? How about the deaths of young athletes – is it just a mere frequency illusion?

    4. It seems there is some valid concern about taking an mRNA vaccine as a young man and getting an unlucky shot in the vein, resulting in the increased likelihood of myocarditis, and maybe sudden death. Could you please put any number on it?

    5. When do you expect more studies evaluating the effectiveness and safety of Paxlovid? Not that I want to demonize Pfizer, but I’d love to have more independent data points.

    6. Testing keeps on being massively used, costly, moderately accurate, and inconvenient. It’s been two years and nobody introduced the cough-based diagnostic apps to the mainstream despite all potential advantages and the initially promising results. Why?

    7. When do you expect to feel that, as a global society (or as the developed countries), we’ve mostly recovered from the socio-economic and (mental) health burden caused by the pandemic? Or “will things never be the same”?

    • TheZvi says:

      #1 Much lower due to population differences, unknown if more than that, posts try to answer
      #2 I answer best I can, but probably something like 50 / 50 / 75+ but who knows / 90+ / 90+.
      #3 No, not with any probability that matters.
      #4 no, please, everyone STOP IT, it’s not high enough to be worth bothering. Epsilon.
      #5 is never.
      #6 is FDA.
      #7 is to some extent never, and to some extent we have to fight for it.

      • Best bet on #5: FDA will give an EUA for paxlovid, and then everybody will watch what happens to the many, many patients who get it — more or less the equivalent of a Phase IV trial.

        mRNA vaccine safety does something similar. Having been given to at least 2 billion people, we’re watching the largest Phase IV trial in human history. And the safest and most successful.

  37. q3e9z9 says:

    what’s your take on the current safety of group singing events like the solstice in NYC? if Omicron is going to take over in a few weeks nationwide, I would expect it to be significantly closer in NYC, and if one singer has it, it seems likely everyone will catch it.

  38. Pingback: Covid 12/9: Counting Down the Days | Don't Worry About the Vase

  39. Pingback: Omicron Post #6 | Don't Worry About the Vase

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