Omicron: My Current Model

A year and a half ago, I wrote a post called Covid-19: My Current Model. Since then things have often changed, and we have learned a lot. It seems like high time for a new post of this type.

Note that this post mostly does not justify and explain its statements. I document my thinking, sources and analysis extensively elsewhere, little of this should be new.

This post combines the basic principles from my original post, which mostly still stand, with my core model for Omicron. I’ll summarize and update the first post, then share my current principles for Omicron and how to deal with and think about it.

There’s a lot of different things going on, so this will likely be incomplete, but hopefully it will prove useful. The personally useful executive summary version first.

  1. Omicron has already taken over, most cases are being missed, crunch time is now. Crunch time will likely last 1-2 months.
  2. First two shots don’t protect against infection, boosters do somewhat (60%?).
  3. Vaccination and natural infection protect against severe disease, hospitalization and death (best guess ~80% reduction in death for double vaccination, 95%+ reduction in death for boosters but too soon to know).
  4. Tests work, but when delayed are mostly useless for preventing infection especially when delayed, as Omicron can spread within 1-2 days after exposure. Rapid tests mostly test for infectiousness, not being positive.
  5. Omicron probably milder than Delta (~50%) so baseline IFR likely ~0.3% unless hospitals overload, lower for vaccinated or reinfected.
  6. Being young and healthy is robust protection against severe disease and death, being not that means a lot more risk. Long Covid risk small but real for all age groups, vaccination likely helps a lot.
  7. Medical system is under strain, could be overwhelmed soon, should be better again in a few months at most if it gets bad. Delaying infection has value but stopping it fully is likely not worth the cost. If you care about real prevention, the tools that matter are vaccination, good masks (N95 or even better P100+), social distancing and air ventilation.
  8. Vitamin D and Zinc, and if possible Fluvoxamine, are worth it if you get infected, also Vitamin D is worth taking now anyway (I take 5k IUs/day). Paxlovid is great (~88%) if available right after you test positive, but in very limited supply for now.
  9. Default action on positive test is 5 days isolation at home as per new CDC guidelines, if possible is good to get a negative rapid test before ending isolation. If things get bad, especially if you have trouble breathing, call your doctor, seek treatment and so on.

Here are the old principles that still apply, with adjustments as appropriate:

  1. Risks follow Power Laws. Focus on reducing your biggest risks.
  2. Sacrifices to the Gods are demanded everywhere. Most intervention effort treats Covid-19 as a morality in which the wicked must be punished, rather than aiming physical interventions to achieve physical results.
  3. Governments Most Places Are Lying Liars With No Ability To Plan or Physically Reason. They Can’t Even Stop Interfering and Killing People. There is a War, and the WHO, FDA and CDC, and most similar agencies abroad, and most elected officials, are not on our side of it. Instead they focus mostly on getting in the way, protecting their power and seeking to avoid blame on a two week time horizon.
  4. Silence is Golden. Talking or singing greatly increases infection risk, and the directions people face matter too. You’re still not safe or anything, but it helps.
  5. Surfaces are Mostly Harmless. Mostly don’t worry about them.
  6. Food is Mostly Harmless. Mostly don’t worry about it.
  7. Outdoor Activity Is Relatively Harmless. It’s a huge relative risk reduction.
  8. Masks Are Effective. I’m less excited about cloth masks than I used to be, but I remain confident in N95s, and if you actually need to not get Covid-19 you can step up and use P100s or other heavy-duty options at the cost of social awkwardness. My rule of thumb at this point: Cloth masks are for satisfying mask requirements. N95s are for reducing Covid-19 risk. P100s are for actually attempting to prevent Covid-19. Choose your fighter.
  9. Six Feet Is An Arbitrary Number. There’s still nothing better than an inverse square law, so by default I presume 12 feet is a quarter of the risk of 6 feet, and 3 feet is quadruple the risk, there is no magic number. No one seems to care about distancing much anymore. If there was one big omission last time, it was not focusing on air ventilation and flow.
  10. Partial Herd Immunity Matters. 75% immunity no longer cuts it under Omicron, but every little bit helps. This isn’t an all-or-nothing situation. Every person that is immune, or even partially immune, slows the spread.
  11. Yes, We Know People Who Have Been Infected Are (Largely) Immune. This is less absolute than it used to be. Infection by Delta or earlier strains provides strong protection against severe disease, hospitalization and death, but not total protection, and it provides far less protection against infection.
  12. Our Lack of Experimentation Is Still Completely Insane. Yes.
  13. We Should Be Spending Vastly More on Vaccines, Testing and Other Medical Solutions. Yes.
  14. R0 Defaults In Medium-Term To Just Under One. This is true because case rates and behaviors and rates of previous infection adjust until it becomes true. It’s importantly not true if pushed past its breaking point, and the question is whether or not this happened with Omicron. But in a few months, it will be true again either way.
  15. The Default Infection Fatality Rate (IFR) Is At Most 1%. Still true, but my estimates are now doubly lower for better treatments and Omicron being milder, see the new section.
  16. Many Deaths and Infections are missed. The numbers I put here no longer apply, and the rate at which cases are missed varies a lot based on conditions. My guess is that most deaths are now identified in the United States, but that most cases are once again being missed under Omicron because they’re milder and testing is once again in short supply.
  17. People Don’t Modify Behavior Much In Response To Rules. Most of the reaction to conditions is private choices on how to react. Private reaction to Omicron happened despite not much public imposition of new rules. Vaccine mandates are the one big exception.
  18. It’s Out of Our Hands. Almost entirely true at this point. It’s on individuals to react wisely.
  19. Support Longevity Research. If you think that people dying is bad, maybe we should do something about it.

Next, how to personally think about Omicron beyond the above.

First, infection.

  1. Importance of air ventilation is the biggest thing I didn’t talk about before. It makes a huge difference to risk of infection whether or not there is good air flow. The glass barriers in restaurants are probably counterproductive (and my not realizing this early on was a mistake on my part).
  2. You are probably going to get Omicron, if you haven’t had it already. The level of precaution necessary to change this assessment is very high, and you probably don’t want to pay that price.
  3. You can probably guard against Omicron if you want to do so badly enough and don’t need to work outside the home, either short term or entirely. This means a P100-style or better mask, if you’re actually trying. It means extreme social distancing and isolation and caring about ventilation. It also means getting vaccinated and boosted. For those who are immunocompromised or otherwise at extremely high risk, this is a reasonable option.
  4. There are a ton more cases out there than are being reported. Hard to tell exactly how many, but it’s a lot more. In addition to missing a lot of cases, being several days behind can mean you’re at several times more risk than it otherwise looks like at any given time, until things stabilize. So looking at current positive tests can be an order of magnitude or more too low.
  5. Omicron spreads easier than Delta even among the unvaccinated. We don’t know this for a pure fact yet but it seems very likely to be a large effect. Assume the amount of exposure it takes to reach critical mass has gone down.
  6. Vaccination with one or two doses of current vaccines is minimally protective against infection by Omicron. The data isn’t fully in, but this seems clear. If you haven’t been boosted, your protection is mostly against severe disease, hospitalization and death, rather than infection, although you’re somewhat less likely to spread the disease further because you’ll recover faster.
  7. Vaccination with three doses is protective against infection by Omicron, but less protective than vaccines were against Delta. As a rule of thumb I am currently acting as if a booster shot is something like 60%-70% protective against infection but I don’t have confidence in that number. The main protection is still against severe disease, hospitalization and death.
  8. The generation time (serial interval) of Omicron is lower than Delta. Someone who is infected today will often be highly contagious the day after tomorrow, and may be infectious tomorrow. Much of infectiousness proceeds symptoms.

Next, testing and isolation.

  1. PCR tests are useful and accurate, but don’t mean you’re not infectious, and if they are delayed they become useless. The ideal is getting it back in 24 hours, but even that is a lot of the window before someone is infectious, so this doesn’t provide that big a risk reduction against Omicron. If it takes 48+ hours, use other than for treatment is greatly reduced.
  2. Rapid tests are useful and mostly tell you if you’re currently infectious. They can have ‘false’ negatives, and actual false negatives, mostly because you can be infected but not infectious, and then you’ll mostly come back negative. Also user error is always an issue. Rapid tests are the more useful way to identify who is infectious and prevent spread, but far from foolproof.
  3. All rapid and PCR tests detect Omicron. I include this because I know of people who aren’t confident on that and are freaking out a bit.
  4. A negative rapid test should be necessary before ending isolation. The CDC’s new guidelines don’t say this but this seems overdetermined and obvious to me. If you care about not being infectious, you should check on that before exposing others.
  5. The majority of infectiousness is within the first five days, and CDC guidelines now only require five days of isolation. That doesn’t mean five days is suddenly safe instead of unsafe, but the show must go on, so the rules have changed. Five days plus a negative test seems fine in general, but I still wouldn’t visit any grandparents that soon.

Next, vaccination, prognosis and treatment.

  1. Omicron is probably substantially milder than Delta. My guess is something like 50% milder, so half the risks. How much comfort that provides is your call.
  2. Being young is still the best defense. Everyone please stop being terrified about what might happen to young children. Most deaths will still be among the old and unhealthy. Remember that these are orders of magnitude differences.
  3. Being healthy still helps a lot. If you are at a healthy weight and don’t have diabetes, and aren’t immunocompromised, those are also big games. If you do have these issues, that’s a problem. See my old post on comorbidity.
  4. Vaccination is highly protective against severe disease, hospitalization and death. The vaccines are likely somewhat less effective against Omicron than Delta here, but still highly effective. Protection against hospitalization is probably something like 80%, with likely additional protection above that against severe disease, and then even more protection against death.
  5. Booster shots are even more protective. I urge everyone to get their booster shots.
  6. Previous infection, including by Delta, is highly protective as well. It’s at least similar to being vaccinated normally. Unclear if it’s better than that.
  7. The risks of Covid-19 prevented by vaccination greatly exceed the risks of vaccination. Even the specific ‘risks’ of vaccination are net decreased by vaccination, because it prevents Covid-19 and makes Covid-19 more mild. If you are worried about unknown risks, get vaccinated. There are a few exceptions for specific medical situations, if you think you’re one of those exceptions talk to your doctor.
  8. Most cases will be asymptomatic or mild, even if you are unvaccinated. It’s important not to forget this, or pretend otherwise in order to scare people.
  9. If you do have symptoms or test positive, take at least Zinc and Vitamin D. You should be taking Vitamin D regardless. This isn’t a statement that you shouldn’t take anything else, but there’s nothing else that I know rises to this level.
  10. If you test positive, consider Fluvoxamine. It is an SSRI, so it’s not something one should take lightly or proactively, only when you know you’ve been infected. Again, I’m not saying not to take anything else that I’m not listing, I’m merely saying I don’t have this level of confidence in anything else that’s available. Merck’s pill increases risk of mutations and I now believe it should not have been approved, but it likely is good for your personal health outcomes if you can get it in time and adhere to the protocol. If you do take it, you really really really need to follow the full protocol exactly.
  11. If you test positive and can get it in time, take Paxlovid. Paxlovid reduces hospitalization and severe disease by about 88%. If you’re young and in good health and don’t want to take from the currently limited supply, I applaud that decision until there’s sufficient supply.
  12. By default, recover while isolating at home. The medical system is there if you need it, but most of the time you will not need it. Trouble breathing is the biggest ‘seek treatment now’ sign, but I am not a doctor, this is not medical advice, and when in doubt call a real doctor.
  13. Once you go to the hospital or otherwise seek treatment, I don’t have anything for you beyond wishing you luck. If I get sick, I will follow my wife’s advice, as she is a doctor. Can only focus on so many questions at once.
  14. If the hospitals get overloaded things get much worse. A lot of patients that would otherwise live, will die without treatments the hospitals can give, especially oxygen.
  15. Getting Omicron in January (or late December) is worse than getting it in February, which is worse than getting it in March. At some point in January (or maybe February, but probably January) there will be a turning point where strain on hospitals and the testing system begins to decline. If you get sick during the period when things are bad, then your prospects are worse. A small amount worse if the system is merely under strain, but much worse if things start to collapse and capacity runs out. Also Paxlovid is coming.
  16. Long Covid is real but rare and risk scales with severity. This is not something we can be confident in, and there are big unknowns to be sure, but my baseline continues to be that Long Covid risks are mostly proportional to short-term serious Covid risks aside from not scaling as much with age, and other things that reduce one reduce the other. Long Covid is still the biggest downside to getting Covid if one is young. I wish I could put a magnitude on this risk, but my best guess continues to be that this is not that much worse or different than e.g. Long Flu or Long Lyme, sometimes getting diseases does longer term damage than we realize and curing and preventing disease is therefore even more valuable than we think. But to extent you worry, Paxlovid probably does a lot to prevent this, so holding out until it is available would help you here.

Other modeling observations and general prognosis.

  1. Omicron is already the dominant strain. Delta will not go away entirely, but is unlikely to be a substantial presence going forward.
  2. Things will peak in January, or perhaps February (or possibly the last few days of December). This is overdetermined.
  3. After the peak things will probably decline rapidly, then stabilize at a new normal level. Fluctuations will happen as before, but there won’t be another Omicron peak like this one. If there is sufficient overshoot on immunity things might collapse further.
  4. There might be another strain in the future. I don’t know how likely this is, but that’s the most likely way that things ‘don’t mostly end’ after this wave.
  5. Once this wave is over and Paxlovid is widely available, restrictions don’t make sense. Continuing to require distancing or masks, or pushing hard on further vaccinations, isn’t justified by the levels of risk we will face, and there’s no collective risk justification either.
  6. Taking action to ‘stop the spread’ mostly no longer makes sense. The spread isn’t going to be stopped, that ship has very much sailed. Slowing it down a bit has some value, but ‘pandemic ethics’ no longer apply.
  7. Modifying how you live your life also won’t make sense. Covid-19 will be one more disease among many, and life will be marginally worse, but by about April you shouldn’t act substantially differently than if it no longer existed.
  8. We’ll have to fight to end many restrictions. They will by default continue long past the point when they stop making any sense. Various forces will fight to use these restrictions to expand their powers permanently.
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74 Responses to Omicron: My Current Model

  1. delete after editing says:

    much of infectiousness proceeds symptoms -> precedes

  2. Dave says:

    Thanks Zvi, this is very good stuff.

    On #4 from your omicron facts list: This has me concerned personally. My brother lives with our parents, who are in their 70s. Everyone in the house is very covid cautious, but he does work in an office that isn’t remote.

    His routine has been to test every 3 days to protect them. Is this no longer sufficient? We really don’t want our parents to catch it until they can be sure of getting paxlovid.

    • TheZvi says:

      It reduces your risk substantially, but if you want e.g. 90% reduction it’s not enough.

      • Dave says:

        Thanks. I think there are enough tests on hand to move to every other day for a month or so. Perhaps that’s his best option.

      • TheZvi says:

        If there’s a month to do it, this would be the month. Working in an office means you don’t have a lot of good options, but if they’re OK with it I’d look into super-masking (P100+).

      • Dave says:

        He’s answering phones, so not really an option. On the plus side, there are only two other employees regularly in the office. (On the minus side it’s a pretty MAGA town, so one of them has only had one shot and the other is probably unvaccinated.)

      • Dave Kasten says:

        If I were your brother, I’d look to stack as many modifiers to help myself as possible. Like literally go down the list — e.g., can he forward the phones to his cell phone, work from home and just eat the extra minutes’ cost for a month? Can he work from a room in the office where he can open a window and haul in a space heater? Can he answer phones on the night shift so there’s fewer people around and aerosols have had time to drop out of the air somewhat?

        Sorry he has to deal with this, and wishing you all safety.

      • Dave says:

        Thanks. I don’t mean to suggest it’s a terribly desperate situation, there is another place he could stay for a while although it would be less than ideal for him in a number of ways. It would be good for him and his son if he could keep staying with them, but he may decide that either he wants to move out for a little while or look for a different job.

  3. Charles Scheim says:

    Thoughts on how infectious someone is with two shots + booster versus unvaccinated or two shots/no booster?

  4. Yellowface Anon says:

    Talking about Permanent Midnight:

    From Post #10: “Israel was going to roll out a 4th dose for at least some citizens, but decided to hold back when the data came in that Omicron was milder.”

    I’m a bit confused, how does their Green Pass work? I think these expires 180 days after the last COVID/booster shot. I can imagine a least 5 ways to intentionally create a large mass of those who are willing to remain vaccinated and/or can be vaccinated, but have their Green Passes withheld. The simplest is to deny boosters, saying you are sufficiently protected with a certain number of shots (medical interpretation), yet letting your Green Pass expire without automatic renewal (administrative hurdle). Any political establishment with an interest to create a precariat and a subordinate population (think Palestinians) will have an interest to do that.

    These are what I originally want to request:

    – Updating this post: https://twitter.com/NateSilver538/status/1423301403649396738 and think about how the view has changed in the face of Omicron.
    – Predicting whether more consequential variants will emerge in 2022 and 2023.
    – COVID’s going to be endemic and become relatively less fatal. Will vaccine passports stay, and will people be willing to renew them at that point in order to participate in economic and social life? If not, exitism is gradually but inexorably supercharged.

    • TheZvi says:

      Good questions. My guess is updating the post isn’t the right way to handle them, but they’re worth addressing on their own.

      On the Green Pass, such things work however people decide that they work. I doubt they would create a situation where people’s Green Passes were impossible to renew and yet were necessary, but it could happen.

      My presumption is that creating an intentional Catch-22 here is highly unlikely given the incentives involved, even if you think the worst of those involved. It’s more likely to happen through a kind of universal malice (that looks a lot more like stupidity) than specific malice.

      • Yellowface Anon says:

        Makes good sense – probably they will offer boosters should they decide only those can mean life-long protection.

        About 53) to 56), those are basically what antivaxxers & libertarians have been saying all along. It especially makes sense when a majority of the population everywhere in developed countries are vaccinated.

        Do you think we should keep vaccine passports indefinitely, because that is the definite mark (pun intended) between conformism to the COVID response vs exitism? How about exitism in general in response to institutional failures or actual malice at centers of power? These are more political than public health. If a majority of people choose to exit, prepare for 1992 Russia-level of dysfunction, and here is where exitism will help to survive the madness by those further in the Right.

      • TheZvi says:

        I would have thought it was obvious from everything here that I do not endorse long term vaccine passports. Their plausible justifications expire along with everything else some time around March.

        The idea that a majority or even a large percentage of people would choose ‘exit’ over getting jabbed every so often strikes me as absurd, like it comes from some alternate universe.

      • Ariel says:

        Israel is fairly good, even a bit too good, at removing restrictions, including green passes, as soon as cases are not that high. Of the current government, the only person I imagine supporting more restrictions is the current PM Bennett, and even he’s pretty anti-restrictions.

        The previous PM Netanyahu hated COVID a lot more and was also waay less anti-restrictions.

        BTW even if there’s official a green pass, when COVID levels are low 99% of the people won’t check it. Last time that happened 2 weeks before the government officially removed the requirement.

      • Yellowface Anon says:

        It’s called Going Galt and it is the position of those mostly Trumpists (Trump himself had the vaccine) and libertarians who are starting to implement their alternative institutional building plans, and we probably aren’t at an even decent level of institutional trust, as evidenced by 3). What better incentive to start rushing for the exits than in-your-face gatekeeping biased against you (which is the point of vaccine passports)?

      • TheZvi says:

        I expect the number of people that actually Go Galt to be more like the population of Galt’s Gulge e.g. not very high, and for them not to have use of a limitless energy source or that level of raw human capital. I agree people talk about such things sometimes but… yeah, no, my model says it doesn’t happen.

  5. yudovina says:

    You did a rapid about-face on molnupiravir, from “FDA are the devil for thinking about it” to “it shouldn’t have been approved”. Can you comment more on the thought process? Specifically, do you stand by both of those assessments (which were made at two different times, with different information available), or did you underestimate the possibility of discovering something like this during a longer approval process?

    • TheZvi says:

      Sure. If it wasn’t a threat to create new variants, it would clearly be something that needs to be approved. However, I now see that this threat is of sufficient magnitude that I don’t think the drug should be approved, it’s a public bad and a private good and the risk is not worth it.

      To the extent that the FDA was stalling because of that same concern, they were doing a reasonable thing, but as far as I can tell they never took that concern especially seriously, so it doesn’t ‘get them out of’ it.

      • Donald Fagen says:

        I think you may be getting misled here by the classic medical trap of ‘pathophysiologic rationale.’

        As far as I know, the risk of the Merck pill to cause mutations is a mechanistic hypothesis, not one based on real world evidence. These can sound really convincing but they are a dime a dozen in the world of therapeutics.

        I would be interested to know what’s the strongest case that you know for avoiding use of the pill.

      • TheZvi says:

        Covid is a case where mutation is an especially salient risk, and the reasons they give to not worry about it are the opposite of reassuring, and I’m seeing enough other expressions of concern to myself be concerned here.

        Is it possible it’s a nothingburger? Absolutely. But to me the precautionary principle is now attached here and I want no part of it.

      • John V2 says:

        Replying to Donald here: Molnupiravir works by a metabolite causing mutations during RNA transcription. If the dose is high enough, a replication error cascade occurs even with proofreading, and the new virus is nonfunctional. Think of it as Thalidomide for virus. Hamsters we can give enough Molnupiravir for long enough, because they are in a cage, so the virus clears. Humans? Different story. Humans aren’t in cages under supervision, so they might not take the entire course, or they might pass on a mutant to a caregiver/roommate/unlucky person before clearing. That mutant has a nonzero chance of being Bad For Humans. Neither CDC, nor FDA, nor Merck know how close to 0 the odds are. Do we as a species feel lucky?

  6. SamChevre says:

    Trouble breathing is the biggest ‘seek treatment now’ sign, but I am not a doctor, this is not medical advice, and when in doubt call a real doctor.

    I’m also not a doctor, but one supplemental piece of advice: pulse oximeters are cheap (less than $20). Get one, and use it a few times while healthy to calibrate to your normal. If you are sick and your blood oxygen is steadily low, go to the hospital even if you don’t notice that you are having trouble breathing, but–that’s a classic sign of pneumonia, and steroids and oxygen make it a whole lot less damaging in most cases.

  7. Sam says:

    #28: “PCR tests are useful and accurate, but don’t mean you’re not infectious…”

    Is the statement that (presumably negative) PCR tests “don’t mean you’re not infectious” mostly about false negative results (regarding which https://www.lesswrong.com/posts/cEohkb9mqbc3JwSLW/how-much-should-you-update-on-a-covid-test-result cites a sensitivity of around 95%; https://www.uptodate.com/contents/covid-19-diagnosis#H3384281277 has some more pessimistic analysis), or is there some other reason I’m not aware of that this is true? (Or did you mean to write “don’t mean you’re infectious”, in reference to the more widely-discussed issue of positive PCR tests after someone is no longer infectious?)

    • TheZvi says:

      I meant that given all the delays, and when the PCR tests come back positive in the progression, you can’t be that confident you’re not infectious, even if the test isn’t strictly in error (the 5% where it’s outright missed is not the biggest concern here, although it’s a concern).

      • Sam says:

        Thanks for clarifying. (And since I don’t remember having commented before, thanks for these posts in general – I’ve been reading them regularly for over a year and have appreciated them.)

  8. Evan Þ. says:

    Do you have any data (or guess) on how a J&J vaccine + mRNA booster compares to two shots of mRNA + booster? My sister got J&J last spring, so I’m interested.

    Also, for our regularly scheduled reminder that making things as easy as possible matters: My grandma just said that she wants to get a booster, but she hasn’t been able to because she can’t figure out how to sign up, and her healthcare aide can’t figure it out either. I’ll try to help her tomorrow.

    • Evan Þ. says:

      Update: My grandma’s booster shot is now scheduled for next Monday. It was pretty easy for me, but apparently not for people who aren’t familiar with computers.

      (Also, thanks for the link, Nechaken!)

  9. Nechaken says:

    Evan — See slide 22 of the Heteralgous Boost Study. https://www.fda.gov/media/153128/download

  10. David+Speyer says:

    You write about your recommended behavior after a positive test; what is your recommended behavior after an exposure? Say you learned that you had spent an hour masked indoors in the presence of a masked COVID+ person the previous day, would this change your behavior at all?

    • TheZvi says:

      To some extent you should assume you’re exposed every day unless you’re hiding in your house, at this point, but of course there are levels. If you spent an hour like that, I’d say you have a decent chance of having caught it, so you shouldn’t do things that you wouldn’t do if you had e.g. a 20% chance of being positive.

  11. Albert001 says:

    Can you comment as to your current views on how much wearing masks protects others in indoor settings? Obviously we’re talking about KN95 masks or better.

    • TheZvi says:

      They reduce effective exposure by a lot, but if you’re being overkilled anyway they won’t be enough, basically. If I had to pick a number, 50-75% or so effective reduction.

  12. cakridge2 says:

    Can’t reply directly to the comment for some reason, but above you predict that the justification for vaccine passports ends in March with everything else. I’d like to predict, on condition of that being true, that it is unlikely that a new variant will come along to continue the pandemic given that new variants seem to take longer to show up.

    Consider Alpha, which took ~9 months to show up after COVID Classic in March 2020, Delta, which showed up in June 2021 or so, and Omicron, which took another 5 months to show up after Delta.

    If we’re on pace to be done by March, we could be done totally.

    • TheZvi says:

      To be clear, the *justifications* for it are done by March. Then, as I say, we’ll have to fight to get such things actually lifted, although I do expect to mostly succeed on this.

  13. Legrand says:

    Really excellent summary of data and analysis. Question: How do these two statements not contradict each other?

    46. If the hospitals get overloaded things get much worse. A lot of patients that would otherwise live, will die without treatments the hospitals can give, especially oxygen.
    54. Taking action to ‘stop the spread’ mostly no longer makes sense. The spread isn’t going to be stopped, that ship has very much sailed. Slowing it down a bit has some value, but ‘pandemic ethics’ no longer apply.

    • TheZvi says:

      To me they’re very compatible – there’s some value in slowing things down a bit, but not a ton of value, and if you go on to infect someone else they were probably going to be infected soon anyway. The ones who don’t get infected soon are the ones taking large precautions.

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  17. Egg Syntax says:

    Hi Zvi, thanks so much for the summary post; this gives me something to send to the people in my life who aren’t willing to read through all the weekly(-plus) updates. Two questions:

    – ‘There might be another strain in the future. I don’t know how likely this is…’ — I would think it would be *highly* likely, nearly to the point of certainty. We’ve already seen C-19 produce variant after variant, and with less than half the global population fully vaccinated (per Our World In Data) I see no reason whatsoever why we should expect that to slow down any time soon. What am I missing here about your thinking? Maybe it’s just a matter of wording, but the quoted bit above seems to suggest that you find it quite plausible that there *won’t* be another strain.

    – ‘Long Covid is real but rare..Paxlovid *probably* does a lot to prevent this’. What is that last statement based on? I haven’t yet seen any reason to have expectations one way or the other on Paxlovid’s impact on long covid. Is it just a trivial consequence of your broader belief that risk scales with severity? ie since Paxlovid decreases severity, it should decrease long Covid risk ~proportionally?

    Thanks!

  18. Allen says:

    I’m immuno compromised (mantel Cell Lymphoma in remission after being treated with Retuximab). No antibodies after 3 shots of Moderna, Will Paxlovid be effective if I should get infected despite my best efforts to avoid any exposure?

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  20. driveby says:

    Pretty much in the same place, but I didn’t get the vaccine and probably won’t. If I haven’t gotten it, and haven’t gotten covid by now, with the diminished effectiveness against omicron and the evidence of the effectiveness of my exposure control methods…I’ll just continue to take preventative measures until April.

  21. bm says:

    any thoughts on sinus rinsing?

  22. Isaac says:

    Yes. Paxlovid interferes with the virus’ replication, the issue of an immune response is irrelevant

  23. AL says:

    If you accept that becoming infected is inevitable, there is perhaps more nuance to the question of when to become infected than just “try to wait until the wave crests”. I assume there is a sweet spot for vaccine immunity, and subject to hospital capacity (or maybe not even that), for an individual, getting infected sooner might be better than later. Population-wide, sooner might yet be better as well. Yes, that would crash the hospitals, but it would be a short crash, and it might reduce the odds of a more dangerous variant emerging. At this point my sympathy is with health care workers and the immunocompromised. A rapid pandemic end for both groups might be preferable to status quo. Covid is not going to kill most IC persons directly; the threat posed by stress and endlessly stretched hospitals is difficult to quantify, but likely significant.

  24. Ray Lopez says:

    It’s not inevitable you will get Covid-19 if everybody is forced to take the vaccine. If the H.I.T. is say 87% then vaccinating over 87% of the population will eventually reduce transmission to zero. That may not be politically feasible but it’s a fact, and what quarantine laws were written to do back in the 19th century and still good law today. Surprised otherwise reasonable people don’t mention this, I guess it’s their libertarian priors at work.

    • A1987dM says:

      No, because the vaccine effectiveness against transmission is less than 87%.
      Before Delta it would have been possible to achieve herd immunity by vaccinating enough people, but it no longer is.

    • Graham Blake says:

      Herd immunity was never possible at a threshold that high (or probably any threshold) while pediatric vaccinations were unavailable. Not just in terms of percentages, but also in terms of population dynamics. Herd immunity thresholds assume that immunity is evenly distributed. With the entire pediatric population lacking immunity and clustered together in schools and other environments, there was always a large reservoir of near-zero percent immunity for chains of transmission to remain unbroken. Unfortunately, at the same time that pediatric vaccination became widely available, it also became moot in terms of stopping transmission. Better luck next variant.

      • John says:

        Singapore had no clusters originating in schools (except staff who did not have contact with children) for months in the 1st half of 2020. If you want more robust data, I recommend the following study (Results first, then URL)

        “We found that propagation inside of the bubble group was small. Among 75% index cases, there was no transmission to other members in the classroom, with an average R* across all ages inside the bubble of R* = 0.4. We found a significant age trend in the secondary attack rates, with the R* going from 0.2 in preschool to 0.6 in high school youth.”

        https://journals.lww.com/pidj/Fulltext/2021/11000/Age_dependency_of_the_Propagation_Rate_of.2.aspx

  25. CPS says:

    what’s your take on vaccinating children? Needed to slow the spread? Risky? Not a priority if 60+ people aren’t boosted?

  26. Brandon Tice says:

    Sorry if this was addressed elsewhere, but what’s your take on the risks of catching COVID-19 for pregnant women? My wife is in her first trimester and it seems like the consensus is “we’ll likely get COVID at some point, despite having 3 shots”. But I’m wondering if we should still be trying to delay her catching COVID as long as possible, to avoid complicating the pregnancy.

    • TheZvi says:

      Vaccines help a lot. Everything’s scarier when pregnant but I don’t see any signs the baby is in danger. Yes we’ll all likely catch it, but if she makes it another three months, that wouldn’t be true anymore, so…

  27. A Lonely Person Who Keeps Testing Positive After 9 Days of Boring Isolation says:

    Dear Zvi,

    Thank you so much for this.

    You say, “A negative rapid test should be necessary before ending isolation.”

    What if a person isolates for ten days and is still testing positive on the rapid test at day 10? Day 15? Is there any point where a person can stop isolation without a negative rapid test, simply because the isolation has gone on so long?

    I know that a long time ago, the CDC believed that covid would become inactive after 9 days, even if the viral DNA was still present in a person’s body. Do you think that was true at the time? And is it still true now for omicron?

    Thank you so much!

    Sincerely,
    A Lonely Person Who Keeps Testing Positive After 9 Days of Boring Isolation

    • TheZvi says:

      I do not believe there is any ‘hard and fast’ rule that says you’re definitely no longer infectious after some amount of time. But there’s also no such rule for a random person, either.

      If your symptoms are fully gone and have been for more than a day, but you keep somehow testing positive on rapids, you need to eventually make a call. If you’re not under any real pressure, I’d wait until day 14, but given the current amount of infection I would say day 10 is reasonable.

  28. Beep says:

    Fairly accurate but a couple of issues. Your statement that natural infection protects against severe disease is simply not accurate. It certainly does not protect against Omicron, and even though Omicron seems Less serious, with the increased infectivity we may end up with more hospitalizations than previous waves. Yes, there seems to be some decreased risk, but nowhere near what the antivaxxees would have us believe. I have lost count of the number of previously infected, non-vaccinated patients I have seen who required intubation and died.

    I am not aware of any basis for your statement that we are all going to get infected anyway. The consequences of people believing that are obvious and the data simply isn’t there.

    • Johnv2 says:

      I am not aware of any basis for your implication that some will never be infected. The consequences of people believing that are obvious and the data supporting such a conclusion simply isn’t there.

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  37. Ryan says:

    Wow! Thank you!! This seems great. This blog post was linked to “what we’re reading” in the Odd Lots newsletter. I really love that this blog post is a “just the facts, ma’am” sort of thing. It seems unpolarized and apolitical which is a breath of fresh air. I wish the government, the media, and maybe the public at large was more about “just the facts, ma’am” and less about dramatization.

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