COVID-19 Megathread 6: Return of the Omicron

[emailking]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

Why? They're recommending N95 because there isn't a supply issue for health care workers with those anymore, and they protect better against the super contagious Omicron. It has nothing to do with after the pandemic.

[Calthrina950]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

Why? They're recommending N95 because there isn't a supply issue for health care workers with those anymore, and they protect better against the super contagious Omicron. It has nothing to do with after the pandemic.

I simply don't trust the CDC on this anymore, and I strongly suspect that they're not going to reverse their recommendations-at least, not anytime soon.

[emailking]

They recommended vaxxed can go maskless back when cases were 10-20K a day. I don't see why they wouldn't go back to that when the cases finally subside.

[GregTheGreat657]

They recommended vaxxed can go maskless back when cases were 10-20K a day. I don't see why they wouldn't go back to that when the cases finally subside.

I sure hope this is right

[Calthrina950]

They recommended vaxxed can go maskless back when cases were 10-20K a day. I don't see why they wouldn't go back to that when the cases finally subside.

Are you sure? I feel that they are beginning the process of implementing rolling mask mandates that will never entirely disappear.

[emailking]

Obviously I'm not sure. So you predict they'll never recommend removing your mask. But they did do that last year.

[Bandit3 the Worker]

Isn't Oregon about to make its mask mandate permanent?

[Calthrina950]

Obviously I'm not sure. So you predict they'll never recommend removing your mask. But they did do that last year.

They did, and they won't again. They won't be comfortable enough with changing the mask recommendations in that manner, and will always take the most cautious approach.

[emailking]

They did, and they won't again. They won't be comfortable enough with changing the mask recommendations in that manner, and will always take the most cautious approach.

But you don't know that any more than I do. :shrug:

[Calthrina950]

They did, and they won't again. They won't be comfortable enough with changing the mask recommendations in that manner, and will always take the most cautious approach.

But you don't know that any more than I do. :shrug:

Their behavior in response to the Omicron variant doesn't give me much confidence.

[GregTheGreat657]

The US should start shipping vaccine doses overseas in large numbers and providing the means to get those shots in arms. This is coming from someone who is generally against foreign aid

[Hammy]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

[Calthrina950]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

[Bandit3 the Worker]

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

Someone told me that schools and other institutions could be sued if they didn't follow CDC rules on masks, even though the CDC is not a legislative body. But I asked them why restaurants can't be sued for serving sushi or hamburgers that aren't completely overcooked, which the CDC also advises against. But they just shrugged.

I also read that schools were requiring masks because their insurers would drop them if they didn't. So a lot of this is being commandeered by insurance companies.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

I am confused as to how omicron is killing people while at the same time, not resulting in many people needing ventilators?

Wasn't everyone that was dying of covid dying because they literally could not breath?

If people are dying, but not due to their lungs failing, what are they dying from re: covid?

What is omicron's upper respiratory/sinus nature targeting that is killing people?

Pre-Omicron variants of COVID-19 such as the Delta variant and going back to the original version were infectious because they spread well by docking to ACE-2 receptors in human cells. But in addition to that, they were helped in binding more efficiently to ACE-2 receptors by an interaction they had with TMPRSS2 proteins, which made the binding of the virus' spike protein with the ACE-2 receptors even more efficient.

Now, guess what particular cell in the human body just so happens happens to have a lot of TMPRSS2 proteins (as well as ACE-2).

...


That's right, the Alveoli cells in your lungs.

...

So this combination of lots of TMPRSS2 and ACE-2 in your lungs is what made previous variants of the virus so good at spreading rapidly in the lungs, and consequently at causing ARDS (Acute Respiratory Distress Syndrome). ARDS is what most people think of when they think of severe COVID symptoms, and that is what leads patients to be put on a ventilator and, if they are unlucky, to eventually drown to death in their own lung fluids.

What changed with Omicron is that it binds even more effectively with ACE-2 receptors than Delta and other variants. However, by sheer luck of the draw in the process of random mutation, it happens to have been the case that the same mutations that made Omicron even more efficient at infecting via ACE-2 also happen to have made it less efficient at using TTMPRSS2 proteins to help facilitate the process of infection/spread.

This is the thing that makes Omicron, on average, "milder" than Delta and other variants on the level of an individual person who is infected (albeit not necessarily for society and the healthcare system as a whole, given the rapid spread). We are VERY lucky that this happened to be the case, because if it were not the case, then Omicron would spread even more efficiently than Delta and other variants in the lungs, and presumably ARDS would be even more common than with Delta.

So what this means is that Omicron is less effective at infecting Alevoli (lung) cells because of all the TMPRSS2 in those, but is also (in general) more effective than previous variants at infecting most other cells in the human body - which tend to have large amounts of ACE-2, but which don't have much TMPRSS2.

However, I presume that over the last year or two you have probably read at least some articles about how COVID-19 infects other organs besides the lungs, such as your brain, heart, kidneys etc, and can cause organ damage, strokes, heart attacks, etc as a result.

Now, consider the fact that Omicron is more efficient at Delta in spreading within other organs, with the one major exception of the lungs. This means that although you would expect to see less frequent ARDS per infected patient, one would also expect to see at least as much frequency of other harmful effects of the virus, such as myocarditis, strokes, heart attacks, neurological symptsom, kidney failure, and other assorted organ damage. In fact, if anything, one would expect to see more of that and for those non-ARDS-related symptoms to be more harmful than with previous variants, due to the fact that Omicron spreads more efficiently in most other cell types besides the Alveoli.

So, the reason why patients are dying even when ventilator use is down is that you have less ARDS per infection, and consequently less need for other ventilators, but you still have all the other symptoms and organ damage that COVID can cause, and may well even have more of that than before per patient (although I don't think that is definitively known yet).

This is also the reason why anyone who thinks that Omicron is "just a cold" and you should "just get it over with" etc is taking a major risk with their health. Because, although it is true you are less likely to get ARDS from an Omicron infection (although there is still more than enough of that) than from other variants, you are probably at least as likely, if not more likely, to get other harmful symptoms from Omicron than you were from other variants that were less effective at spreading in non-lung cells. And if you get long term organ damage as a result of your infection, then you will be lowering your future life expectancy. Organ damage which you may get as a result of your Omicron infection then becomes is a "pre-existing condition" or "co-morbidity" which is likely to increase your chance of dying or suffering severe disease if you are subsequently re-infected with a different COVID-19 variant in the future. Repeat this cycle of being re-infected with different variants every year or so enough times, and your chances of getting a co-morbidity from a previous infection which makes your future infection worse starts to become something you ignore at your own peril.

Another thing that everyone should be aware of is that it's pretty likely that the next variant won't be related to Omicron, but is more likely to be related to one of the earlier variants (or to come out of left-field entirely). Why is that? Well, for one thing Omicron was not related to Delta. And Delta was not related to Alpha. So we have plenty of precedent at this point for new variants arising which are not related to the previously dominant variant.

There is also a logical reason why you would expect that to be the case. That is that by now - and certainly by the time this Omicron wave has receded - the great majority of people in the world, and certainly the great majority in the United States, will have some degree of immunity from a combination of previous infection and/or previous vaccination. And in particular, after the Omicron wave, most people will have some degree of immunity, if only temporarily, against Omicron itself in particular. If you have just been infected with Omicron, you are likely to have more immunity to another variant which is similar to Omicron than to another variant which is dissimilar from Omicron, and therefore not descending evolutionarily from Omicron.

So as a result, one of the main ways that new virus variants are likely to be more efficient at spreading than previous variants is not necessarily by being intrinsically more transmissible than previous variants, but rather by evading the immunity of people who were infected with previous variants. Other things equal, you would expect that a future variant which is related to Omicron to be less efficient at evading the immunity of people who have been recently infected with Omicron than a future variant which is un-related to Omicron.

And if a future variant is un-related to Omicron, it won't be descending from a virus with the mutations that make Omicron less effective at infecting the Alveoli with TMPRSS2. It will instead be evolutionary related to and descended from a previous variant like Delta, Alpha, Epsilon, Mu, the original variant, or whatever else out of left field. And if it is un-related to Omicron, then there is no particular reason to think that it will have the same mutations as Omicron which happen to make Omicron less efficient at infecting lung cells in particular (even while making Omicron more efficient at infecting human cells overall). And that means that the next variant is more likely to efficiently use TMPRSS2 to help infect lung cells and thus cause more ARDS again, similar to the other previous non-Omicron variants. Or maybe it won't. Maybe we'll get lucky. But maybe it will. There is no particular way to know in advance. Just, "do you feel lucky?"

Every other dominant variant, with the one exception of Omicron so far, has been more severe than the previous one, and we also know that other beta-coronaviruses such as MERS and SARS-1 are more severe and have higher fatality rates than COVID-19. That is worrisome, and means there is potential for things to get worse, even after (seemingly) getting temporarily better on the level of the infected individual spared of ARDS with Omicron. But that is also by no means guaranteed, and for all we know things could go the other way entirely.

So for the foreseeable future, it seems that we are likely to continue this cycle of having a couple new variants each year, which may be more severe or alternatively less severe. One would suspect that probably some will be more severe, some less. There will probably be some nothingburger waves with nothingburger variants, which then get followed up by a really horrendous wave. Or vice versa. Once an Omicron-like wave has swept through the population, the population will have some temporary immunity to an Omicron-like variant. So then a non-Omicron-like variant will evolve. Then the non-Omicron variant will sweep through the population, giving the population some temporary immunity against that. And then another new variant will evolve, which may be more like Omicron, or alternatively could be something else entirely.

[compucomp]

Leave it to this forum to criticize the CDC when they issued greatly belated guidance that to anyone paying attention since January 2020 is as obviously true as saying that the sky is blue. Also at long last they emphasize that one wears a mask to protect oneself; emphasizing that the masks primarily protect others was a messaging blunder, forced by not recommending N95/KN95 masks, and fed the perception that the masks are ineffective and undoubtedly hurt compliance.

There's a reason the masking recommendations are quickly adopted by governments, and you know exactly why; if we're recommending N95 I can't say it's zero cost anymore but the cost is still very low, $0.50-$2 apiece.

[YE]

How effective are these “high quality masks” at stopping omicron to begin with given how contagious it is? Is this another case of Democrats virtue signaling?

[compucomp]

How effective are these “high quality masks” at stopping omicron to begin with given how contagious it is? Is this another cases of Democrats virtue signaling?

The virus did not mutate to become smaller size nor gain teleportation ability. Ask anyone working in a medical environment; the answer to PPE that's not effective enough is more effective PPE or more layers of PPE, not abandoning PPE altogether.

[Hammy]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

But again, that should not reflect negatively on the CDC. If elected officials started forcing people to evacuate for hurricanes for example, the solution would not be to eliminate the warning system.

[Calthrina950]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

But again, that should not reflect negatively on the CDC. If elected officials started forcing people to evacuate for hurricanes for example, the solution would not be to eliminate the warning system.

The CDC's main problem is that their messaging has not been good, particularly over the past several months. Yes, they are experts, and should be given deference, but their recommendations certainly don't seem to imply that the situation has improved. In many ways, we've regressed.

[DINGO Joe]

January will be the 6th straight month with Covid deaths above 1000/day  The previous high streak was  Nov 2020-thru Feb 2021, which did have a much higher surge of deaths, but basically COVID seems to have gone from a boom-bust cycle to more of a steady drumbeat though the deaths do rotate some regionally, except Arizona where they just always die.

[compucomp]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

But again, that should not reflect negatively on the CDC. If elected officials started forcing people to evacuate for hurricanes for example, the solution would not be to eliminate the warning system.

The CDC's main problem is that their messaging has not been good, particularly over the past several months. Yes, they are experts, and should be given deference, but their recommendations certainly don't seem to imply that the situation has improved. In many ways, we've regressed.

That's because the situation has not improved and has in fact regressed. Hospitalizations are at a record. Deaths are back up, around 2K a day. We might not hit 1M cases a day on the 7 day average but it got pretty close. Maybe the risk to each individual person is less, particularly if you've gotten the vaccine and booster, but it turns out that Omicron is so contagious it's causing lots of excess death and putting severe pressure on the hospitals anyway.

I wish the next poll that tests how much the population supports mask mandates and vaccine mandates adds an option that says "COVID is not a threat and all containment measures should be discontinued", because this is the position this forum is coalescing around. Time to see if this position really has majority support like this forum likes to claim. Alternatively if it shows up with 25% support it's time for this forum to rethink.

[Torie]

This is the best and most insightful article I have read about Omicron, which poses all the right questions, not only for myself but for how to fashion public policy appropriately.  As for myself, I wish I knew all the answers. If I did, the odds will be higher than they are now that I can prudently end my self exile from life sooner rather than later.

https://www.newyorker.com/magazine/2022/01/24/do-the-omicron-numbers-mean-what-we-think-they-mean

[Hammy]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

But again, that should not reflect negatively on the CDC. If elected officials started forcing people to evacuate for hurricanes for example, the solution would not be to eliminate the warning system.

The CDC's main problem is that their messaging has not been good, particularly over the past several months. Yes, they are experts, and should be given deference, but their recommendations certainly don't seem to imply that the situation has improved. In many ways, we've regressed.

That's certainly true, and unfortunately symptomatic of this entire administration.

[Calthrina950]

The CDC did double down on its masking recommendations yesterday, urging people to wear the "mask or respirator" that is "most protective" for them. So, they're not explicitly endorsing N95 masks, but they certainly are indicating support for them. This reinforces my conviction that the CDC will continue to recommend mask wearing in public long past the end of the pandemic.

The CDC is well within their authority to issue guidance which is exactly what they're doing--they're issuing health guidance. They issue the same guidance with the flu. The problem here isn't with the CDC, it's with the elected officials who are trying to impose this guidance into law.

That is indeed the problem. The point has been made that very few people actually followed or cared about CDC recommendations prior to the pandemic, but since the pandemic, their recommendations-particularly on masking-have been converted into law in many jurisdictions.

But again, that should not reflect negatively on the CDC. If elected officials started forcing people to evacuate for hurricanes for example, the solution would not be to eliminate the warning system.

The CDC's main problem is that their messaging has not been good, particularly over the past several months. Yes, they are experts, and should be given deference, but their recommendations certainly don't seem to imply that the situation has improved. In many ways, we've regressed.

That's certainly true, and unfortunately symptomatic of this entire administration.

To further expand upon my points, I've been harshly critical of the conspiracy theories which have been bandied about concerning Dr. Fauci, and I certainly think that the CDC is an important government agency worth preserving. But I'm not going to blindly and uncritically accept their recommendations, as I think doing so would be almost as reckless as believing the nonsense of anti-vaxxers and conspiracy theorists.