COVID-19 Megathread 6: Return of the Omicron

[ilikeverin]

https://www.washingtonpost.com/health/2020/11/09/pfizer-coronavirus-vaccine-effective/

In Pfizer’s 44,000-person trial, there have so far been 94 cases of covid-19, the illness caused by the coronavirus, in people who were not previously infected. Fewer than nine of those cases were among people who received two shots of the vaccine, a strong signal of efficacy.

Even if only the placebo group is getting infected, 94 cases out of a 44,000 person trial seems like a shockingly low number of infections, considering over 1% of the whole US population has been confirmed infected within the last two months, and everyone in the trial is being regularly tested.

Presumably, the kinds of people who would be willing to beta test the efficacy of a COVID-19 vaccine would also be the kinds of people who would be taking lots of precautions anyway.

[ilikeverin]

https://twitter.com/thehill/status/1327816877301772291

I mean, at this point we can't blame people...

Humans are social by nature, and unless the very old and sick are present, I'm fine with people celebrating their holidays together in private.

Because in much of the US right now, in a group of 10 randomly selected adults, it's more likely than not that at least one of them will have COVID, and, during the course of the meal, will infect the other nine.

[ilikeverin]

https://twitter.com/thehill/status/1327816877301772291

I mean, at this point we can't blame people...

Humans are social by nature, and unless the very old and sick are present, I'm fine with people celebrating their holidays together in private.

Because in much of the US right now, in a group of 10 randomly selected adults, it's more likely than not that at least one of them will have COVID, and, during the course of the meal, will infect the other nine.

So that means we should all be planning on having a distanced Thanksgiving?

Or, at least, a small one. Maybe combine 2-3 households at most, and quarantine and get tested before (and after). I have a few friends who are in self-isolation right now so they can make sure to see their families without (significant) risk. Personally, I live alone in a town I moved to three months ago, nowhere near family, so I'll probably do all my celebrations virtually. I'm sad about that, but I don't want to take the risk of infecting one of my parents.

[ilikeverin]

Of course, this just points to the absurdity of all the vaccine companies just waiting around for enough people to be infected rather than implementing challenge trials in the first place.

There are huge ethical issues involved in those. We'd be deliberately exposing people to a disease for which we know we have no cure and only spotty treatments. This is made especially dire because we especially want to know how these vaccines help older adults... could you imagine a challenge trial where you give an 80-year-old COVID? Especially if you've given that 80-year-old a placebo vaccine? I don't know if it was the correct decision because ethics tends not to have correct answers, but it's a very understandable one.

[ilikeverin]

Of course, this just points to the absurdity of all the vaccine companies just waiting around for enough people to be infected rather than implementing challenge trials in the first place.

There are huge ethical issues involved in those. We'd be deliberately exposing people to a disease for which we know we have no cure and only spotty treatments. This is made especially dire because we especially want to know how these vaccines help older adults... could you imagine a challenge trial where you give an 80-year-old COVID? Especially if you've given that 80-year-old a placebo vaccine? I don't know if it was the correct decision because ethics tends not to have correct answers, but it's a very understandable one.

Nobody was suggesting involving 80-year olds in the challenger trials.

But you'd have to if you want to make sure the vaccine worked for 80-year-olds. Otherwise we maybe have a vaccine that works fine for 20-year-olds and no one else.

But if they are volunteers, I don't really see what the issue is.  If you support other rights related to bodily autonomy like abortion and assisted suicide, why shouldn't a person be able to volunteer to risk their health to benefit the health of millions of other people?

I think the counterargument to this is that we don't want a world where people who don't volunteer are considered selfish, and we don't want a private drug company deciding which lives are worthy of sacrifice for this greater good.

  If it is unethical to allow volunteers for this, how is it ethical to ask for volunteers to join the military? (FWIW, I've been signed up on the list of volunteers at 1DaySooner for months.)

Because we pay those people, allow that to become their occupation, and (theoretically) treat them better after they've left the service, by giving them (what should be) superior healthcare and a preference in many types of employment.

[ilikeverin]

Vaccinating just 20 million people within the next month should have a huge effect if we can correctly coordinate who to vaccinate.  I believe the oldest 6% of our population is responsible for about 60% of covid deaths.

There seems to be general consensus that the first doses will be given to healthcare workers, which I think makes complete sense.

[ilikeverin]

Why are women so much less likely to say they will get it than men?

This is true across a lot of "health and wellness" sort of things. IIRC, women are also less likely to like GMOs and more likely to buy organic, and are much more likely to be anti-vaxxers.

[ilikeverin]

The FDA expert's panel voted 17-4-1 to endorse the Pfizer vaccine; the no and abstain votes were mostly from folks who seemed worried that they were endorsing it for anyone 16 and older (they wanted it to be 18 and older, as there wasn't much evidence about 16 and 17 year olds). Otherwise, the data seemed very strong. We'll probably have approval in the next few days, as early as tomorrow.

[ilikeverin]

That's going to be something that depends on the state. I can't remember which ones, but I've certainly seen states specifically include dentists in essentially the next wave of vaccinations.

[ilikeverin]

I think it's far enough after Thanksgiving that we can say that we didn't get the doomsday that many folks predicted from the Thanksgiving holiday. Eyeballing the NYT trendlines, I'm seeing unmitigated spikes in a couple of places: Northern New England, and the broader Sunbelt (TN, CA, AZ, SC, GA, NC, etc.). Very happy to see the downward trend here in Erie County

[ilikeverin]

I think it prolonged the spike. 2500-3500 deaths a day is pretty bad. Not sure anyone was saying it would be much worse than that.

I'm not sure. I mean, deaths are a lagging indicator, so things aren't really priced in yet there, but as far as cases go, I was expecting things to be much worse. But "prolonged the spike" is an entirely plausible and reasonable interpretation. (And it may have caused another spike in some of the states I enumerated.)

[ilikeverin]

Yeah, I'm not a fan of the tenor of these arguments. Yes, it's true vaccines aren't getting out very well... but deviating from the formulation of the vaccines that we know works just to get an extra, I don't know, 500,000 doses out this month doesn't make much sense to me if it might also reduce their efficacy. The problem is not the formulation of the doses, the problem is the logistics of the supply chain; changing the ways that we give the vaccines out does not actually fix the thing that's causing the holdups.

[ilikeverin]

Does anyone know if the vaccine is supposed to give lasting immunity, or if we’ll have to get a vaccine every year like the flu?

Given how short the vaccine has been around, we have no idea yet! It seems like immunity after infection holds up pretty well so far (see here for example) and there's no particular reason to think immunity generated by a vaccine would be different from immunity generated by a live infection, but this is something we'll have to figure out through trial and error over time.

[ilikeverin]

Just curious, has anyone around here gotten the vaccine? Wondering the range of side effects were. One of my brother’s friends got it and said all he had was a sore arm. Hopefully getting mine next month.

I've not heard of any friends/family having anything other than a sore arm!

[ilikeverin]

Welp.

Case rate is still continuing to improve, at least.

The casualty rate will always lag behind the case rate due to the slow nature of the virus. Overall, we should expect the casualty rate to drop more significantly between next week and the one after.

If we're doing vaccinations right, too, numbers should also start decreasing due to them around mid-February. Vaccination rates are low, but theoretically they ought in part to be going to some of the folks at highest risk of death.

[ilikeverin]

https://twitter.com/politicalmath/status/1353821818449129473?s=20

I've been following these numbers too and have been very confused by them. I don't doubt that some parts of NY are running out of vaccines (Erie County has had to cancel appointments)... I'm wondering if the figures he's citing about the state running out of vaccines might just be ones administered by the state or by counties, and the vaccines that aren't being used are being administered by hospitals or pharmacies.

[ilikeverin]

Interesting how there's no commentary whatsoever about how it's significantly more challenging to lead a vaccination effort in a state of 20 million than it is in a state of less than 2 million...

Percentage of vaccine doses delivered depends on absolute population now?

Yes, there seems to be a strong correlation there. The best states by proportion of vaccines administered and proportion of residents vaccinated, by and large, seem to be small states. There seems to be something about small states by population (and, interestingly, not by density or by area, both Alaska and Connecticut are doing great) that makes vaccine distribution easier.

[ilikeverin]

The updated numbers for COVID-19 in the U.S. are in for 1/27 per: https://www.worldometers.info/coronavirus/country/us/

I'm keeping track of these updates daily and updating at the end of the day, whenever all states finish reporting for that day.

ΔW Change: Comparisons of Weekly Day-to-day Growth or Decline of COVID-19 Spread/Deaths.

• IE: Comparing the numbers to the same day of last week, are we flattening the curve enough?

Σ Increase: A day's contribution to overall percentage growth of COVID-19 cases/deaths.

• IE: What's the overall change in the total?

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1/17: <Sunday>

• Cases: 24,482,050 (+176,007 | ΔW Change: ↓19.04% | Σ Increase: ↑0.72%)
• Deaths: 407,202 (+1,941 | ΔW Change: ↑8.13% | Σ Increase: ↑0.48%)

1/18: <M>

• Cases: 24,626,376 (+144,326 | ΔW Change: ↓36.10% | Σ Increase: ↑0.59%)
• Deaths: 408,620 (+1,418 | ΔW Change: ↓28.17% | Σ Increase: ↑0.35%)

1/19: <T>

• Cases: 24,806,964 (+180,588 | ΔW Change: ↓19.75% | Σ Increase: ↑0.73%)
• Deaths: 411,486 (+2,866 | ΔW Change: ↓34.11% | Σ Increase: ↑0.70%)

1/20: <W>

• Cases: 24,998,975 (+192,011 | ΔW Change: ↓22.61% | Σ Increase: ↑0.77%)
• Deaths: 415,894 (+4,408 | ΔW Change: ↑1.82% | Σ Increase: ↑1.07%)

1/21: <Þ>

• Cases: 25,196,086 (+197,111 | ΔW Change: ↓15.06% | Σ Increase: ↑0.79%)
• Deaths: 420,285 (+4,391 | ΔW Change: ↑7.99% | Σ Increase: ↑1.06%)

1/22: <F>

• Cases: 25,390,042 (+193,956 | ΔW Change: ↓23.65% | Σ Increase: ↑0.77%)
• Deaths: 424,177 (+3,892 | ΔW Change: ↑0.78% | Σ Increase: ↑0.93%)

1/23: <S>

• Cases: 25,566,789 (+176,747 | ΔW Change: ↓13.20% | Σ Increase: ↑0.82%)
• Deaths: 427,635 (+3,458 | ΔW Change: ↑1.56% | Σ Increase: ↑0.82%)

1/24: <Sunday>

• Cases: 25,702,125 (+135,336 | ΔW Change: ↓23.11% | Σ Increase: ↑0.53%)
• Deaths: 429,490 (+1,855 | ΔW Change: ↓4.43% | Σ Increase: ↑0.43%)

1/25: <M>

• Cases: 25,861,597 (+159,472 | ΔW Change: ↑10.49% | Σ Increase: ↑0.62%)
• Deaths: 431,392 (+1,902 | ΔW Change: ↑34.13% | Σ Increase: ↑0.44%)

1/26 (Yesterday): <T>

• Cases: 26,011,222 (+149,625 | ΔW Change: ↓17.15% | Σ Increase: ↑0.58%)
• Deaths: 435,452 (+4,060 | ΔW Change: ↑41.66% | Σ Increase: ↑0.94%)

1/27 (Today): <W>

• Cases: 26,166,201 (+154,979 | ΔW Change: ↓19.29% | Σ Increase: ↑0.60%)
• Deaths: 439,517 (+4,065 | ΔW Change: ↓7.78% | Σ Increase: ↑0.93%)

Looks like the numbers are starting to drop. Maybe the vaccines are already having a small impact after all.

There's some speculation about that, and it's not clear that that's the case... the rates are still too low (especially folks with a second dose). However, one thing the vaccines might be doing is driving people to change their behavior: if people know a vaccine is coming - like, pretty urgently, about to arrive! - they might change their behavior so they don't get sick when they know they won't have to wait forever to get away from it.

Not to mention that we're now getting further and further away from holidays that we feel required to be around others for! Although the fact there's not major holidays in January can't explain everything. Some part of it is probably some touches of herd immunity, but, again, that can't explain everything either - rates are dropping almost everywhere, regardless of previous prevalence.

[ilikeverin]

Yes, Tylenol seems to be the right choice for folks who have a reaction, from what I've heard!

[ilikeverin]

Has anyone found a good link explaining why cases are down so much basically everywhere across the US?  As of today, we will down more than 50% from our national peak less than a month ago.  Some states like South Dakota are down nearly 90%.  But this hasn't been in the news nearly as much as when cases were rising.

Well, it can't really be the inoculations; it's not penetrated fully enough into society to be able to move the needle. And, contrary to opponents of lockdowns, it's probably not entirely "herd immunity" or something like it, either; it's happening fairly uniformly across the country, and remaining hotspots are not necessarily places that were less affected early on (e.g., there's still lots of cases in the Rio Grande Valley, where there have been for while).

So, seems like it's behavior change on some level or another, which was probably the case for previous waves, too. It helps that we're out of a time of year with great family gatherings, which probably contributed to the wave in November/December (not as much as feared, but still did in all likelihood). It also helps that it's cold in the north, which helps incentivize people not to leave their house.

One explanation I've seen bandied about is that it actually is the vaccine... not the immune responses to it, but the fact that the pandemic suddenly seems temporary again. During the first lockdowns last year, in March/April, compliance was very good, in part because people were talking about the lockdowns in temporary terms. When it turned out we were in it for the longer haul, with things seeming indefinite, people probably just said, "screw it", threw up their hands, and partied. As we see vaccines being let out, suddenly we're in a world where the pandemic seems temporary again, and maybe people say, "eh, I can hold off on having this baby shower till the summer". Staying in seems bearable again. But I haven't seen hard facts about this. I'd love to see a poll asking people when they think they're going to get the vaccine and when they think social distancing restrictions will be relaxed.

[ilikeverin]

Anybody else who’s young fine with waiting on getting a J&J? I might be able to get one of the others starting next and if I get offered on, I’ll definitely take it but I don’t need the efficacy of the others and the one shot and done sounds much better.

There's absolutely no reason to wait for any vaccine; get the first one that's offered to you. They all prevent severe disease, hospitalization, and death.

[ilikeverin]

https://scitechdaily.com/most-americans-say-theyll-continue-health-precautions-after-the-covid-19-pandemic/

A new national survey of more than 2,000 Americans by The Ohio State University Wexner Medical Center finds most plan to continue many of the pandemic precautions in the name of public health, even when the pandemic is over.



The survey found that nearly three-quarters (72%) of Americans plan to continue to wear masks in public, four out of five (80%) will still avoid crowds and 90% plan to keep up frequent handwashing and sanitizer use after COVID-19. Gonsenhauser says it’s encouraging that people are willing to continue these practices and that this year’s flu season is proof of their effectiveness.

Somehow I really doubt this. But let's entertain this for a moment, if this was true, this means the end of conventions and large gatherings

lol. This is absolutely not happening. I'd love to see the wording of the poll questions.

[ilikeverin]

Numbers look great

This is something I really want to push back against. It's absolutely true that the trends in numbers are good. They're fantastic, actually. But the absolute numbers still aren't promising. In many places, cases are still quite a bit higher than they were last summer. Here in Erie County, COVID-19 Projections estimated that about 100 people a day were getting infected last summer; as of the beginning of the month, they estimated that number was about 600 people a day. Cases are getting better, but they were off of a huge peak, so they're still quite dire.

I think this is separate from the discussion of schools reopening; I think there's been good (and, in my mind, fairly convincing) arguments that schools are not major infection vectors when administered properly (we can look internationally to really see this). But just because the trend is good doesn't mean the absolute level is good, and I don't think the trend should be used to justify reopening anything.

Is there any data showing that teachers are more likely to catch the virus than other in person workers?

It's not clear in the US context.

[ilikeverin]

Looking at the Covid tracking project, it seems that New York has the highest number of hospitalised people per capita, and the second highest level of daily cases per capita (highest being South Carolina). Is Cuomo doing something wrong?

Cuomo has been doing many things wrong for a while. I can't claim much about the hospitalizations, but some part of the daily cases is probably just testing... NY is still testing at a good clip, pushing its observed rate higher. If you look at a site like COVID19 Projections, which incorporates both observed rates and test numbers into their estimates of prevalence, it's on the high end for the states but not as ridiculously so as the numbers suggest.

[ilikeverin]

GeorgiaMod's post said what I was going to say much more clearly and eloquently. I think the short version is: we're at nowhere near the level of vaccination that we'd necessarily see cases falling, so we shouldn't be too upset to see cases rising (except insofar as it tells us that people or governments are doing stupid things). However, we are at a level of vaccination (and a time post-vaccination) where we should see deaths falling, and indeed we are

We have the good news we could reasonably expect now, and hopefully soon enough (say, June) we'll see Israel-style good news on cases, too.