Coronavirus

[AlanSubie4Life]

Did you read the paper? Nothing irresponsible about reporting what they found. The study followed confirmed cases of the variant and discussed the outcomes. Highly vaccinated Danish population is faring (relatively) well against this variant… that is good news. Acknowledging good news is ok

I did, and the paper is fine. But it also doesn't mention IFR. It actually didn't break out deaths amongst vaccination status, even. I didn't say anything was irresponsible about what you posted, or even what you said. I was just commenting that the reason this information (on IFR) is not out there from reliable sources is because no one knows the answer, and the reliable sources know it's not responsible to assess it at this time.

I've said several times exactly what I think we're dealing with with Omicron. Just calling it like it is. But there are things we don't know, like IFR or even CFR. (The CFR from the paper is not a real CFR since it doesn't provide vaccine status of the deaths, which is now relevant (when it was novel you could just do a simple calculation). But calculating CFR and combining unvaccinated/vaccinated is fairly meaningless since the results can't be extended to anywhere else. Keep in mind that they test at some of the highest levels in the world too so that also drives down their CFR. All the same things we know from two years ago, and have discussed ad nauseam.)

IFR and CFR are terrible metrics anyway since in general you can't extend them from one country to another in any meaningful way for obvious reasons (age, health, testing, vaccination rate).

 

[cwerdna]

Investigators Launch Probe Into COVID Testing Company was in local news last night about "Center for Covid Control".

Stop Work Order Issued for COVID-19 Testing Location Operating Improperly - City of Lakewood was in Lakewood, WA w/the same outfit.

What's the Center for COVID Control? Questionable sites spotlight nation's thirst for quick testing

Americans in states across the nation are raising concerns about a string of COVID-19 testing sites run by the so-called "Center for COVID Control."

www.usatoday.com

WINK News Investigates: COVID testing location in Bonita Springs providing negative results before people get tested - someone at work posted a tweet to the video in this story. At least this page has the text if that's you want.

If you use a testing site, make sure it's legit.

 

[Norbert]

To be clear, as far as I can tell, any part or even all of the current increase in death rate that we are seeing for the US, could still be a result of delta infections around end of December, given that the percentage was still very high (surprisingly for me). That should change in the coming weeks, assuming that Omicron will not only decrease the percentage of Delta but also the absolute numbers of Delta (and any other variants), as seems to be expected.

 

[EVNow]

In king county , WA - the graphs of cases and hospitalization look very similar.

Fatalities have gone up too - but with low numbers, nothing conclusive.

 

[golfcart]

I posted that paper because it is the best documentation I have seen where only confirmed positive pcr omicron cases were used in the study and things like age distribution, vaccination status, date of positive test, and hospitalization/death is tracked (at least at the group level). It seems pretty solid and I could only find it referenced on somewhat sketchy websites. I'd also think by now they'd have good data out of South Africa widely available.

I did, and the paper is fine. But it also doesn't mention IFR. It actually didn't break out deaths amongst vaccination status, even. I didn't say anything was irresponsible about what you posted, or even what you said. I was just commenting that the reason this information (on IFR) is not out there from reliable sources is because no one knows the answer, and the reliable sources know it's not responsible to assess it at this time.

I didn't ask if you read the paper to be a jerk, sometimes folks just skim for the info they are looking for and don't read through the whole thing. Sure it doesn't mention IFR but you have a documented group of positive tests that were followed closely. As far as vaccination status goes, in the caption for table 4 it specifically states:

Table 4. Vaccination status for individuals ≥12 years infected with Omicron compared to
other variants, from 21st of November to 28th of December 2021. The table includes only
samples taken at TCDK where the variant PCR answer is known.

Vaccination Status (Omicron Cases)	Percentage
Not Vaccinated	8.7%
First Dose	2.4%
Primary Vaccine Schedule (2 doses)	82.7%
Revaccinated (booster?)	6.2%

The vaccination table has about 5k less entries than the deaths table so I will assume those are the under 12 cohort which they state is not included in the vaccine table. So I would argue that vaccine status is in fact very well known in establishing an upper and lower bound. If we assume that the 8.7% of unvaccinated make up the entire pool of deaths you could get a best case for vaccinated and vice versa.

Agreed it would be nice if you knew the age, previous infection status, and vaccine status of each death but with a sample size of over 50k you can extrapolate what a 90% vaccinated population age 12+ looks like. Since people under 12 don't die of this unless they have multiple comorbidities, excluding the young would not skew the results towards a more optimistic answer in any way. At least table 8 breaks down the age distribution.

I would take the study as a good sign, but not more than that, for two reasons:
1) The absolute number of deaths in the study is quite low and might be somewhat random.
2) More importantly, the timespan of observation seems to have often been too short, and especially since Omicron does appear to be milder per person, it might on average take longer to die from it, in case that happens. Also, not being a doctor, I'd have the question if then instead it might have a lasting negative effect in some number of cases.

What do you think is a reasonable timespan? Table 9 states:

Table 9. Number and proportion of Omicron related deaths compared to other variants,
data included in the table are from 21st of November to 28th of December 2021. The table
only includes samples with a known variant.

and if you look at the top left column heading in the table it says:

Dead within 30 days after a positive test

and table 10 takes it out to date of data extraction which is January 2nd with the death numbers unchanged. Table 2 shows the date of positive test (I believe), so there are tens of thousands of omicron cases in that study that have had 3+ weeks pass since the positive test date along with a decent amount in the 1-2 weeks since positive test range. I guess it is possible that the later samples take a huge turn for the worse... or that this variant takes longer to kill but given the low percentage of hospitalizations I find that hard to believe. Not saying your concerns aren't valid but I feel like they are reasonably addressed by the paper. They could follow up in a couple weeks and be even more difinitive I suppose.

 

[golfcart]

Here's the actual study with 52,297 Omicron and 16,982 non-Omicron (almost all Delta) confirmed infections. I can't find the 18 deaths in the Omicron group. I only see one. But Figure 1 shows virtually all Omicron infections occurred in the last half of December with the vast majority in the final week. These people didn't have enough time to die by January 1, or in most cases not even enough to be hospitalized.

This study focused on the relative risk between Omicron and Delta. I don't see how to use this data to estimate IFR/CFR.

That is a lot to parse through but great info. Thanks for that.

 

[bkp_duke]

So personal question, were you boosted? And if so what do you say to the people who question why anyone should get boosted if it doesn't stop them from getting Covid? AND for those same people if they do get Covid should they then still get boosted?
Thanks, and speedy recovery.

Yes, received 3 x Moderna doses in total. Booster received 2 months ago.

The data is becoming very clear on this - people that were vaccinated have a much milder course of the disease. People that were vaccinated AND boosted have an even milder course of the disease. I've said this before, but it bears repeating, vaccines are NOT designed primarily to halt the spread of a virus. It's a GREAT side benefit when it happens, but the primary design goal is to increase the immune response to prevent 1) DEATH and 2) reduce the need for hospitalization. In these two metrics, the COVID vaccines have performed exactly as they should, and very very well.

People that previously had COVID should definitely get boosted. Fantastic example right now is my business partner, who refused to get a booster because he "had COVID antibodies" from a prior infection. He went to the ER yesterday with, and his words, "lung pain". He wasn't bad enough to be admitted and his vitals were normal, but he's having a pretty rough go of it. All because, to be blunt, he doesn't like being told what to do. Mind you, this person knows I am an MD and a Ph.D., have worked with viruses, etc. He's asked me my opinion, and still didn't want to get vaccinated because . . . he's stubborn. I hope he doesn't have any lasting consequences of his decision.

 

[Norbert]

What do you think is a reasonable timespan? Table 9 states:

Table 9. Number and proportion of Omicron related deaths compared to other variants,
data included in the table are from 21st of November to 28th of December 2021. The table
only includes samples with a known variant.

and if you look at the top left column heading in the table it says:

Dead within 30 days after a positive test

and table 10 takes it out to date of data extraction which is January 2nd with the death numbers unchanged. Table 2 shows the date of positive test (I believe), so there are tens of thousands of omicron cases in that study that have had 3+ weeks pass since the positive test date along with a decent amount in the 1-2 weeks since positive test range. I guess it is possible that the later samples take a huge turn for the worse... or that this variant takes longer to kill but given the low percentage of hospitalizations I find that hard to believe. Not saying your concerns aren't valid but I feel like they are reasonably addressed by the paper. They could follow up in a couple weeks and be even more difinitive I suppose.

"Dead within 30 days" would be fine with me as a reasonable timespan (though it would be better if a study then also showed that after 30 days the number of deaths really approaches zero, since in much earlier discussions it seemed the tail can be long.)

To me it looks like the number of Omicron cases per date in Table 2 is the third column plus the forth column, so the study seems to have only about 300 Omicron cases with 30+ days before Jan 2nd.

(And by my count only about 6,500 Omicron cases with 3+ weeks, which with 18 deaths would result in a ratio of about 0.28%, which in turn at currently almost 800K cases per day in the US would be about 2,200 deaths per day. Of course that would be attributing all 18 to those 6,500, but then there are only 300 with 30+ days among those, and it would also ignore any differences in vaccination, health and any other differences. And at those numbers, the uncertainty is definitely large. So in summary I wouldn't really want to draw any conclusions from all that.)

 

[golfcart]

"Dead within 30 days" would be fine with me as a reasonable timespan (though it would be better if a study then also showed that after 30 days the number of deaths really approaches zero, since in much earlier discussions it seemed the tail can be long.)

To me it looks like the number of Omicron cases per date in Table 2 is the third column plus the forth column, so the study seems to have only about 300 Omicron cases with 30+ days before Jan 2nd.

(And by my count only about 6,500 Omicron cases with 3+ weeks, which with 18 deaths would result in a ratio of about 0.28%, which in turn at currently almost 800K cases per day in the US would be about 2,200 deaths per day. Of course that would be attributing all 18 to those 6,500, but then there are only 300 with 30+ days among those, and it would also ignore any differences in vaccination, health and any other differences. And at those numbers, the uncertainty is definitely large. So in summary I wouldn't really want to draw any conclusions from all that.)

IIRC median time from initial symptoms to death with covid was shown to be ~18 days and we don't know that these people were tested the day they initially had symptons (most likely after). So I'd say using 30 days would be very conservative, 15 days would probably catch at least half, 20 days would probably catch most... but it is hard to say definitively. Hopefully the do a follow-up in late January at that point it should be a pretty definitive dataset.

 

[Norbert]

IIRC median time from initial symptoms to death with covid was shown to be ~18 days and we don't know that these people were tested the day they initially had symptons (most likely after). So I'd say using 30 days would be very conservative, 15 days would probably catch at least half, 20 days would probably catch most... but it is hard to say definitively. Hopefully the do a follow-up in late January at that point it should be a pretty definitive dataset.

The median for Omicron might be larger than for the other variants, as I mentioned. For any of those numbers you might get a quite different result. Similar to your suggestion above to attribute all deaths to the unvaccinated to get some limit as the study doesn't separate deaths by vaccination, this calculation shows the number resulting from attributing all deaths to the "reasonable" subset of the data using timespans that you mentioned. As such the calculation is meant to illustrate the high uncertainty at this point (from my point of view), and not meant to be a realistic calculation. Some time ago we had studies from Iceland which appeared quite atypical, difficult to interpret and reconcile with numbers from other countries, so that for example is also a reason for caution.

However if/when there is an update, I'd defintely be interested to see it.

 

[SDRick]

People that previously had COVID should definitely get boosted. Fantastic example right now is my business partner, who refused to get a booster because he "had COVID antibodies" from a prior infection. He went to the ER yesterday with, and his words, "lung pain". He wasn't bad enough to be admitted and his vitals were normal, but he's having a pretty rough go of it. All because, to be blunt, he doesn't like being told what to do. Mind you, this person knows I am an MD and a Ph.D., have worked with viruses, etc. He's asked me my opinion, and still didn't want to get vaccinated because . . . he's stubborn. I hope he doesn't have any lasting consequences of his decision.

Curious about your partners age, weight and general health. How long ago did he get COVID and how long do you recommend waiting to get a booster if you tested positive from prior infection?

 

[bkp_duke]

Curious about your partners age, weight and general health. How long ago did he get COVID and how long do you recommend waiting to get a booster if you tested positive from prior infection?

My business partner is mid-30s, somewhat overweight but has dropped a lot of weight in the past year in an effort to improve his health. He says he got COVID about a year ago. I would not get a booster until at minimum 2 months after 100% of symptoms have resolved. Probably more like 5-6 months is better. There is not much point in priming your immune system after your antibody levels are high and you have just fought off the infection.

 

[SDRick]

My business partner is mid-30s, somewhat overweight but has dropped a lot of weight in the past year in an effort to improve his health. He says he got COVID about a year ago. I would not get a booster until at minimum 2 months after 100% of symptoms have resolved. Probably more like 5-6 months is better. There is not much point in priming your immune system after your antibody levels are high and you have just fought off the infection.

I'm sure you will agree that weight and diabetes are negative factors. Also curious if athletes, particularly runners or those subjected to anaerobic lung stressing exercise is protective?

 

[bkp_duke]

I'm sure you will agree that weight and diabetes are negative factors. Also curious if athletes, particularly runners or those subjected to anaerobic lung stressing exercise is protective?

Yes, any below average health person is at increased risk.

Unfortunately, being say an Olympic athlete is not protective over someone in normal health. Elite athletes that have gotten COVID have reported it was one of the greatest de-conditioning experiences of their lives.

 

[AlanSubie4Life]

So I would argue that vaccine status is in fact very well known in establishing an upper and lower bound. If we assume that the 8.7% of unvaccinated make up the entire pool of deaths you could get a best case for vaccinated and vice versa.

Yes, I know, I mentioned this in my first response. It's just that we don't know the breakdown of deaths by group (I think actually more of them would be vaccinated than you might expect since it's a more vulnerable older population even when ~90% of people are vaccinated). And also it hasn't been long enough. We're just rehashing at this point, so that's all I have to say for now.

I have little doubt that the fatality rate for Omicron will be notably lower than it was for Delta, and I think we'd be seeing worse numbers here if that were not the case, even at this early stage. There seems to be widespread agreement on that reduced virulence by the experts (and there's a potential mechanism for it). It's just that it is still likely way too high (for the unvaccinated). Lower is a relative term. And due to limited data gathering/availability, it's difficult in many places to separate vaccinated outcomes from unvaccinated outcomes.

It's not like reduced virulence hasn't been mentioned by reliable sources which were linked here: I linked to this in mid December, Coronavirus (There are reasons why the CFR dipped so low, of course, discussed further down. But it seems clear in retrospect that it IS lower.)

And on December 17th there was a post with a possible reason for the reduced virulence. And even earlier than that there was discussion in this thread about the possibility of it being more mild than Delta (which, to be clear, does not mean it is mild).

In the end we just have to wait another couple months to know the actual answer to all these questions. In the meantime I'm avoiding it.

 

[msm859]

My business partner is mid-30s, somewhat overweight but has dropped a lot of weight in the past year in an effort to improve his health. He says he got COVID about a year ago. I would not get a booster until at minimum 2 months after 100% of symptoms have resolved. Probably more like 5-6 months is better. There is not much point in priming your immune system after your antibody levels are high and you have just fought off the infection.

And how long is it expected for the boosters to last. It seems the consensus is that 5-6 months after being fully vaccinated you need a booster. Are they going to say that you will need another booster after 5-6 months?

 

[bkp_duke]

And how long is it expected for the boosters to last. It seems the consensus is that 5-6 months after being fully vaccinated you need a booster. Are they going to say that you will need another booster after 5-6 months?

No one knows. Remember, I've said I'm AMAZED that the current vaccines even work against Delta and Omicron. There have been so many mutations accumulated in these viruses that we are immunizing against something substantially different. That is a testament to how well these vaccines were built in the first place. Can't say that about the Chinese and Russian vaccines. Everything I hear is that their effectiveness against the new strains is very low.

EDIT - also remember that this is becoming an endemic virus. By definition that means LESS deadly. As that happens, it will become more and more like the common cold (there already are 6 common coronaviruses that cause the common cold). At that point, we won't need vaccines for this.

 

[TEG]

Fantastic example right now is my business partner ... he doesn't like being told what to do ... he's stubborn...

Are those characteristics you want in a business partner?

 

[bkp_duke]

Are those characteristics you want in a business partner?

Given that he owns more of the company than I do, it's his call to make (stubbornness in business). We've both made millions in the business, so I would say I can live with those characteristics.

 

[scottf200]

a) Nice summary graphic and text.
Article: Visualizing How COVID-19 Antiviral Pills and Vaccines Work at the Cellular Level
Full graphic shortcut URL: Visualizing How COVID-19 Antiviral Pills and Vaccines Work at the Cellular Level

b) State/Territory-Coordinated Distribution of COVID-19 Therapeutics

State/Territory-Coordinated Distribution of COVID-19 Therapeutics

Table of state/territory-coordinated distribution of COVID-19 therapeutics.

www.phe.gov