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About the series
Rates of new cases of COVID-19 have increased rapidly, and in 36 states there is not enough hospital capacity or a threat of running out of hospital capacity due to this wave of COVID-19 infections.
The Centers for Disease Control and Prevention (CDC) chart below shows the problem (blue line is the seven-day moving average of cases, yellow line is hospitalizations).
Source: CDC, January 7, 2022.
The good news is that the ratio of new cases to hospitalizations is three times lower compared to the peak of January 9, 2021. The bad news is that we have about three times as many newly diagnosed cases, so we see the same 16,500 new hospitalizations this January as we saw last January. Neither new cases nor hospitalizations seem to have peaked yet, so in the healthcare delivery system conditions will continue to get worse over the next few weeks, after which we will hopefully see a decline in new Omicron cases.
The problem of healthcare system capacity is not limited to hospitals. At one community health center in Boston, a quarter of the staff are out with COVID-19. This means a limit to urgent care and well-child visits, so vaccinations will again decline. Many hospitals around the country are postponing elective surgery. This includes surgery to remove cancer and surgery to address serious orthopedic injuries – so this delay will certainly worry patients and could also worsen outcomes and costs later this year.
Thousands of schools across the country have moved to remote sessions, either due to high rates of infection of students or shortages of staff due to employee illness or quarantining.
Studies continue to show that those who are infected with Omicron are likely to be less sick than those who were infected during previous waves of COVID-19. It appears that this variant is better at evading immunity and replicates even more rapidly in the upper airway leading to increased transmissibility. But it replicates less effectively in the lungs, leading to less respiratory failure.
The Journal of the American Medical Association published data from the recent Omicron wave in South Africa based on 17,200 patients seen in emergency departments of a 49-hospital system. The study showed that fewer patients were admitted with acute respiratory conditions during Omicron than during the first three waves of COVID-19.
Caroline Maslo, MD, PhD, et al, Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous Waves, JAMA, December 30, 2021.
Data from a preprint (not yet peer reviewed) study of over 575,000 newly diagnosed cases of COVID-19 across multiple healthcare systems in the U.S. show that Delta was far more likely to cause emergency room visits, hospitalizations, intensive care stays and mechanical ventilation. The data also show that the difference extends to those under five years of age, who are not yet eligible for vaccination.
Source: Wang, et al, Comparison of outcomes from COVID infection in pediatric and adult patients before and after the emergence of Omicron, MedRxIV, December 30, 2021.
The Omicron variant evades immunity offered by two previously available monoclonal antibodies, REGEN-COV (Regeneron), and bamlanivimab and etesevimab (Lilly). The monoclonal antibody that remains effective, soltrovimab (Glaxo Smith Kline), is in short supply. The two promising oral drugs, molnuprivir (Merck) and paxlovid (Pfizer), are slowly becoming available at pharmacies, but are still in limited supply. They are indicated for treatment of those with laboratory-diagnosed COVID-19 who are at high risk for complications and must be given within three to five days of symptoms.
The CDC now recommends booster shots when eligible for all those age 12 and up. Booster eligibility begins at five months (Pfizer and Moderna) and two months (Johnson & Johnson) after the primary series. The agency also recommends an additional dose for both children over age five and adults who are immunocompromised.
Age or status | Recommendation | Comment |
---|---|---|
Immunocompromised adults and children | 3 doses + booster when eligible | |
Ages 18 and up | 2 doses + recommended to get booster | J&J booster at 2 months after first dose and Pfizer or Moderna booster at 5 months after completing primary series |
Ages 12 to 17 | 2 doses + eligible for booster | J&J booster at 2 months after first dose and Pfizer or Moderna booster at 5 months after completing primary series |
Ages 5 to 11 | 2 doses | |
Under 5 | No vaccine currently approved |
Quarantine (for those exposed to COVID-19, whether in the workplace or elsewhere):
Isolation (for those diagnosed with COVID-19):
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.