This is the first one of these emails going up in semi-public, but I’m going to pretend that I’m still writing just to my friends and family and their friends and families. (Here’s my brief intro note.) I try to keep these letters short, but today’s will be on the long side because I’m stepping back for a minute over Christmas.
First, I briefly reverted to data-yelling mode and wrote an op-ed for the Atlantic about how bad case and testing data is about to get in the US. It's not a particularly cheery or actionable essay, so honestly, only read it if you were planning to monitor case numbers over the holidays. The 30-second version is that holidays disrupt testing and reporting and we're already in yet another test shortage, so US covid data—hospitalization numbers excepted—will be crappy and unreliable for several weeks.
Some super basic basics
Omicron is very good at spreading and lots of us will get it. We're certain to see some serious illness during the omicron wave, and overtaxed hospitals will result in reduced care for everyone who needs it. Also, I think it's useful to be clear that for most people—especially vaxxed and boosted people—getting covid this winter will be miserable and extremely inconvenient but not deadly. I say this not to downplay the importance of precautionary measures, but to note that this kind of illness is something you can plan for. This is a good time to get a pulse oximeter and learn how to use it. I think you should get a backup battery for your thermometer, maybe even an extra thermometer. Buy some soup! Get ready to keep your germs to yourself for ten days if you need to. Check on your neighbors if you can, and consider throwing some money at your local food banks and/or mutual aid organizations, because the next month is going to be extra bumpy for a lot of people.
High-filtration masks still work and cloth masks are probably not going to make the cut although I personally appreciate every person who wears any mask at all in public buildings. If you're in a high-risk situation and feeling anxious, please know that lots of people are doing their best to protect you, even though you can't see it.
What to do if you test positive
The NYT has a great explainer on what to do after a positive test that collects lots of good guidance in one place, and the CDC has info as well. I recommend bookmarking those pages for yourself and/or others because lots of us are likely to need it or know people who do. Also maybe you would like this explainer on how to use rapid tests.
What to do if you need a test and can't get one
This is a harder answer, but a lot of people are having a lot of trouble getting tests right now, at least in the US. If you're symptomatic or know you've been around someone with covid, you may be able to call your county/city health authority and ask for advice on finding a test. If you're seriously ill and need medical care but don't know if it's covid, call ahead and find out the protocol for the hospital or clinic you're going to—some places will want to test you outside before you go in the building, for example. Speaking of which, the CDC would like you to get immediate medical care if you have any of these symptoms:
Persistent pain or pressure in the chest
Inability to wake or stay awake
Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
If you're not sick but you're worried and can't find a testing site or at-home test that's accessible to you, you're probably stuck with some uncertainty. It's wise to remember that omicron is really good at infecting even vaccinated people, so if you have reason to believe you’ve been exposed, it would be a huge kindness to limit your contact with vulnerable family members/friends/crowds of humans with unknown risk levels.
Vaccines: okay against omicron infection w/mRNA booster, quite good for staying out of the hospital
Precise numbers on vaccine effectiveness against omicron infection would be cool, but we still don't have those. We have UK estimates ranging from about 50 to 80% effectiveness against infection for a three-shot Pfizer series (previously featured in this newsletter) and we have evidence from Moderna that their booster is much better than two shots alone. The big non-mRNA vaccines—J&J, Sinovac, AstraZeneca, and others—appear to provide pretty much zero protection against infection, which suggests that omicron transmission will hit the many countries and communities relying on those vaccines especially hard. A previous infection, for what it's worth, is probably only offering about 19% effectiveness against infection.
Lots of people are getting or will get omicron, but a lot of people have at least some immunity at this point—perhaps 80-90% in the US—which should blunt the virus's effects on individual humans. We can still expect vaccines to help keep people out of the hospital. And again, mRNA boosters are the smart move here, if you have access to them.
When will we know about disease severity?
Is omicron going to behave like a cold? Maybe! Is omicron's severity about the same as delta in a population like the UK's or US's? Could be. The answer is probably in between, but we still don't really know. There are a ton of wishful and anxious guesses about severity floating around news sources right now, but it really is just guessing. We can't assume that South African data will translate neatly to areas with older populations and different levels of immunity, and the data is still out in the UK. BUT it looks like we should have a lot more solid data on real-world severity in the UK by the first of the year.
In the meantime, I liked Derek Thompson's review of the situation at the Atlantic, especially his conclusion that it’s smart to be both optimistic and cautious. If you like details, the Financial Times article linked from this tweet is a good summary of early research, or you can get the highlights from one of the authors on Twitter.
What you do before we get solid severity data should probably be based on your and your family's personal situation (risk tolerance, physical and mental health, overall priorities) and on your wider community's risks and needs—ideally including the load on your local hospitals, which you can look up right here, at least at the weekly level.
Kids and omicron
There was a concern several weeks ago that more kids were being hospitalized with omicron in South Africa than was previously expected, which led to a lot of sensational headlines, but the South African public health establishment suggested that the data probably reflected little kids with fevers being hospitalized as a precautionary measure, not severe pediatric covid. Despite being glued to my screen whenever new studies emerge, I haven't seen any reason to believe that omicron is making kids sicker than, say, delta.
I'm hoping it will be much milder, but that's just a hope—it's probably most reasonable to assume for now that omicron and delta pose similar threats to unvaccinated kids who haven't had covid before—and that that risk is unevenly distributed. If you have young kids or hang out with a lot of people who do, I recommend glancing over the distinctive symptoms of MIS-C, the very rare but dangerous covid complication some kids develop, just so you know what to look for.
Finally, there's a ton of debate about closing schools that you couldn't pay me enough to engage with, but realistically, unless omicron reverses course and miraculously disappears, it's wise to expect rolling school closures because you physically can't keep schools open if tons of people are out sick or in quarantine.
Long-term vaccine effects
How are we feeling about potential long-term effects of covid vaccines, especially with more boosters looming? A lot of answers to this tend to assume that it's always asked in bad faith, but I think it's a perfectly reasonable question. The wonderful people at the Children's Hospital of Philadelphia do a nice job of succinctly covering the scientific basics of why specialists aren't worried about long-term vaccine effects, and I also liked this write-up on the history of vaccine technologies and what it's taught us about long-term effects. I found both pieces soothing! The possible long-term effects of covid itself, on the other hand, are both unsettled and also unsettling. We're not even sure how much vaccines reduce the likelihood of long covid symptoms, although they seem to help. Mysteries abound.
I wish you all the best possible holiday break if you’re getting one, and Merry Christmas to youse who are Christmas people. It’s a meaningful holiday for me and I plan to celebrate by being offline with my family and listening to a lot of weird early modern music cranked to eleven.