The COVID-19 Pandemic: Waiting for OmicronDec 27, 2021
As I write this, I am in Florida with its alternate vision of the COVID-19 pandemic. As my wife and I awaited her daughter at the Sarasota airport after arriving, a grandfather picked up his teenage grandchildren and told them to put away their masks, “You are in Florida now, a no-mask state.”
Only a month has passed since the World Health Organization named Omicron a variant of concern. We have learned that it is highly infectious, but there is mounting evidence that its virulence is less than Delta’s. In the Gauteng province in South Africa, one of the sites where Omicron was first identified, surveillance data show that case numbers peaked quickly and are now declining. In Colorado, case numbers are starting to rise, likely signaling the start of an Omicron surge. The rate of test positivity is also increasing.
The impact on Coloradans and on Colorado’s healthcare system will depend on the virulence of the Omicron variant. Hospitalizations in the state for COVID-19 continued to decline through December 24 reaching 1,006, well below the fall peak of 1,576 on November 23. Omicron could turn the hospitalization curve upward again, given the lag of 10-14 days between infection and hospitalization. However, three new reports released last week indicate that COVID-19 caused by Omicron could be less severe than that caused by the Delta variant. The reports, which are not yet peer-reviewed, are based on national data from South Africa, England, and Scotland. All show reduced risk for hospitalization from infection with Omicron versus Delta, with the degree of reduction in risk ranging from about 40% down to 80% among the reports. The findings in England and Scotland should be generalizable with some confidence to the United States. With surging cases in Eagle, Pitkin, and Summit counties, we will accrue data in Colorado soon enough.
Testing remains a touted strategy for reducing infection. But try and find a test! Stores don’t have them and Amazon projects delivery at a week or more in the future. Colorado has its Rapid At-Home testing program, which appears not to be functioning as billed at the moment. About a month ago, we easily obtained test kits. Now, after completing the Individual Enrollment Form more than a week ago, I have yet to receive the confirmation email and order form. President Biden has promised to make 500 million rapid tests available, but a system is not in place for their distribution and the needed production capacity is not ready.
From President Biden’s pledge to ensure the availability of tests for all, there are numerous steps from the manufacturing of FDA-approved tests to putting them into the hands of the public. A framework is lacking for this purpose. By now, the country should have established the necessary processes and a management structure that is better than ad hoc. The same failing remains with personal protective equipment for respiratory protection. Can we assemble the apparatus to put tests in the hands of the public quickly? Before the Omicron surge crests?
Relevant is a spat between the New York Times and Abbott as to whether the company destroyed millions of tests at a facility in Maine in August. Per the telling by the Times, workers at the Maine facility were instructed to destroy kits and were then laid-off. Per Abbott, the story is quite different. Regardless, capacity is currently inadequate to make rapid tests and there does not appear to be a stockpile. Where does responsibility lie for assuring that tests are available, affordable, and accessible? The Food and Drug Administration approves the tests but does not manage supply and delivery.
We will learn more about Omicron in the last days of 2021. Hope for the best and Happy New Year.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health