Severity of Omicron Wave = Current Delta Severity + Impact of Shift to Omicron - Impact of More Boosters And in the low-escape scenarios at least, those latter two terms are roughly netting out, leaving the severity of the omicron wave similar to the recent history, with delta.

While the recent experience includes some booster effects, it won’t include much from boosters in the first half of December, nor in the second half, or in January – all of which are included in the LSHTM model. So in summary we have the following equation:

…be similar in severity to the recent experience of delta. But hang on, didn’t we say that LSHTM were implying that omicron increased severity, not left it the same? We must be missing something, and we are: the impact of more boosters going into arms.

We can estimate that the current UK ratio of admissions to infections is around 0.9% (assuming that we detect around 50% of cases, and noting that the ratio of admissions to cases is around 1.8%). So for the “low escape” scenarios, LSHTM are estimating that the omicron wave will

So the LSHTM model is in a similar place to my made-up numbers above – their estimate is that omicron will result in higher severity overall. We can confirm this by looking at the ratio of hospitalisation to infections in their output scenarios. (note: my table, not theirs)

If we do the same calculations, looking at (1-VE) and how this changes, we can estimate that in the “low escape” scenarios, severity will go UP by a factor of ~1.6, and by a factor of ~2.2 in the “high escape” scenarios (note this varies a bit by vaccine status, but not by much)

With all this in mind, we’re ready to look at what LSHTM assumed for their VE under different scenarios and vaccine statuses (and note they have modelled prior infection as having similar protection to 2 doses of vaccine).

Now these were all just made-up numbers to show that an escape variant doesn’t necessarily drive less severe outcomes… it all depends on what happens to VE vs. severe, or rather to (1 - VE vs. severe) in relation to the movements in (1 - VE vs. infection)

…that aren’t prevented – from 5% of the pre-vaccine total up to 20%. Meanwhile the number of infections not prevented is only increasing by a factor of 3 – from 30% up to 90%. Hence the severity ratio increases by a factor of 4/3 (from 1.7% to 2.2%).

And what’s happening here is that while VE vs. severe disease dropping from 95% to 80% might not seem that bad – it’s only 15%, compared to the 60% fall in VE vs. infection (from 70% to 10%). But that drop from 95% to 80% is really a fourfold increase in the severe infections

What happened here? Well, mostly what happened is that we were focused on VE when we should have been focusing on (1 - VE). As has been explained by @BristOliver and others several times, that’s often the number that really matters, and which drives outcomes.118159

Infections are now reduced by 10%, to 900, and severe cases are reduced by 80%, to 20. So the severity ratio is now 20/900 = 2.2%. So that’s…. oh. It’s gone up, not down. Check the figures: that’s right. Our new variant with a lot of breakthroughs made severity worse??

So this is maybe a bit like omicron – it permits a lot more infections, but still has a (we hope) a decently strong effect against severe disease. Given that it’s permitting a lot more (typically mild) infections, the severity ratio should have fallen, right? Let’s check:

But now let’s see what happens when we introduce a new variant, with significant immune escape. Let’s assume our VE vs. infection is nearly wiped out, dropping to only 10%. The VE vs. severe disease is better preserved, but still drops to 80%.

Here the severity ratio has been reduced to 5 / 300 = 1.7%. So far, so good – the vaccines have substantially reduced the severity of the disease, as well as the number of infections.

Now suppose we have a strongly effective vaccine, which has a vaccine effectiveness (VE) of 70% vs infection, and 95% vs severe cases. Once this vaccine has been rolled out, for the same amount of exposure, we’d expect infections to reduce to 300, and severe cases to only 5.

Let’s start by supposing that pre-vaccine, we have 1000 infections, of which 100 are severe (requiring hospitalisation). So I’ll report this as a severity ratio of 100 / 1000 = 10%.

However, this rosy picture is not guaranteed. To explain this, I need to get pen & paper out, and go on a small mathematical diversion – but don’t worry this is all primary school maths (addition and multiplication), there’s no log scales or differential equations in sight.

The hope is these effects make the omicron wave significantly less severe on average. Omicron’s large immune escape means it has many more susceptibles to infect than delta, so can spread faster and further – but a lot of these infections will be mild.

a) Higher levels of immunity in the population (from vaccines / boosters and infections) b) Higher levels of immune escape by omicron –permitting many more reinfections and ‘breakthrough’ (post-vaccine) infections, which tend to be milder on average.524203

So the best assumption is that it is similar to delta on that count (and we should consider scenarios on both sides). But even if its intrinsic severity is similar to delta’s, the experienced severity of an omicron wave may be quite different to previous waves, due to:

So it’s really a game about severity, and that’s where things get a lot more uncertain. At the moment I don’t think we have any solid evidence that omicron is intrinsically more, or less, severe than delta – i.e. the impact it would have on an unvaxxed / uninfected population.

Still, I expect a large wave of omicron cases in the UK, even if it doesn’t stay at a constant 2-day doubling period. NPIs and voluntary behavioural adjustment may also help to flatten the wave, but that won’t stop a very large number of people getting infected.

But it wouldn’t be totally surprising if these rates of growth did change over time, as omicron works its way into different networks and localities that have different levels of immunity. We might well see some similar surges and pauses as it spreads across the UK.

There are also some hints from South Africa and Denmark that high rates of growth may be slowing after an initial surge. I’m not close enough to the data to give a confident explanation of what’s going on – please follow @lrossouw and others for that.

n the meantime, omicron has continued its path towards world dominance, and is now firmly established in the UK, with an apparent doubling time of around 2 days – although with some hints that it may have slowed very slightly in recent days.

In case you missed it, there’s a great explanatory thread here from @BarnardResearch. But in summary their scenarios are looking at 20-35 million omicron infections, and peak hospitalisations somewhere between half and double the January 2021 level.

Most of what I said in last week’s thread (see below) remains true. And I was somewhat gratified to see that the great minds at @cmmid_lshtm, using far more computer power than the back of my envelope can provide, came to very similar conclusions:

Another week, another long thread on omicron. This time, I’m still concerned, but perhaps a bit less worried than I was – mainly because I’m starting to be more confident that our experience of omicron will be significantly milder than earlier covid waves.

Project N95 is a national non-profit working to provide equitable access for all to affordable, authentic respiratory protection and health products through education, advocacy and distribution of vetted goods and services.

The trusted source

#Omicron is spreading fast. WHAT CAN YOU DO? Great new animation from @VickiGSP

10.1101/2021.12.27.21268459

The recent emergence of the SARS-CoV-2 Omicron variant is raising concerns because of its increased transmissibility and by its numerous spike mutations with potential to evade neutralizing antibodies elicited by COVID-19 vaccines. The Dominican Republic was among the first countries in recommending the administration of a third dose COVID-19 vaccine to address potential waning immunity and reduced effectiveness against variants. Here, we evaluated the effects of a heterologous BNT162b2 mRNA vaccine booster on the humoral immunity of participants that had received a two-dose regimen of CoronaVac, an inactivated vaccine used globally. We found that heterologous CoronaVac prime followed by BNT162b2 booster regimen induces elevated virus-specific antibody levels and potent neutralization activity against the ancestral virus and Delta variant, resembling the titers obtained after two doses of mRNA vaccines. While neutralization of Omicron was undetectable in participants that had received a two-dose regimen of CoronaVac vaccine, BNT162b2 booster resulted in a 1.4-fold increase in neutralization activity against Omicron, compared to two-dose mRNA vaccine. Despite this increase, neutralizing antibody titers were reduced by 6.3-fold and 2.7-fold for Omicron compared to ancestral and Delta variant, respectively. Surprisingly, previous SARS-CoV-2 infection did not affect the neutralizing titers for Omicron in participants that received the heterologous regimen. Our findings have immediate implications for multiples countries that previously used a two-dose regimen of CoronaVac and reinforce the notion that the Omicron variant is associated with immune escape from vaccines or infection-induced immunity, highlighting the global need for vaccine boosters to combat the impact of emerging variants.

Immunogenicity of heterologous BNT162b2 booster in fully vaccinated individuals with CoronaVac against SARS-CoV-2 variants Delta and Omicron: the Dominican Republic Experience

10.1073/pnas.2110117118

There is ample evidence that masking and social distancing are effective in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. However, due to the complexity of airborne disease transmission, it is difficult to quantify their effectiveness, especially in the case of one-to-one exposure. Here, we introduce the concept of an upper bound for one-to-one exposure to infectious human respiratory particles and apply it to SARS-CoV-2. To calculate exposure and infection risk, we use a comprehensive database on respiratory particle size distribution; exhalation flow physics; leakage from face masks of various types and fits measured on human subjects; consideration of ambient particle shrinkage due to evaporation; and rehydration, inhalability, and deposition in the susceptible airways. We find, for a typical SARS-CoV-2 viral load and infectious dose, that social distancing alone, even at 3.0 m between two speaking individuals, leads to an upper bound of 90% for risk of infection after a few minutes. If only the susceptible wears a face mask with infectious speaking at a distance of 1.5 m, the upper bound drops very significantly; that is, with a surgical mask, the upper bound reaches 90% after 30 min, and, with an FFP2 mask, it remains at about 20% even after 1 h. When both wear a surgical mask, while the infectious is speaking, the very conservative upper bound remains below 30% after 1 h, but, when both wear a well-fitting FFP2 mask, it is 0.4%. We conclude that wearing appropriate masks in the community provides excellent protection for others and oneself, and makes social distancing less important.

An upper bound on one-to-one exposure to infectious human respiratory particles

VACCINES Speaking of boosters, it’s not great news I’m afraid. Updated vaccine effectiveness analysis shows mRNA boosters beginning to wane from one month (week 5-9) for Omicron, and as low as 30-50% effective from 10 weeks post-booster. This effect is not seen with Delta.

As a parent, it has become of increasing concern that the Government has not yet committed to funding increased ventilation in classrooms, in the form of approved HEPA air filter systems/air purifiers.This petition is to ask the Government to immediately fund these in schools/colleges/unis.

Funding for ventilation in all school/college/uni classrooms

The health care crisis is of governments making over three decades. Closing half general and acute beds, closing acute hospitals and community services,eviscerating public health, no service planning. Plus unevidenced policies on testing and self isolation of contacts. @dthroat

I am a full-time GP with 2 children of primary school age, one who is clinically vulnerable Unless the situation with schools changes to provide a safe place for education, I am considering a career break to home school my children @nadhimzahawi @sajidjavid @NHSEngland

It is time to discard the notion that two doses of mRNA means “fully vaccinated” It is time to discard the notion that prior SARS-CoV-2 infection means you don’t need to be vaccinated.

KEY POINT: Increasing immunity with an mRNA booster shot on top of prior infection or prior 2x mRNA vaccination confers 30x to 200x higher neutralization titers vs Omicron or PMS20

Longitudinal analyses of plasma from individuals who were vaccinated only (2x mRNA or 1x J&J) shows substantial Omicron escape

Longitudinal analyses of plasma from convalescent individuals (1m, 6m, 12m after infection) shows substantial Omicron neutralization escape

We compared Omicron to an antibody resistant spike (PMS20) that we previously designed. Omicron distribution of changes and neutralization properties are similar to PMS20. Suggests that antibody evolutionary pressure drove Omicron emergence

By Fabian Schmidt, @FraukeMuecksch, Yiska Weisblum, Justin Da Silva, Eva Bednarski, Alice Cho @VinciZijun, @c_gaebler @marinacaskey Link to full manuscript:

Not the first, but a quite comprehensive analyses of Omicron neutralization resistance with @theodora_nyc, @NussenzweigL Bottom line is fairly consistent with other mini-studies out this week, some quantitative discrepancies between groups

Claiming young people are better off getting infected than vaccinated, using this kind of language in the child vax debate probably doesn't help hesitancy

And this messaging couldn't possibly put young adults off having the jab? So why were adults with underlying health conditions prioritised around the world, and have they suffered from vaccine complications?

Have wondered about Ladhani for a while. Interesting to note he's retweeting links to UsForThem and T4recovery

The presenter of Room 5 and Tunnel 29 on her own life-changing medical diagnosis.

Helena Merriman, Bus driver Tracey Scholes, Pardons for women tried as witches

What psychology can contribute to pandemic response - free symposium 15th March https://us06web.zoom.us/webinar/register/WN_24BAGla3R4Kqaqe5YN1qEA… New with endorsement by the @BPSOfficial Crisis, disaster and trauma psych section Please share.

Newsnodes and BNO News are working together to cover the coronavirus outbreak in the United States. Statistics on cases, deaths, testing, and hospitalizations are updated daily for all states and territories. National statistics are updated daily between 6 and 9 p.m. ET.

United States Monitor

Nathan Grubaugh@NathanGrubaugh·Sep 24, 2021So, yeah, @Newsweek and others, lets put the brakes on the R.1 stories. There will likely be new real threats to sound the alarms about in the future, but this ain't one of them 1650

The meat of the @Newsweek stories is that "Scientists fear the variant's mutations could lead to increased resistance to protective antibodies". I'm not buying that either. In our analysis, R.1 has only a moderate effect on antibodies. (3/4) https://medrxiv.org/content/10.1101/2021.07.14.21260307v1

Data from GISAID and displayed on @DiseaseOutbreak shows that in the US R.1 peaked at ~1% in March-April, and there hasn't been a blip since since June. **It was last detected in the US on July 16th** So not much of a current threat. (2/4) https://outbreak.info/situation-reports?pango=R.1

Hi @Newsweek . I understand that #variant news has been slow recently with the near-complete dominance of Delta, but do you really need to go and make things up? Lineage R.1 is not a concern. Let me briefly explain why. (1/4)

10.1101/2022.01.18.22269452

AbstractBACKGROUND Waning of COVID-19 vaccine protection and emergence of SARS-CoV-2 Omicron (B.1.1.529) variant have expedited efforts to scale up booster vaccination. This study compared protection afforded by booster doses of the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines, compared to the primary series of only two doses in Qatar, during a large, rapidly growing Omicron wave.METHODS In a population of 2,232,224 vaccinated persons with at least two doses, two matched, retrospective cohort studies were implemented to investigate effectiveness of booster vaccination against symptomatic SARS-CoV-2 infection and against COVID-19 hospitalization and death, up to January 9, 2022. Association of booster status with infection was estimated using Cox proportional-hazards regression models.RESULTS For BNT162b2, cumulative symptomatic infection incidence was 2.9% (95% CI: 2.8-3.1%) in the booster-dose cohort and 5.5% (95% CI: 5.3-5.7%) in the primary-series cohort, after 49 days of follow-up. Adjusted hazard ratio for symptomatic infection was 0.50 (95% CI: 0.47-0.53). Booster effectiveness relative to primary series was 50.1% (95% CI: 47.3-52.8%). For mRNA-1273, cumulative symptomatic infection incidence was 1.9% (95% CI: 1.7-2.2%) in the booster-dose cohort and 3.5% (95% CI: 3.2-3.9%) in the primary-series cohort, after 35 days of follow-up. The adjusted hazard ratio for symptomatic infection was 0.49 (95% CI: 0.43-0.57). Booster effectiveness relative to primary series was 50.8% (95% CI: 43.4-57.3%). There were fewer cases of severe COVID-19 in booster-dose cohorts than in primary-series cohorts, but cases of severe COVID-19 were rare in all cohorts.CONCLUSIONS mRNA booster vaccination is associated with modest effectiveness against symptomatic infection with Omicron. The development of a new generation of vaccines targeting a broad range of variants may be warranted.

Effectiveness of BNT162b2 and mRNA-1273 COVID-19 boosters against SARS-CoV-2 Omicron (B.1.1.529) infection in Qatar

Deaths by Grizzly bears each year: ~1.6 Deaths from COVID each year: ~400K. Adjust for age, all you want, his fear of Grizzly bears is irrational. His condescension and complacency about Covid, also irrational.

putting my tweets about VP's recent tweets in a short thread for convenience

is it though? it's pointless in terms of keeping omicron out, but why would it be pointless in terms of reducing mobility and contacts?

We're getting immunity. The COVID-19 vaccine is free, voluntary, and available to everyone in New Zealand aged 12 and over. Find out more about COVID-19 vaccines: https://covid19.govt.nz/vaccines

Ka kite, COVID.

Das hat mich jetzt grad zum Weinen gebracht. Es tut mir so leid.

10.1007/s10654-021-00817-6

We read with interest the manuscript from Subramanian and Kumar [1] (the authors). We have serious concerns about the methodology employed in this study. We detail these below.

Re: Subramanian and Kumar. Vaccination rates and COVID-19 cases

Members of the Independent Sage committee

Who are we?

Following years of growing vaccine opposition and several outbreaks of measles—a vaccine-preventable disease—Facebook established in 2019 its first policy to stop the spread of misinformation about vaccines. Researchers at the George Washington University wondered if the new policies actually worked to stop the spread of misinformation. Jiayan Gu, Ph.D. student along with Lorien Abroms, Professor of Prevention and Community Health and their colleagues created a new paradigm for evaluation of the policy. The team found that Facebook's policy did reduce people's interactions with vaccine misinformation.

Facebook's vaccine misinformation policy reduces anti-vax information

Figures have soared by 1.2m in two years of pandemic as long Covid takes its toll

Covid pandemic sparks steep rise in number of people in UK with long-term illness

BA.2 projections in the US: Coming off of the massive omicron wave (Rt=0.64) will provide a lot of immunity to restrict BA.2 spread rate. A good chance we may see a BA.2 wave in April-May. A lot of factors to consider:

Mass media and policy makers are pushing for a return to pre-COVID times while trying to normalize a staggering death toll

There Is Nothing Normal about One Million People Dead from COVID

After two years of the pandemic, an aspect of the disease remains a stubborn mystery: Why have some places fended off the contagion so much better than others?America was ranked first, on paper, for being ready for a virus outbreak. When a real pandemic hit, though, we have been among the worst in the world in both infections and deaths.“The United States’ poor response to the COVID-19 pandemic shocked the world,” the Global Health Security Index wrote recently. “How could a country with so much capacity at the start of the pandemic have gotten its response so wrong?”We’ve been debating versions of this question the whole time — or finger-pointing about them — but we don’t really know the reasons why.A team at the University of Washington has now taken a crack at some answers.

‘Capitalizing on skepticism’: How the coronavirus has exposed us once again

CDC is working with jurisdictions to provide more information on the demographic characteristics of vaccinated people. These demographic data represent the geographic areas that contributed data and might differ by populations prioritized within each jurisdiction’s vaccination phase. Therefore, these data may not be generalizable to the entire US population. Percentage displayed in the charts below represent the percent of people vaccinated within each demographic group for whom demographic information was available. The completeness of demographic information reported directly to CDC varies by sex, age group, and race/ethnicity. Detailed information on the completeness can be found in each chart.

Demographic Trends of People Receiving COVID-19 Vaccinations in the United States

Worldwide, vaccine hesitancy is proving to be a stumbling block to securing much needed protection against the spread of coronavirus disease 2019 (COVID-19). Now, researchers from Japan have uncovered specific factors that influence attitudes about vaccines, which is valuable knowledge for combating vaccine hesitancy.

Vaccine hesitancy changes over time: Attitudes toward vaccines during the COVID-19 pandemic

Yesterday’s decision hinges on a new and alarming embrace of the right-wing crusade against vaccination.

The Culture War Has Warped the Supreme Court’s Judgment

El conocimiento científico en la pandemia cambia en cuestión de semanas. Algunos temas se olvidan y otros se recuperan de manera cíclica. Cinco meses después del primer estudio, ¿qué ha pasado con la hipótesis de la inmunidad cruzada? Trabajos recientes despejan dudas sobre su papel en la lucha contra la covid-19, todavía rodeado de especulaciones.

Los linfocitos T no nos salvarán del coronavirus, pero ayudarán a resolver el puzle inmunitario

75 years of research on human diseases in 1 minute

ultiple sclerosis, a progressive disease that affects 2.8 million people worldwide and for which there is no definitive cure, is likely caused by infection with the Epstein-Barr virus, according to a study led by Harvard T.H. Chan School of Public Health researchers. Their findings were published today online in Science.

Epstein-Barr virus may be leading cause of MS

Pretty big difference US vs UK in this wave. Vaccination differences likely a big part of it.

"Uncoupled"

A lot of people wear disposable masks.

. I'm guessing it's a good idea to wash/replace them regularly.

Most of it appears to be in this thread actually

So how else could we reduce transmission of an airborne virus if you don’t trust people are savvy enough to get even an ounce of benefit from wearing a mask? Lockdowns and school closures?