Planning to Party Big? Don’t. Party Small.

“Things are not good…Things are not good locally, things are not good nationally, things are not good globally…can you believe this, we’re two years in and the fire hose continues.”

            Daniel Griffin, MD, This Week in Virology podcast, December 16, 2021

“We still have a lot to learn about this variant, but everything we learn leaves me in a sense of awe of what it is doing, how it is doing it, and in addition to not only the physical damage but the psychological damage—coming after two years, coming at the time of the holiday season, coming when people are tired, believing that they have gone through the worst of it. And for some locations in this country you can’t imagine that after you’ve been through a three to four month surge of Delta, that now you have to deal with this… Just know that we’re all in this together… What we need right now is a plan to help us get through the next two to eight weeks…when we’re going to see this viral blizzard… This is the crisis. Right now is when we are going to be severely challenged in ways I don’t think we have been since the beginning of the pandemic.”

            Michael Osterholm, PhD, MPH, CIDRAP Podcast, University of Minnesota, December 22, 2021

“Y’know, it’s a really scary situation.”

            Mercedes Carnathon, PhD, Northwestern University School of Medicine, December 31, 2021,  Bloomberg TV

 

Dear Students,

A couple of months ago, when Georgia had passed the peak of the Delta surge and cases were not yet rising nationally, I was circling the park with my nine-year-old grandson, who was trying to get his sea legs on his new rollerblades. I was intermittently holding his hand and he was intermittently, beautifully tearing away from me. Something about pandemic precautions came up—he was doubly and I triply vaccinated—and he asked me if it was ever going to end. I told him about Delta’s decline and said, “Maybe in a couple of months more we’ll be getting back to normal.”

Without missing a beat he half-shouted, “I’ve heard that so many times!”

What was I going to say? It could only be, “Yeah, I’ve heard it too many times too.”

Cases in the US as of December 30, 2021

After posting about the pandemic regularly beginning March 2020, this is the first time I’ve written since August, when I posted an appraisal called, “Bad Breath.” I said I was done with coddling and cajoling the anti-vaxxers and anti-maskers and I called for urgent widespread mandates and shaming. I also highlighted the dismal failures of testing and tracing programs in our country. I only feel more strongly now.

I didn’t want to be the grinch that stole Thanksgiving or Christmas, and I was discouraged, like Ethan, because I’d heard about the end of this so many times, so I didn’t write. Delta’s course was predictable, with a sharp and deadly rise followed by an equally sharp fall, but not back to baseline. Perhaps my optimism roller-blading with Ethan would pan out and we would get a simmering level we could live with.

Booster shots were rolling out, 5-to12-year-olds were being vaccinated, monoclonal antibodies were helping for the (perfectly predictable) breakthrough infections in the vaccinated and the much more devastating infections in the Bad-Breath-ers, mostly obstinate morons who seemingly want to kill and die.

Then for our Thanksgiving present we got Omicron, which is in some ways putting us back to square one.

It’s taken about a month to learn the basics of this morph of the virus, which like Delta came from a part of the world with the dismally low vaccination rates the virus loves. It has over 20 mutations, unprecedented in previous versions. It spreads much, much faster than Delta, which itself had spread much faster than earlier versions. It is replacing Delta almost everywhere on the planet, and it is doubling in prevalence every 2 to 3 days. Existing vaccines are less effective against it, although they are still quite effective. Some monoclonal antibodies are effective, some aren’t.

It may cause fewer serious cases than previous morphs, but the infected population is so huge and rapidly growing that the very ill Omicron victims will overwhelm hospitals wherever it takes hold. Emergency room and ICU doctors and nurses in Michigan, Minnesota, Rhode Island, North Dakota, and other states are begging for more staff, including imploring colleagues who have quit, retired, and burned out to please, please come back.

These are still mostly Delta cases but Omicron will now swell the hospitalized Delta ranks and the overlap will extend to deaths. Funeral homes overwhelmed with Delta deaths will now have to stack the bodies higher with Omicron.

Those who know say the next two to eight weeks will be dominated by Omicron. Omicron cases, Omicron hospitalizations, Omicron deaths. The case fatality rates may be lower, but a smaller proportion of a very large number of cases is still a lot of deaths. The surge may come and (mostly) go in just a few weeks, as it has in South Africa. But they will be a heck of a few weeks.

After that, who knows? This virus is a genius at implementing Darwin’s theory of natural selection. It evolves every month, every week, every day.

Flights are being canceled, theaters and restaurants closing, universities—including ours, at least for January—going back online; some countries are slamming back into major lockdowns.

We have the same powers we have had for a year, some for two years: vaccinations, masking, social distancing, testing, tracing, and quarantine. We are just not doing any of them well. We are tired. I am tired. So do we want to slap ourselves and wake up and do the right thing, or do we want to spread disease and kill others or lay down and die ourselves?

Who is surging most now? 18 to 39-year-olds. Yes, they too go to the hospital. Yes, some die. Many more will spend their long lives with long Covid. Many will bear the guilt and the regret of having made others sick.

There is some good news. Oral monoclonal antibodies. A new oral antiviral that works. Boosters for 12 to 17-year-olds. Test-to-Stay programs have begun to keep schools open safely, and new data suggests that quarantines need not last 10 days, because with proper masking, 7 or 5 days may be sufficient.

Vaccinations are still rolling out in large numbers, but these are mostly third shots, which sensible people are lining up for, while progress in vaccinating the obstinate Bad-Breath-ers remains slow enough to bring hospitals and funeral homes to their knees and to ensure that we don’t see normal again for a long time. Scores of millions have failed to get even one dose of some of the best and safest vaccines known in the history of medicine. Their foul breath is a threat to you and those you love.

The President has finally announced that our country will step up free widespread testing. Half a billion tests will be available in late January. This means one or two tests for each person, coming to a spot near you after the Omicron surge is probably mostly over. Too little, too late. Kind of like experiencing a harsh December winter and ordering thousands of snowplows that will arrive in April.

So a couple of months after Ethan doubted my optimism, we are in what is probably the worst month of the pandemic.

I hope you had a good Thanksgiving, Christmas, and other holidays with your friends and family. I am writing this at noon on New Year’s Eve. If you are planning to party, party small. Ring in the new year—hoping it will be better than the old—with a small number of fully vaccinated people you really care about. And buckle up for a viral roller-coaster ride in the first month of ’22.

Sorry.

Happy New Year,

Dr. K

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 comments

  1. Ron Pell says:

    Well said Dr K. My brother and I, our families and friends are all vaccinated and boosted and spending a quiet NY eve at home in a Connecticut suburb. New year regards to you, your family and my old friend from Brooklyn Larry.
    Best,
    Ron Pell.

Leave a Reply