(2021-12-20) ZviM Omicron Post #8

Zvi Mowshowitz: Omicron variant Post #8. Omicron continues to take over. Official reactions have been relatively mild, with only the Netherlands entering a lockdown that I have seen. Private reaction has been more robust, which is the best way to do it

The big argument in the last few days was over severity.

South Africa

This new wave is milder per case but we already knew that

*The most exciting and confusing thing is that the outbreak seems to be peaking already, at least at its point of origin in Gauteng, as usual not for any obvious reason?

Here’s an excellent interview with Trevor Bedford looking into that question. He lists five potential causes: Lack of testing, underreporting due to mildness, faster generation time, network patterns and differential vulnerability.*

United Kingdom

Denmark

Data on severity in Denmark initially looked rather grim, and was jumped on by all the usual suspects. New data is less grim.

Around the World

The English Study

Here’s the study everyone’s talking about that didn’t find evidence of reduced severity, but did find strong evidence of much more rapid spread and frequent reinfection. Let’s dig in.

The headline takeaway is a doubling time of two days or less, with a 5.41-fold higher risk of reinfection, and declining vaccine effectiveness. Severity isn’t even mentioned here.

Severity and Its Discontents

A common theme of many claims about the severity of Omicron is that there is ‘no evidence’ of reduced severity. This is obvious nonsense

*The study didn’t show that Omicron is milder than Delta, so the study showed that Omicron is not milder than Delta.

Except that it did not do this. It did provide some evidence against such a hypothesis, especially stronger versions of it, by not finding an effect, but the study lacked sufficient power to draw much of a conclusion even on its own terms.*

It is very clear from the body of the article, without having to look at the paper, that the paper was designed to measure likelihood of infection, and lacks the power to know about severity.

That is not about to stop headline writers

Then he says the quiet part out loud.

You’re off message, you need to stop being off message, and we’re going to cast out anyone seen being off message.

Because ‘mild’ implies not taking things seriously, but exponential growth means even a mild version could get really, really bad, which is totally true.

So yes. If you have ten or a hundred times as many cases, being milder only goes so far, and exponential growth still kills a lot of people. That doesn’t mean the right thing to do is start lying about the situation. Lying keeps backfiring, and we keep noticing this yet thinking it might work for us.

Omicron did not evolve from Delta, which is by itself strong evidence for the prior that it’s probably milder. Why should Omicron’s baseline assumed severity be that of Delta rather than that of the strain it evolved from?

It seems, once again, like such Very Serious People think that the word ‘mild’ will give the wrong idea of magnitude and/or cause behaviors they don’t like, and thus the concept must be blocked out and destroyed and those promoting it shamed.

My take based on current evidence is that we can rule out dramatically milder versions, we can rule out substantially more severe versions, and the question is whether this represents something like original strain or is similar to Delta, and we still don’t have that answer.

Spread

Policy Response

*The Biden Administration is scrambling to respond to Omicron.

You see, they didn’t see it coming, just like they didn’t see Delta coming.

That seems very much like a their failure to see things problem*

their response is to ignore what is about to happen, not do anything to substantially increase testing capacity or to facilitate treatment, downplay case counts and tell people to focus on severe disease and death.

*There are two classes of tools, the Good Tools and the Bad Tools.

Vaccines, boosters, masks, social distancing and isolating when sick are The Good Tools. Those are indeed good tools.

Paxlovid, other treatments, rapid tests and any additional restrictions that people associate with ‘lockdowns’and updated boosters for Omicron are the Bad Tools, which must never be mentioned. If we mentioned them, people might be less inclined to vaccinate, so Very Serious People are acting as if they represent an infohazard*

Paxlovid remains illegal, and testing is backing up to the point of uselessness in large part because the FDA refuses to approve many tests that are in widespread use in Europe.

*“Are we going to have more than $10 billion worth of needs and costs on Covid, especially in regards to testing?” Becerra said. “There’s a strong chance we will, depending on where Omicron takes us.”

Ten billion dollars is nothing. We had a stimulus for six trillion. It’s crazy that we’re even blinking at ten billion in real costs.*

A reminder that the Biden administration wanted everyone boosted, and the FDA said no. The invisible graveyard is once again visible, and once again about to get larger.

Threads and Articles

Science general summary from 17 December. Optimistic on severity, points out that at sufficient scale things still get ugly. Frustratingly still refusing to admit Omicron is more infectious in addition to having escape properties, both of which seem like settled issues by now.

Trevor Bradford thread analyzing vaccine and booster effectiveness. It is looking more and more like the booster shot makes you dramatically better at fighting Omicron than the initial shots, probably because the two-shot method was never right to begin with. If you haven’t gotten your booster, strongly consider doing so, and definitely do not attempt to wait for an updated vaccine

Retrospective

Outlook

Chance that Omicron has a 100% or bigger transmission advantage in practice versus Delta: 90% → 85%.

Chance we are broadly looking at a future crisis situation with widely overwhelmed American hospitals, new large American lockdowns and things like that: 35% → 30%. The hospitals are at capacity now, but the early promising signs (or more exactly, the lack of signs of either panic or truly horizontal lines) makes me somewhat less concerned that we’ll be unable to handle things