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Making sense of this week's omicron news

Editor's Note: This is an excerpt from a special coronavirus edition of WBUR's morning newsletter, WBUR Today. You can get regular weekday updates about the latest coronavirus surge and other news Boston is talking about by signing up for WBUR Today.


The numbers in Massachusetts are worse than they’ve ever been, so it's time to bring you a special update.

Digging into the numbers

Let's start with some relatively positive news before we get into the nitty gritty: Initial research shows the omicron variant, which has quickly swept the globe, may result in less severe cases of COVID-19. Why is that? The best guess right now is that omicron develops so quickly that the infection sets up shop in the body's airways, rather than the lungs.

The other positives to mention: vaccines and therapeutics. During the 2020 holiday surge, we essentially had no vaccines and a limited number of IV-administered therapeutics. Fast forward to now: there are three vaccines in the U.S. — all of which have shown strong booster responses to omicron — and two newly approved pill-form therapeutics (though the distribution of these has not really hit the market for everyone just yet).

Have vaccines and treatments made a difference? In short, totally.

The current situation: the state's positivity rate is through the roof. Cases have never been higher. And all of this is happening without the restrictions on indoor gatherings and crowds that were in place last year.

But until the last couple days, hospitalizations were lower than they were a year ago. They've since accelerated. Still, as WBUR's Gabrielle Emanuel notes below, fewer patients need ventilators than in the past.

And deaths are considerably lower than last year, and trending up at a slower rate. Of course, deaths are a lagging indicator, but given the trend from last year — and the growing evidence that omicron is less lethal than previous variants — things seem less terrible by this metric.

In short, there's more COVID flying around than ever, but our overall outcomes are better. While we wish there were fewer breakthrough cases among the vaccinated, the data from the state clearly shows that vaccinated people are far less likely to contract COVID, and if they do, they are less likely to require hospitalization or die from the illness.

Cause for concern: trends can look promising, but the overall number of cases are still swamping our hospitals. If you listen to care providers, they are struggling. Unless your doctor wants you to visit the hospital, don't go. Give them the space they need to do their jobs. And help them out by getting your shots and wearing your masks.

Other COVID confusion this week

  • The CDC shortened the required isolation period for people who test positive, from 10 days to just five. There’s some research to support that change, and other countries have adopted similar policies, but those nations require a negative test before people can exit isolation. The CDC’s new guidance does not, and that's why critics are skewering the agency for its lack of consistency.
  • Even if there was a testing requirement, it would be really difficult to find one right now. Stores quickly sell out of at-home tests, free kits are snapped up by an anxious public, and people are waiting hours in line to take the more accurate PCR tests.
  • Asked about the wildly long testing lines last week, Gov. Charlie Baker pointed his finger at President Biden, blaming a laggy federal response for the relative scarcity of tests. And new Boston Mayor Michelle Wu’s team has called the waits “unacceptable,” though standing up new testing locations could take weeks. CIC Health CEO Tim Rowe says in many cases, "there's not actually a shortage of tests." He says the lines are largely caused by logistical and staffing issues.
  • In schools, the return from the holiday break has been fraught, with deliveries of at-home tests for staffers arriving late — and in some cases expired. That led to the usual squabbling over whether to open in-person classes or return briefly to remote learning, with the same sides lining the same trenches. (The state is adamant that it will not allow districts to provide remote sessions.) We also learned this week that many of the masks provided to schools by the state are not graded for medical use.

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If you are completely exasperated by all of this, you're not alone.

We'll be back with more of these coronavirus newsletter specials if there are big, new developments. In the meantime, I'm glad we got a chance to chat again, though honestly I'd much rather start a book club with y'all than have to go over more COVID stuff. How's that for a resolution?


Q&A

WBUR health reporter Gabrielle Emanuel has been in the trenches of omicron reporting, talking to everyone from epidemiologists to pandemic forecasters to get a better understanding of this new wave of cases. She kindly answered some of our questions about the surge and what to expect in the coming weeks.

Is there light at the end of the omicron tunnel?

Experts say the peak is projected to come before the end of this month. For the U.S. as a whole, the wave will likely peak in about two to four weeks. But predictions are best when they are tailored to a specific city.

“There’s some evidence that cases may be already starting to peak in Washington, D.C. So, for a place like Boston or New York City it could be one to three weeks instead of two to four weeks before we see the peak,” said Samuel Scarpino, managing director of Pathogen Surveillance at the Rockefeller Foundation. He pointed to forecasts produced by the COVID-19 Scenario Modeling Hub.

What should we expect from omicron?

There is evidence from South Africa and elsewhere that omicron spreads extremely quickly, but that the virus is less severe for many. In Massachusetts, we are already seeing how fast it's spreading. The official case counts are incredibly high, and there are signs that the coronavirus is even more widespread than the official numbers coming from the state.

One indication comes from wastewater. Analysis of the amount of COVID in the sewage in the Boston area shows cases are climbing exponentially – somewhere between five and 10 times higher than the previous peak depending on how you count. It's significantly higher than the spike seen in the official case counts.

“The level is absolutely terrifying,” said Jeremy Luban of UMass Medical School.

Why is there this gap between wastewater measurements of COVID and official case counts?

There are likely a couple things going on here. First, testing. A lot of people aren’t getting tested because it’s hard to find a test or lines are long. Plus, more people are using at-home rapid tests, and those results are not reported to the state or included in official case counts.

Second, the folks at Biobot Analytics, who do a lot of wastewater analysis for the Boston area, said they think it's a sign that a lot of people have very mild cases or are totally asymptomatic. Thus, they don’t realize they have the virus or need a test. This is likely thanks to a less severe variant, as well as vaccinations and boosters.

But some people are still being hospitalized and dying. How do things look different in the hospitals this wave?

Internal forecasting by MGH suggests COVID hospitalizations will keep rising for the next two weeks.

However, Kyan Safavi, medical director of Health Care Systems Engineering at MGH, said a higher percentage of COVID patients are in the hospital for a totally separate reason, and they just happen to also test positive for the coronavirus. Overall, those patients are less severely ill. Beginning next week, Massachusetts hospitals will start to differentiate in their reports between patients they admit primarily for COVID-19 and those admitted to be treated for something else who end up testing positive for COVID-19. So, we'll soon have a clearer picture of what's happening in terms of serious illness. Up until now, percentage of patients on a ventilator has served as a helpful indicator.

“In the spring of 2020, about 38% of all of our COVID hospitalizations were on the ventilator during the peak of that wave. In wave two, it was about 20%. And so far in December and through today, we’re closer to 13%,” he said.

What are you changing about your life?

I keep hearing from experts that if you have the luxury to buckle down and lie low for the next three or so weeks that will really help. So, I am doing that as much as possible. And, if I do need to go indoors in a public place, I’m wearing a NIOSH-approved N95 mask.


Resources

WBUR's Gabrielle Emanuel contributed to this report.

Roberto Scalese Twitter Senior Editor, Digital
Roberto Scalese is a senior editor for digital.

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