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Washington hospitals will face an unprecedented capacity crisis in January

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[KIRKLAND, Wash.] – (MTN) The promises of the COVID Omicron variant being “very mild” and only a cold are crumbling in London and New York. The crush of COVID-related hospitalizations has United Kingdom officials considering additional restrictions while New York officials issued a warning about a shocking rise in pediatric hospitalizations. Hospitals in Washington are more than 90 percent occupied, leaving almost no capacity to deal with any kind of surge, COVID or otherwise.

Reports, studies, and data are pouring in at an incredible rate from around the world with confusing and conflicting headlines. In the United States, the politicization of the COVID epidemic has created a news cycle more aligned to opinion and speculation, than a cautious review and analysis of available data. If Washington follows the United Kingdom and New York, hospitals across the state will be overwhelmed by the end of January.

When Omicron was first announced by the World Health Organization on Nov. 26, many latched on to the words of Dr. Angelique Coetzee, chair of the South African Medical Association when she described the variant as “very mild.”

“Most of them are seeing very, very mild symptoms and none of them so far have admitted patients to surgeries. We have been able to treat these patients conservatively at home,” she said.

Within hours more details emerged that had many advising caution. Dr. Coetzee isn’t a hospitalist and runs a private practice in the South Africa capital of Pretoria. She based her statements on seeing 24 patients, mostly college students, and 50 percent were vaccinated.

The World Health Organization (WHO) addressed her statement in a press release on Nov. 28.

“There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants. Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.”

A month has passed since the WHO announced Omicron was a Variant of Concern (VOC). Data from South Africa, the UK, and New York is providing critical information on what will happen next for other nations including the United States.

Malcontent News has analyzed multiple studies, COVID case rates, hospitalization information, and mortality data from South Africa, the United Kingdom, and New York City. Our conclusion is that without drastic action in the next seven to ten days, Washington hospitals will face an untenable crisis by the end of January.

Researchers at the London School of Hygiene & Tropical Medicine (LSHTM) estimated Omicron was doubling every 2.4 days in the UK and has an Rt or “R naught” of 4.4. Rt is a measure of how quickly a disease can spread. At 3.0, up to 50 percent of people can expect to become infected with the Omicron variant – at 4.0, the figure jumps to 90 percent.

On Dec. 23, Trevor Bedford, Ph.D. with Fred Hutch, estimated that Omicron was doubling every 2.4 days and had an Rt of 4.4 in King County.

Case information from South Africa’s hospitals has revealed that recent previous COVID Delta variant infections are not providing much protection from the Omicron variant. As hospitals in Gauteng Province became filled with COVID patients, reaching a peak days before Christmas, a pattern emerged. Over 80 percent were unvaccinated, and in the ICU, almost all the patients were unvaccinated.

Mortality rates in South Africa remained low through Dec. 10 and then started to climb. On Sunday, 66 were dying of COVID daily based on the 7 day moving average, 87 percent are unvaccinated and 466 total deaths have been recorded in the last week.

While it is factually correct that only 26 percent of all South Africans are vaccinated against COVID, in Gauteng the numbers more closely mirror some Eastern Washington counties. On Dec. 17 South African officials reported 44% of all eligible adults in Gauteng are fully vaccinated, including 66% of people over 50 years old. Even at 26 percent, Stevens County is only 33 percent vaccinated and already experiencing high transmission.

South African officials found that although the risk of hospitalization from Omicron was as much as 70% lower than Delta, once a person was hospitalized, the disease progression resembled Delta with similar patient outcomes. Scientists in Europe and North America worried that the younger, relatively healthy population was masking the true impact of Omicron. Hospitals also saw a surge of children under five being hospitalized.

Washington and King County have far fewer children under 18 and a much older population than South Africa. The single biggest factor that determines the outcome of a COVID infection is age, even among the vaccinated. Multiple studies have concluded that without a booster shot, neutralizing antibodies against COVID has faded away, leaving the T cells to respond in a secondary response. Boosters dramatically improve the body’s response to Omicron, but less than half of eligible residents of King County have been boosted.

In a damaging blow to reaching a better understanding of the Omicron variant, the South Africa Department of Health announced on Dec. 24 the nation would stop most contact tracing, reduce quarantine times for infected people, and significantly reduce COVID testing. Reducing the number of tests will lower the daily case count while inflating the percentage of hospitalization patients. Shortening of quarantine periods for positive tests while ending most contact tracing could drive a new surge of community transmission.

As Omicron started to spread around the world, the National Health Service (NHS) in the UK reported 131 Omicron variant cases on Dec. 8. The first Omicron variant death was reported on Dec. 14 and by Christmas Eve, the NHS reported 122,186 cases as hospitalizations started to surge.

Bedford predicted on Dec. 18 that King County would have 2,100 new COVID cases by Dec. 23, which would shatter previous records. King County Public Health reported 2,879 new cases, a 169 percent increase in a week. Hospitalizations are a trailing indicator and looking at London and the UK, an increase in King County is roughly a week away.

Today, UK COVID hospitalizations are doubling every ten days. For the unvaccinated, people from 50 to 79 have a 30-fold greater chance of being hospitalized. The Intensive Care National Audit and Research Centre examined hospitalization data from May to November and found that the unvaccinated had a relative risk to be hospitalized 60-times higher than the vaccinated – that data was without boosters.

According to the most recent data available, the UK National Health Service reported 1,171 people were admitted to hospitals with COVID on Dec. 20 – the highest number since Feb. 19 and higher than during the Delta wave. On Dec. 22, the 7-day moving average for new hospitalizations in London had reached 386, just a handful of cases below a “trigger number” of 400. The figure is half of the previous record peak of 850. If cases double again in the next ten days, a new and awful record would be in reach.

The LSHTM released an updated pre-print study on Dec. 23 modeling four potential scenarios for the UK and the progression of Omicron. The report was adjusted to factor in newly available data from the Imperial College of London published on Dec. 22. Report 50 hypothesized previous Delta infections combined with high vaccination rates in the UK would reduce the risk of hospitalization from an Omicron infection by 50 percent.

“These results suggest that the introduction of the Omicron B.1.1.529 variant in England will lead to a substantial increase in SARS-CoV-2 transmission, which, in the absence of strict control measures, has the potential for substantially higher case rates than those recorded during the Alpha B.1.1.7 winter wave in 2020–2021. This is due to Omicron’s apparent high transmissibility and ability to infect individuals with existing immunity to SARS-CoV-2 from prior infection or from vaccination.”

Only one scenario found that hospitalizations would be below the record the UK set in January 2020. The most likely scenario of high immune escape with high booster dose efficacy predicts hospitalizations could soar to 5,000 a day by the end of January 2021. The National Health Service would have no capability to care for that many patients, even if they only required a few days of care with hydration and oxygen support.

The study also found that this was not inevitable, and additional mitigation plans to slow the spread of COVID could protect the hospital system and UK residents alike. However, the steps required are very unlikely to be taken or tolerated.

“The introduction of control measures is projected to partially suppress Omicron transmission; however, in the most pessimistic scenario, we project that stringent control measures such as those implemented following the Alpha B.1.1.7 winter wave of transmission may be required to ensure that healthcare services are not overwhelmed.”

In the United States, federal officials have openly stated concern that restrictions such as those used in the spring of 2020 could bring a wave of domestic terrorism. On Nov. 11, the National Terrorism Advisory System Bulletin stated, “Pandemic-related stressors have contributed to increased societal strains and tensions, driving several plots by DVEs, and they may contribute to more violence this and next year. If a new COVID-19 variant emerges and new public health restrictions are imposed as a result, anti-government violent extremists could potentially use the new restrictions as a rationale to target government or public health officials or facilities.”

In King County, there are very few remaining public health options. The county has had a mask mandate in place since July with varying levels of compliance. Proof of vaccination or a negative COVID test is required to go to restaurants, bars, theaters, sports events, movies, gyms, and entertainment venues. However, one doesn’t have to dig deep to find Facebook groups and online lists of hundreds of businesses ignoring these requirements.

On the other side of the country, New York City is seven to ten days ahead of Seattle. Tens of thousands of, “guess who has COVID,” social media posts morphed into, “this is much worse than I thought” updates over the Christmas holiday. The number of hospitalized COVID patients almost doubled in a week in the City – from 1,046 on Dec. 18 to 1,904 on Dec. 24. The number of coronavirus patients in the ICU went from 187 to 283 during the same period. On Christmas Eve, parts of Manhattan had the highest COVID transmission rates on the planet.

New York Health Commissioner Mary T. Bassett issued a statement on Christmas Day, with pediatric COVID hospitalizations quadrupling in three weeks. “We are alerting New Yorkers to this recent striking increase in pediatric COVID-19 admissions so that pediatricians, parents, and guardians can take urgent action to protect our youngest New Yorkers.”

Officials did not release a patient census but did offer some information. Half of the hospitalized children were under five. None of the children under 12 were vaccinated, and only one-third of adolescent patients from 12 to 17 were fully vaccinated. Booster shots are not available to children under 16, and only recently became available to 16 and 17-year-olds.

The Washington Post reported that pediatric hospitalizations for COVID had jumped 31 percent in ten days, with almost 2,000 children hospitalized – a grim and new national record.

Pediatrician Aaron Milstone with Johns Hopkins University School of Medicine urged parents who have children with “cold” symptoms to assume “it’s Omicron until proven otherwise,” in an interview with the Washington Post.

Unlike South Africa and the United Kingdom which released updated reports over the Christmas holiday, data hasn’t been available from the Washington State Depart of Health (WSDoH) since Thursday. With new cases doubling every 2.4 days in King County, it is almost certain Washingtonians will see a dramatic increase in new COVID cases and COVID hospitalization in the coming week.

When it comes to the state’s ability to cope with another surge, Washington State Hospital Association (WSHA) Vice President Taya Briley minced no words during a Dec. 23 press briefing.

“Even if most people don’t get really sick, there are a lot of people who are getting infected with omicron, and some portion of them will get severely ill and need hospital care. Even if it’s a small portion of the overall total, this could mean a huge number of people getting sick enough to need hospitalization.”

Mark Taylor of the Washington Medical Coordination Center at Harborview Medical Center in Seattle, echoed her perspective.

“We really do not currently have the capacity within our facilities to accommodate a large surge as we just came through with the Delta surge.”

The most recent data available from the WSDoH is from Dec. 22. On Wednesday, there were 702 COVID patients hospitalized in Washington, with 95 requiring ventilators. The number of hospitalized patients had increased 13 percent in 48 hours before the Christmas holiday data break.

Using the 7 day moving average data from the Healthcare Readiness tab from the WSDoH COVID dashboard, there are an estimated 652 staffed acute care and 145 staffed ICU beds available across the state. If COVID cases were to double over the next ten days regional hospitals will run out of all beds, unless other measures are taken.

Demoralized doctors and nurses are already in a physical, emotional, and mental health crisis as the Delta wave was coming to an end. Over the weekend, many expressed fury at new guidelines released by the Centers for Disease Control (CDC) on Christmas Eve.

The new guidelines reduced the amount of time medical personnel needs to isolate if they have close contact or are positive for COVID. If hospitals move to contingency care hospital workers could be made to return to work after five days, even if they are mildly symptomatic. Under crisis standards of care, employees could be made to continue to work even if they are experiencing mild or moderate symptoms.

The CDC defines moderate illness as, “individuals who have evidence of lower respiratory disease, by clinical assessment or imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level.”

More troubling, The update has no specific requirements for N95 masks or N100 respirators, defining facemasks as, “OSHA defines facemasks as “a surgical, medical procedure, dental, or isolation mask that is FDA-cleared, authorized by an FDA EUA, or offered or distributed as described in an FDA enforcement policy. Facemasks may also be referred to as ‘medical procedure masks’.”

The medical community is concerned that COVID could be passed to patients hospitalized for other reasons, while spreading among other staff, limiting the ability to meet rising cases. In states where medical personnel isn’t required to be vaccinated, data from South Africa and the UK suggests the CDC guidelines could have a devastating impact on hospital readiness.

As a better understanding of Omicron has become available a grim picture for January is emerging. In King County, 81.3% of all residents five and older are fully vaccinated. That is almost ten percent lower than London and the vaccination rate for Washington state isn’t much higher than Florida.

Several studies have shown that the current vaccines from Moderna and Pfizer have significantly reduced effectiveness without a booster. The Johnson & Johnson vaccine is even less effective. Boosters have been proven to provide additional projection, but breakthrough cases remain frequent. For most of the vaccinated that develop symptoms, their cases are mild to moderate.

The number of breakthrough cases had driven up anti-vaccination rhetoric at a national and even local level, with Jason Rantz criticizing the King County vaccine mandate.

“But if Omicron evades the vaccine and the best protection, according to the city, and the department is to abide by procedures used before a vaccine was even available, then what sense did it make to fire unvaccinated staff? They’re just as vulnerable to the dominant variant as the vaccinated.”

The statement is factually incorrect, given the evidence from South Africa, Israel, Denmark, and the UK showing that while breakthrough cases among the vaccinated are high, hospitalizations are extremely low.

Several case studies on the true number of breakthrough cases and vaccine effectiveness have emerged in an unlikely place. Multiple cruise ships have had their itineraries disrupted due to onboard COVID cases. The Royal Caribbean ship, Odyssey of the Seas, was denied entry to two ports of call after confirming 55 coronavirus cases onboard. The ship left port with 95 percent of passengers fully vaccinated. The ship has 3,587 guests and 1,599 crew onboard. If every confirmed case was among vaccinated individuals, the breakthrough rate is around one percent. Officials have stated the cases are asymptomatic or mild.

The new case rate in King County is growing as fast as London with a similar Rt, which indicates up to 90 percent of residents will become infected with COVID in the next 60 days. Most of those cases will be asymptomatic or mild, but for the elderly, children under five years old, the unvaccinated, and the immunocompromised the data strongly suggests outcomes are similar to Delta.

Considering all we have learned about Omicron since Nov. 27 and looking at the data through a clinical, not-politically motivated lens, an unprecedented crisis will arrive with the New Year. If cases continue to double every 2.4 days and the Rt stays above 4, up to 90% of King County residents will be infected over the next 60 days. If COVID hospitalizations double every ten days starting this week, the state will be out of resources by Jan. 15.

As the Omicron variant spreads through Eastern Washington, likely fueled by Christmas holiday travel, officials will look to Western Washington to take their patients. The issues experienced during the Delta surge of patient transfers by aircraft and ambulance will be even worse due to winter weather and an increasing number of sickened personnel.

With pandemic fatigue, politicization, Christmas and New Year’s travel and celebration, and no ability to add additional public health measures without risking a violent response, it seems unlikely that we will prevent what is coming.

Health and Lifestyle, Local, National

COVID cases fueled by Omicron skyrocket globally, nationally, and in Washington

Texas officials report the first Omicron related fatality in the United States

Editor’s Note: As a policy, Malcontent News does not quote or publish data from pre-print studies. The transmission rate of the Omicron SARS-CoV2 variant is so high it is spreading at a rate faster than the scientific review process. For this reason, we are using pre-print studies in our reporting and analysis for the Omicron variant. We will continue to backlink to all quoted sources to support transparency in reporting.

Updated: Story edited to report first Omicron death in the United States

[KIRKLAND, Wash.] – (MTN) Washington state moved back to high transmission risk for COVID as new cases fueled by the Omicron variant grew 32 percent over the weekend. The highly contagious variant was discovered in South Africa, spreading to over 90 countries in six weeks.

The United States was reminded how serious Covid-19 is this evening, with Texas reporting the first Omicron-related death in the nation. Judge Lina Hidalgo of Harris County, Texas, tweeted that a man in his 50s had died of Omicron. He was unvaccinated and had health issues. It is reported he was treated with monoclonal antibodies, which have been rendered ineffective against the Omicron variant.

The U.S. Centers for Disease Control (CDC) reported 73% of new COVID cases across the United States are the Omicron variant, swamping Delta cases. The World Health Organization estimated cases are doubling every 1.5 to three days.

The CDC estimates that Omicron is 90% of new COVID cases in the New York City area, the Southeast, the Ohio River Valley and Great Lakes states, and the Pacific Northwest. Omicron cases have been detected in 48 of 50 states, with Montana, Indiana, and Vermont confirming cases this afternoon.

On December 20, North Dakota, Montana, Indiana, and Vermont reported their first confirmed Omicron cases and Texas reported an Omicron-related death – Oklahoma and South Dakota lag the rest of the country in genomic sequencing of test samples

In Miami, lines of cars waited for hours to get COVID tests. Governor Ron DeSantis had boasted Florida had conquered coronavirus on Oct. 27, using data from the New York Times. On Monday evening, Florida reported more than 7,000 new cases a day, an increase of almost 300% in two weeks – second only to Hawaii.

The Washington State Department of Health (WSDoH) reported a sharp increase in COVID cases. The counties with the highest rates were distributed across Washington from the Olympic Pennisula to the Palouse. Only Wahikakum County reported low community spread on Monday.

Percent of Total Population Fully VaccinatedPercentage of Vaccinated People with Booster DoseTotal Population in GroupAverage 7-Day New Case Rate
70.00% or above39.15%2,343,250170.1
60.00% to 69.99%35.36%1,669,300136.0
50.00% to 59.99%32.23%3,339,300111.6
40.00% to 49.99%29.41%268,97577.6
32.70% to 39.99%35.38%151,85085.5
7 Day New Covid-19 Cases per 100K average by Vaccination Rate for Total Population, Adjusted for Population by County, Booster percentage is based on totally fully vaccinated, not eligible, Average 7-day New Case Rate <25 normal, =>25 to 99.9 moderate, => 100, high transmission

Federal officials believe the actual case count is much higher due to asymptomatic carriers and home testing, which isn’t reported to county and state health departments.

According to the University of Washington Virology Lab, the genomic sequencing of SGTF COVID test samples was 70% positive for Omicron on Dec. 16. Data provided by Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division, showed Omicron cases had been lab-confirmed in Benton, Franklin, King, Pierce, Snohomish, Thurston, Walla Walla, Whatcom, and Yakima Counties.

Researchers had looked at test samples as far back as Nov. 7 from Idaho, Oregon, and Washington.

Frustration was building on social media as Western Washington residents tried to find rapid COVID antigen tests, booster shots, and appointments for children 5 to 11 to get vaccinated. People waited for hours in long lines to get lab tested for Covid-19 and worried about travel plans as the time to get test results back grew past 72 hours.

Seattle Mayor Jenny Durkan announced that the Rainier Beach and West Seattle vaccination clinics will remain open for boosters and vaccinations into January 2022. Tests sites across the city run in cooperation with the University of Washington are expanding hours to try and meet growing demand. There are fixed test sites at Aurora, SODO, Rainier Beach, and West Seattle, as well as seven Curative kiosks placed throughout the City. In partnership with the City of Seattle, UW Medicine has also opened a site at City Hall, which is available to the public. Appointments are encouraged at all locations, and sites will be closed on Christmas Day.   

Area hospitals are at capacity even though COVID hospitalizations are low

The number of hospitalized COVID patients in Washington has slowly dropped through December. The WSDoH reported there were 640 hospitalized Covid-19 patients on Sunday, and 81 were on ventilators. The numbers are significantly higher than the end of the Fifth Wave in late May, and area hospitals are already filled with non-COVID patients.

Data from the U.S. Health and Human Services (HHS) found regional hospitals have scant resources to manage another surge. Almost half of the regional hospital beds available are at Swedish on Broadway in Seattle and St. Joseph’s Medical Center in Tacoma. The report indicated there were 730 beds available, but that includes resources for pediatric patients and neonatal incubators. Available ICU beds include NICU incubators, PICU beds, and critical care resources for post-surgical, transplant, trauma, and burn patients.

HospitalCityAcute Care TotalAcute Care AvailableICU TotalICU Available
OverlakeBellevue26417344
Swedish – Cherry HillSeattle17024216
Seattle Children’sSeattle308299612
U.W. Medical CenterSeattle6415813998
Swedish – BroadwaySeattle568907955
HarborviewSeattle40099710
Virginia MasonSeattle238203313
EvergreenHealthKirkland2518372
Swedish – IssaquahIssaquah10083026
Valley MedicalRenton292365027
St. Anne’sBurien161443123
Swedish – EdmondsEdmonds1731495
Harrison MemorialBremerton28136496
MultiCareAuburn13831161
St. FrancisFederal Way15545151
St. Anthony’sGig Harbor1080163
ProvidenceEverett61147778
Tacoma GeneralTacoma310-9462
Mary Bridge Children’sTacoma8334114
St. Joseph’sTacoma5732347614
Data is through December 9, 2021, as reported to the U.S. Health and Human Services for all hospitals with more than 50 beds and ICU resources within 30 miles of downtown Bellevue – acute care beds include adult, pediatric, and neonatal, ICU beds include NICU, PICU, and specialized critical care units for post-surgical, trauma, and burns

In a worrying sign from New York, officials reported on Monday night that while many people are experiencing breakthrough cases and having mild symptoms, unvaccinated individuals were 11 times more likely to be hospitalized.

More data released on vaccine and monoclonal antibody effectiveness against Omicron

In an announcement early Monday, Moderna said preliminary data from lab testing found that a booster of the currently available vaccine increased antibody levels to an effective level. The drugmaker said its currently FDA-approved 50 microgram booster increased neutralizing antibody levels 37-fold against Omicron and 83-fold with a 100 microgram “full dose” booster.

An independent study released last week that evaluated the effectiveness of the Pfizer, Moderna, and Johnson & Johnson vaccines had similar results. Vaccine effectiveness appears to be significantly impacted by how long ago someone received their final dose or booster. Multiple studies have found the Johnson & Johnson vaccine is significantly less effective.

Results from a study that reviewed the effectiveness of the Moderna, Pfizer, and Johnson & Johnson vaccines after three months, more than six months, with the previous infection, and with a booster. The Johnson & Johnson vaccine was evaluated using a Modern 50 microgram dose as a booster

A study from the U.K. found that relying on immunity from a previous COVID infection was only 19 percent effective against preventing symptomatic reinfection and 20 percent when relying on vaccination without a booster. The same study found that a booster dose increased protection by 50 to 85 percent. Overall the risk for reinfection was 5.4 times greater than Delta. The study done by the Imperial College of London used PCR test data from Nov. 29 to Dec. 11.

In New York, hospitalists at Mount Sinai Hospital were advised to stop administering monoclonal antibodies because they were ineffective against Omicron. The memo reported that most people seeking treatment had breakthrough infections with mild symptoms that didn’t warrant hospitalization.

Washington state is waiting for the first 552 doses of the monoclonal antibody sotrovimab. Granted Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration (FDA) in May, it is the only remaining effective early treatment for Omicron in the United States.

Concern grows as the hopes of Omicron being “only a cold” fade away

South Africa officials reported 105 COVID-related deaths across the nation on Monday. The number of ICU patients has increased 144 percent since Nov. 25. Omicron appears to have peaked in Gauteng Province but continues to spread rapidly across the nation of almost 60 million.

United Kingdom officials reported another five Omicron COVID-related deaths, bringing the total to 12. Hospitalizations of children under 5 increased 39% week over week, and thousands of healthcare workers have been stricken with Covid-19 infections, causing staffing issues.

A study by the University of Texas Austin for the CDC was made public on Dec. 16. It looked at 18 different scenarios for the spread of Omicron. In ten of those scenarios, the healthcare system in the United States is overrun by patients.

President Joe Biden will address the nation on Tuesday to outline the administration’s new steps to aid states and communities while trying to curb the spread of COVID.

Yesterday, former President Donald Trump addressing a crowd of admirers in Dallas told the audience he had received his booster. A smattering of jeers and boos rippled across American Airlines Center.

“Don’t, don’t, don’t, don’t …” he said.

“There’s a very tiny group over there,” the former President added.

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Where London goes with Omicron Seattle will follow, with the rest of the US close behind

[KIRKLAND, Wash.] – (MTN) A record 93,000 new COVID cases were reported in the United Kingdom by the National Health Service just hours after Trevor Bedford, Ph.D., an Associate Professor, Biostatistics, Bioinformatics and Epidemiology Program Vaccine and Infectious Disease Division, at Fred Hutchinson Cancer Research indicated that where London goes, Seattle will follow five days later.

France closed its borders to the UK on Friday evening and on Saturday, London Mayor Sadiq Khan declared a “major incident” as Covid-19 hospital admissions rose 30% in a week. The National Health Service reported seven people have died from the Omicron variant and believe that “hundreds of thousands” of cases are going unreported. Cases are expected to grow at a dizzying rate well into January.

On Friday, Bedford told reporters that 50 percent of new Covid-19 cases in King County, were likely Omicron and doubling every 2.4 days. The next day, Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division tweeted that Omicron was 50 percent of all cases in Washington.

In an interview published on Saturday in the New York Intelligencer, Bedford shared his prediction on what is to come. “I can expect caseloads that are huge. I can easily expect a 50 percent attack rate from Omicron. I can easily expect that.”

“Attack rate,” is how much of the population will be infected – and Bedford predicts that half of the United States population will catch the Omicron variant. Because the United States does not take a national approach to genomic sequencing, and not all hospitals test patients for COVID at admission, the number of people already hospitalized is murky. From the earliest reports, the hospitalization rate was between 2% to 5%.

There was little good news to be found over the weekend on the impact the new wave is going to have on the United States. In the Northeast, Mid-Atlantic, and Great Lakes Region hospitals are already at or over capacity and receiving additional aid from FEMA. Many states are struggling with dwindling testing funds and a lack of data because tracking systems were dismantled over the summer.

A cascade of drug makers indicated late in the week that the current version of monoclonal antibodies in distribution aren’t effective against the Omicron variant. Unlike vaccines, which target all antibodies, monoclonal antibodies only target one. The antibody that was “cloned” in the process was effective against previous variants but doesn’t produce a significant immune response with Omicron.

In a series of studies, only Sotrovimab, produced by GlaxoSmithKline, showed promise against the fast-spreading variant. The monoclonal antibody received Emergency Use Authorization ( EUA) from the U.S. Food and Drug Administration (FDA) on May 26. Health and Human Services (HHS) reported they would be distributing 55,000 doses across the United States this week, with Washington receiving 552.

Back in the UK, the National Health Service reported that on any given day, about one percent of the national health force would be absent from work due to illness. In London, the number of workers calling out sick surged 40 percent. In the United States, healthcare workers have been fleeing the profession for years, while nurses have complained about short staffing for over a decade. Area hospitals will be impacted dramatically if Omicron starts to infect their workforces.

HHS reported over 68,000 people were hospitalized with COVID across the United States. Statewide on Friday, only eight percent of acute care and 12 percent of ICU beds were available. In King County many hospitals are already at or above capacity, but not due to COVID patients. A shortage of staffed skilled nursing and rehabilitation beds has left patients ready for discharge nowhere to go.

Over the summer when patient loads were lower, the Delta wave brought Oregon and Washington hospitals to the brink of crisis standards of care while collapsing the healthcare systems in Idaho and Alaska. Hospitalization rates for COVID and non-COVID patients are already much higher as the region prepares to face the biggest challenge yet.

According to HHS, EvergreenHealth Kirkland had 19 acute care beds available while Overlake had 17. Both hospitals were reporting ICUs near capacity with 3 beds at Evergreen and 4 at Overlake.

During the Delta surge, states learned that activating the National Guard for nurses and doctors was a poor option. Trained hospital staff who are “weekend warriors” were frequently already supporting surging hospital admissions. The activation in some cases made staffing situations worse.

King County residents vented their frustration on social media about the inability to get a booster shot, find home COVID antigen tests, and PCR test results being delayed. In other circles, Seahawks fans raged against the scheduling change against the Rams due to coronavirus.

Officials in the UK pleaded with government officials to implement further public health restrictions to stem the tide of new cases, as models indicate that by January, the island nation could see 3,000 to 4,000 new hospitalizations a day. Londoners were already starting to deal with closed shops and restaurants, and delays in services because so many people have been sickened.

It is unlikely any additional restrictions will be implemented across the United States, where COVID has been turned into a political weapon. The U.S. Department of Homeland Security (DHS) indicated in a Nov. 10 memo, “If a new COVID-19 variant emerges and new public health restrictions are imposed as a result, anti-government violent extremists could potentially use the new restrictions as a rationale to target government or public health officials or facilities.“

Numerous studies and growing real-world data from Africa and Europe indicate that immunity from prior COVID infections or vaccination without a booster provides enough protection to prevent severe COVID symptoms that result in hospitalization and death. Booster shots ideally received within the previous 12 weeks, boost immunity for more.

For people relying on viral vector vaccines such as Johnson & Johnson, AstraZeneca, or Russia’s GNCEM, there appears to be even less protection without a booster. On Thursday, The Centers for Disease Control (CDC) endorsed the recommendation from the Advisory Committee on Immunization Practices (ACIP) to recommend the mRNA Pfizer and Moderna vaccines over Johnson and Johnson. The decision was made due to the waning effectiveness of the J&J vax and nine confirmed fatalities, seven women including one from Seattle, and two men, from vaccine-induced immune thrombotic thrombocytopenia (VITT).

A study published on Dec. 14 found that Moderna with a booster provided the best protection from Omicron, followed by Pfizer with a booster, and then Johnson & Johnson with a Moderna booster. The study also evaluated individuals who had a previous COVID infection and then got vaccinated. They found that immunity was better than vaccination without a booster, but not as robust.

Real-world data from Europe and Africa indicate that relying on immunity from a previous COVID infection is offering little protection from becoming symptomatic. Epidemiologists have stated it is possible to be infected with the Delta and Omicron variants at the same time. It also appears that natural immunity from Omicron won’t protect a person from a later Delta infection.

There is mounting evidence that Omicron is no more severe than Delta, but little evidence it is less so. On Friday the Imperial College of London released a report that found no evidence that Omicron is “mild.”

“The study finds no evidence of Omicron having lower severity than Delta, judged by either the proportion of people testing positive who report symptoms or by the proportion of cases seeking hospital care after infection. However, hospitalisation data remains very limited at this time.”

The challenge for the public and health experts is comparing the current global wave to previous spikes in COVID cases. During the original wave in the spring of 2020, no one had any type of immunity. When the Alpha and Beta waves came in the winter of 2020, vaccines were just rolling out. When Delta arrived the variant was more transmissible and more severe than prior strains. It also was capable of nibbling around the edges of vaccine protection due to its mutations.

Omicron has arrived in a population that has received a variety of mRNA and viral-vector vaccines with different doses as well as disease acquired immunity from different strains. The timing of receiving a vaccine, prior infection, or a combination also impacts how much immunity a person has.

Many people are more mobile and have returned to work and school while simultaneously taking fewer precautions. An additional challenge is the rate of vaccination is not homogenous, with highly vaccinated communities adjacent to vaccine-resistant populations.

All of these factors are obscuring the true nature of Omicron and because the United States does a poor job of genomic sequencing in some states, little is known about the current hospitalized population and which variant patients have.

Although data out of South Africa has been more encouraging, experts had warned that the recent end of the Delta wave, a higher than understood vaccination rate, and the youthful nature of the South Africa population would favor better outcomes. Although only 26% of South Africa’s total population is vaccinated, over 34% of the county was ineligible due to age. On Oct. 20, the nation expanded vaccination to 12 to 17-year-olds and introduced booster shots to adults on Dec. 9. In reality, 44% of South African adults are fully vaccinated, including 61 percent of people over 50. Additionally, only 5.7% of South African residents are 60 or older.

Researchers are watching King County closely for several reasons. The region is a leader in genomic sequencing and research. As Omicron moves through the region it will provide critical data to build a better understanding of transmissibility, the impact on public health measures, prevention and treatment, and how severe Omicron is. King County is highly vaccinated, but has pockets of low vaccine acceptance, providing a more realistic cross-section. Finally, New York City is almost unique compared to other US cities due to its size, reliance on public transit, and the number of people who live in buildings with communal areas.

Dr. Cameron Webb, the senior policy advisor for equity for the White House COVID Response Team shared early symptoms to look for if you start feeling ill.

  • Sore throat, espeically if it is more than mild
  • Headache
  • Fatigue – severe fatigue appears more common in children
  • Runny nose
  • Sneezing
  • Dry cough

County health officials continue to appeal for people to get vaccinated and get a booster shot if they are eligible. They recommend frequent hand washing and wearing an N-95, KN-94, or KN95 mask whenever you’re out of your home, and to stop using cloth masks. When it comes to Christmas and New Year’s celebrations and travel plans, it is recommended to test the day off and celebrate outside or in well-ventilated indoor areas.

Because of the systems put in place by King County Public Health and supported by County Executive Dow Constantine, the region is better prepared to provide vital data to the rest of the nation. It is very likely that by Christmas, Seattle will feel a lot more like March 2020 than December 2021.

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BREAKING: King County residents are urged to prepare for the largest COVID wave to date

[SEATTLE, Wash.] – (MTN) A forecast created by Trevor Bedford, Ph.D., an Associate Professor, Biostatistics, Bioinformatics and Epidemiology Program Vaccine and Infectious Disease Division, at Fred Hutchinson Cancer Research Center, projects that King County will reach record levels by Dec. 22.

In a press conference on Friday, Dr. Jeffrey Duchin, Health Officer, Public Health Seattle & King County said, “The Omicron outbreak we’ve been talking about is no longer theoretical. It is real and it’s here.”

Dr. Duchin shared the current situation in King County, adding that UW Medicine is finding 40% of tests are positive for Omicron and new COVID cases are up 50% since Thanksgiving.

Dr. Santiago Neme, MD, MPH of UW Medicine expressed concern over the number of patients already in Washington hospitals. “Our numbers for COVID infected patients have decreased,” Dr. Neme, said, “but we have been operating at a full or over full capacity for several months in many areas of the state.”

“Any increase in hospital rates or utilization will be pretty challenging for us and very concerning.”

Dr. Duchin added that In King County, hospitals are already caring for twice as many patients as before the start of the Delta wave in August.

Bedford told reporters that the Seattle-Bellevue area would be one of the first cities in the United States to experience widespread Omicron infections and the area was only “a few days” behind London. “New York City is ahead of Seattle and Rhode Island is as well,” he said. But he added this may be due to Seattle having “great S gene drop out data.” S Gene Target Failure (SGTF) is a faster way to identify a likely Omicron variant infection from a positive COVID test. Genomic sequencing is required to make an absolute determination.

Dr. Alexander L. Greninger M.D., Ph.D., M.S., M.Phil., assistant director of the UW Medicine Clinical Virology Laboratory told reporters that sequencing has a 5 to 7 day lag time.

“The number of samples coming into the labs are as high as we’ve seen during the pandemic, yesterday and the day before,” Dr. Greninger added. The UW Medicine Virology Lab has sequenced about 100 samples, and “98 or 99” were positive for Omicron.

The model was created using genomic sequencing data of positive COVID tests, and information on transmission rates from other countries such as the United Kingdom and South Africa. Bedford estimated Omicron cases were doubling in King County every 2.2 days, which is supported by reports from the University of Washington Department of Virology. If the forecast is accurate there could be 2,100 Omicron cases on top of 500 Delta cases in King County by Wednesday. That would far exceed the record number of daily new cases during the fifth wave, and the doubling would continue every one to three days into January.

“Omicron is an airborne disease like Delta and spreads easier indoors, and is a lot more contagious,” Dr. Duchin said, adding, “We do not yet have a clear picture on severity.”

To prepare for the coming wave the message was clear, “The single most important thing you can do is to get vaccinated and boosted even if you’ve had a prior infection,” said Dr. Duchin, “but vaccination alone won’t stop the spread of Omicron.”

King County Health said we need to take advantage of as many layers of protection as we can. That includes wearing tight-fitting N-95, KN-95, or KN-94 masks indoors. The public should avoid crowded indoor spaces, especially if people are unmasked and there is poor air circulation. If anyone feels sick, they should get tested for COVID and stay home to help blunt the spread.

“If you do gather please do safely as possible,” Dr. Duchin appealed. “Limit the number and size of gatherings. Avoid crowded indoor spaces. Do a rapid test on the day of the gathering. Gatherings will be better in large outdoor places or indoor with open windows and doors.”

Dr. Duchin also recommends avoiding travel, especially to areas with high COVID transmission rates. He added that King County has not closed the door on further public health safety measures, but does not plan to add additional measures beyond the guidelines already in place.

The panel stressed that the severity of illness caused by Omicron is still not known. “My read on severity is still difficult – a large portion of infections are both breakthrough and reinfections,” Bedford told reporters. “It may well be the case that Omicron is intrinsically less severe than Delta, but we don’t know. What matters is how many cases do we get and what fraction of those cases require hospitalizations. That is going to be a very large number of cases, severity is not clear enough to know if it will be very bad, bad, or not so bad.”

When asked about breakthrough cases among the vaccinated, Dr. Greninger said, “Moderna and Pfizer are significantly better than Johnson & Johnson.”

“Serious infection is the most important,” added Dr. Duchin. “Meaningful protection against serious infection, hospitalization, and death will protect many of us in vaccinated communities.”

In King County, 160,000 people 12 and older remain unvaccinated and 250,000 have only had a single dose. According to the Washington State Department of Health, about one-third of fully vaccinated King County residents have received a booster dose.

Public and private employers were urged to start contingency planning now to prepare for staffing shortages. “We need to prepare for a large wave of people becoming ill quickly together,” added Dr. Duchin. “We will try to get guidance so we can get people back to work as soon as possible but plan for ‘large scale’ absenteeism.

Public testing sites for COVID will remain open through the holiday season except on Christmas and New Year’s Day. When asked what to do if you need a test on Christmas or New Year’s, Dr. Duchin recommended using a home test versus going to a hospital emergency department.

When asked about the rest of the United States, Bedford didn’t provide an optimistic picture. “Expect things to light up across the United States shortly – first in the cities and then rural areas.”

Looking ahead to the future, Bedford shared that the models he created in the fall have changed significantly due to the Omicron variant.

“Omicron makes things ‘significantly worse.’ I’m quite worried in nine months we will have both Omicron and Delta circulating,” adding, “Omicron will not get us out of this.”

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Omicron variant 20% of Washington COVID cases

[SEATTLE, Wash.] – (MTN) Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division, reported 20% of tests samples submitted for genomic sequencing are positive for the Omicron variant. From Dec. 6 to Dec. 10, Omicron jumped from 1% to 20% of samples tested using an S Gene Target Failure (SGTF) test.

The Washington State Department of Health reported on Dec. 13, 75.3% of residents 12 and older are fully vaccinated. Multiple studies have shown that three months after vaccination, Pfizer, Moderna, and Johnson and Johnson had low neutralizing antibodies against the Omicron variant but enough of a secondary response to prevent severe infections. On Dec. 15, the WSDoH reported 1.48 million people of 3.3 million eligible had received a booster shot. Boosters doses have been shown to increase neutralizing antibodies and add additional protection.

Percent of Total Population Fully VaccinatedPercentage of Vaccinated People with Booster DoseTotal Population in GroupAverage 7-Day New Case Rate
70.00% or above33.67%2,343,25072.1
60.00% to 69.99%30.67%1,669,30093.6
50.00% to 59.99%28.79%3,339,30087.4
40.00% to 49.99%25.62%268,97576.5
32.70% to 39.99%31.51%151,850102.6
7 Day New Covid-19 Cases per 100K average by Vaccination Rate for Total Population, Adjusted for Population by County, Booster percentage is based on totally fully vaccinated, not eligible, Average 7-day New Case Rate <25 normal, =>25 to 99.9 moderate, => 100, high transmission

Statewide, the 7 day moving average for new COVID cases was 84.1, indicating moderate coronavirus transmission across the state. Ferry and Columbia Counties are hot spots, while a surge in new cases in Garfield County was winding down.

On Wednesday, the WSDoH reported four super spreader events on Dec. 4, involving high school wrestling tournaments in Yelm, Puyallup, Sumner, and Lacey. Participants and spectators came from  Clark, Cowlitz, Grays Harbor, King, Kitsap, Lewis, Mason, Skagit, Snohomish, Pierce, Thurston, Whatcom, and Yakima Counties, and one school from Oregon.

Officials reported that 80 to 90 people had confirmed COVID cases so far, and they expect to find more infections. Infections were among vaccinated and unvaccinated individuals, and three genomic sequenced tests were positive for the Omicron variant.

On Tuesday, the U.S. Centers for Disease Control (CDC) presented two potential national scenarios in a closed-door media briefing. The first predicted a continued Delta surge followed by a smaller wave of Omicron cases spiking in the early spring. The second had Delta, Omicron, and Influenza surging simultaneously in January, potentially overwhelming hospitals.

Omicron has world leaders and health officials increasingly worried as cases surge around the globe. Seventy-seven countries and 36 states have confirmed cases.

In South Africa, over 7,300 people are hospitalized, an increase of 81% from a week ago, with cases exploding outside of Gauteng Province. The South Africa Department of Health reported 26,976 positive cases today, and the 7 day moving average jumped to over 23,000 – a new record.

The United Kingdom reported a single-day record for new COVID cases – 78,610. National Health Services leaders said 60% of all cases in London are the Omicron variant and 35% of cases nationwide. British prime minister Boris Johnson told reporters that cases of Omicron are doubling in less than two days.

“I’m afraid we’re also seeing the inevitable increase in hospitalizations up by 10 percent nationally week on week and up by almost a third in London.”

In a political blow, the conservative members of his party voted down stricter measures meant to curb the growing number of hospitalizations.

The European Centre for Disease Prevention and Control Rapid Risk Assessment from Dec. 15 issued a stark warning to the European Union members.

“Although current data on the severity of the infection associated with the Omicron [Variant of Concern] (VOC) remain limited, evidence to date raises concern that the Omicron VOC may be associated with a significant reduction in vaccine effectiveness against SARS-CoV-2 infection,” the report stated.

“Even in the case of lower infection/disease severity with the Omicron VOC, a steep, exponential increase in cases caused by the Omicron VOC will result in a growing number of cases with severe disease. As EU/EEA countries are still facing the severe impact of the Delta VOC wave, a further rise in hospitalisations could quickly overwhelm healthcare systems.”

Many pundits have rushed to declare Omicron as mild relying on abstracts, articles, and soundbites. Many doctors believe the early data is encouraging but caution against rushing to conclusions.

Several publications are quoting an article from the LKS Faculty of Medicine from the University of Hong Kong by Dr. Michael Chan Chi-wai, Associate Professor of School of Public Health and Principal Investigator, and Professor John Nicholls, Professor of Department of Pathology.

The research paper and study data have not been published and currently is under peer review. The article suggested that the Omicron variant can replicate 70 times faster in the lungs’ airways when compared to the Delta variant, creating a higher viral load. Dr. Chan also suggested that Omicron may infect multiciliated cells found in the deep lungs at a slower rate when compared to the Delta variant.

Dr. Chan stressed that COVID infections are complicated, and only looking at the ability to infect lung cells was too narrow to reach a broader conclusion on severity. “It is important to note that the severity of disease in humans is not determined only by virus replication but also by the host immune response to the infection, which may lead to dysregulation of the innate immune system.”

He went on to add, “By infecting many more people, a very infectious virus may cause more severe disease and death even though the virus itself may be less pathogenic. Therefore, taken together with our recent studies showing that the Omicron variant can partially escape immunity from vaccines and past infection, the overall threat from Omicron variant is likely to be very significant.”

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Omicron variant identified in 13% of recent Washington COVID tests

Editor’s Note: As a policy, Malcontent News does not quote or publish data from pre-print studies. The transmission rate of the Omicron SARS-CoV2 variant is so high it is spreading at a rate faster than the scientific review process. It is for this reason, we are using pre-print studies in our reporting and analysis for the Omicron variant. We will continue to backlink to all quoted sources to support transparency in reporting.

[SEATTLE, Wash.] – (MTN) Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division, reported 13% of tests samples submitted for genomic sequencing on Dec. 8 were positive for the Omicron variant. Tentative confirmation was made using an S Gene Target Failure (SGTF) test, with Dr. Roychoudhury indicating in a tweet that it will take a few days for genomic sequencing confirmation.

Using the data provided by the University of Washington, Omicron variant cases in Washington doubled every 24 hours from Dec. 6 to Dec. 8. The total number of new COVID cases being detected indicates that the Omicron variant is rapidly replacing Delta, not adding to confirmed cases at this time.

Nathan Grubaugh, Ph.D., Associate Professor of Epidemiology at the Yale School of Public Health, tweeted researchers were seeing a similar trend among samples collected in Connecticut.

If the rate of new case growth for Omicron continues at the current rate in Washington, it would be the fastest case growth rate observed to date. In South Africa and across the United States, Omicron cases have been doubling every three days. In the United Kingdom, cases have been doubling every two-and-a-half days and in Denmark, every two days.

Sikhulile Moyo, director at the Botswana Harvard AIDS Institute Partnership (BHP) lab in Gaborone and a research associate in immunology and infectious diseases at Harvard T.H. Chan School of Public Health was the first person to sequence the Omicron variant on Nov. 8. He shared his findings on GISAID on Nov 11, which caught the attention of virologists around the world.

Lancet Labs in South Africa started seeing an alarming number of PCR tests from the Gauteng Province missing the target S gene in mid-November. Lancet shared the findings with the Network for Genomics Surveillance in South Africa (NGS-SA), which called an urgent meeting on 23 November. “We were shocked by the number of mutations,” says Tulio de Oliveira in a report in Science, a virologist at the University of KwaZulu-Natal and NGS-SA’s principal investigator.

On Nov. 24, Dr. Alex Sigal of the Africa Health Institute received three test swabs with the Omicron variant and started growing the virus to test it against sera from vaccinated and recovered individuals.

On the same day, Lancet sequenced another 100 samples with the missing S gene, and all were positive for the newly discovered variant. The South Africa Department of Health sent their findings to the World Health Organization (WHO) on Nov. 24, and Omicron was labeled a Variant of Concern (VOC) on Nov. 26.

Despite the first three cases appearing in Botswana, Omicron was likely circulating undetected on several continents by late October. The Centers for Disease Control (CDC) reported last week that the first symptomatic Omicron case in the United States was on Nov. 15. The implementation of international travel restrictions likely had no impact on slowing the spread of the highly infectious variant.

Nevada became the most recent state to report an Omicron variant COVID case on December 14

Preliminary data has emerged over the last week on transmissibility, treatment efficacy, and vaccine effectiveness for Omicron.

A study out of South Africa published on Dec. 2, found that Omicron was 2.5 to 3.5 times more transmissible than Delta. The study, which has not been peer-reviewed, indicated the Rt, a measure of how quickly a communicable disease can spread, is between R12 and R17, which is comparative to measles. On Dec. 8, Hiroshi Nishiura, professor at Kyoto University released a study that found Omicron is 4.2 times more transmissible than Delta with an Rt of R20. If additional research were to find this true, the Omicron COVID variant would be the most transmissible disease observed in the modern medicine era.

Omicron is forecasted to become the dominant strain in the United Kingdom and Denmark this week and was already 44% of detected COVID cases in the UK on Tuesday. The CDC reported tonight Omicron represents 3% of all detected COVID cases in the United States.

Eleven studies and reports, none of which have been peer-reviewed, have been published on vaccine effectiveness in the last 10 days. Studies have evaluated the Pfizer, Moderna, Johnson and Johnson, and AstraZeneca vaccines.

Studies that reviewed the effectiveness of the Pfizer vaccine found that the effectiveness of preventing symptomatic illness dropped from 80% to zero to 35%, depending on the study. Very limited real-world data out of South Africa from Discovery Health released today showed that the Pfizer vaccine was only 33% effective at preventing infection.

The same study found that the Pfizer vaccine was 70% effective at preventing “severe complications of Covid-19,” down from 93% with the Delta variant.

Dr. Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, past Chair of the BMA Public Health Medicine Committee had this to say about the findings.

“Two doses of vaccine are 70% effective at preventing hospitalization. They are not ineffective, but they are much less effective than the 90-95% protection that two doses provided against hospitalization. With a highly infectious variant, this still risks a catastrophic number of hospitalizations.”

A non-peer-reviewed study published on Tuesday evening provided the first data on the effectiveness of the Moderna vaccine, and more data for the Johnson & Johnson/Jassen vaccine.

Researchers evaluated the sera from 239 vaccinated healthcare workers in the Boston area. The study found that for the Moderna and Pfizer vaccine, more than 50% of individuals had no neutralizing antibodies three months after vaccination. The Moderna vaccine showed a 43-fold decrease in antibodies while the Pfizer vaccine had a 122-fold decrease. The Johnson and Johnson vaccine performed better against the Omicron variant versus Delta but had significantly reduced effectiveness versus the original COVID strain.

For individuals who had a prior Covid-19 infection and then got vaccinated more than six months ago, the Moderna vaccine had a 9-fold decrease in neutralizing antibodies, the Pfizer vaccine had a 12-fold decrease, and the Johnson & Johnson vaccine had a 17-fold decrease.

The study also found an mRNA booster within the last three months provided a significant increase in neutralizing antibodies but did not provide the same level of protection versus the Delta variant. The samples from the Johnson and Johnson test subjects were all boosted with a half-dose of the Moderna vaccine.

Two studies on disease acquired immunity found that protection declined significantly compared to previous variants. A study published on Dec. 2 out of South Africa, which has not been peer-reviewed, found that protection against Omicron dropped 240% for individuals who were previously infected by the original strain, Beta, or Delta, and had never been vaccinated. Another study released on Dec. 9 reached a similar conclusion, and in an alarming find, reported up to 40% of individuals who had a previous Delta infection were experiencing reinfection with Omicron. The Delta wave ended on Sep. 19 in South Africa, suggesting it took less than three months for protection to wane.

Scientists, public health officials, and policymakers have been attempting to determine if Omicron is less severe than the Delta variant. The study released from Discovery Health today reported that Omicron was 29% less severe than the original COVID strain.

“Without seeing a preprint or the report on which this press release is based it is difficult to get a clear understanding of the validity of these conclusions,” said Prof. Paul Hunter, Professor in Medicine at the University of East Anglia and a member of the National Institute of Health Research in the U.K. “If these are valid conclusions then there are both reassuring and worrying findings.  The report that reinfections are more common with Omicron has already been published and the evidence is strong that Omicron can increase the risk of infection in people who have already had a COVID infection.”

Other experts warned against reading too much into the Discovery Health report.

Dr. Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said, “This press release outlines preliminary observations of Covid-19 in South Africa during the first three weeks of the wave of infections caused by the Omicron.  It shouldn’t be forgotten that in the UK, during the initial epidemic there was a 5-week gap between the first diagnosis and the first death.  A situation report taken in those first few weeks would not have given us an accurate picture of what was about to happen, so we shouldn’t expect these preliminary indications to be a portent of how the Omicron epidemic will play out here.”

The Centers for Disease Control (CDC) provided detailed information on Dec. 10 about the first 43 Omicron variant cases detected in the United States. The report found that one person required hospitalization and was released after two days. Almost 60% were 39 years old or younger and 33% had recently traveled internationally. Forty of the 43 cases were vaccinated or had a previous COVID infection. Among the 34 who were vaccinated, 14 had received a booster.

Officials believe the high infection rate for vaccinated individuals has created a data fallacy. International travelers are more likely to be vaccinated, younger, and healthier and many were not eligible for a booster.

The Washington State Department of Health (WSDoH) reported 75.3% of all Washingtonians 12 and older are fully vaccinated and almost one in four children five to eleven have received their first dose of the Pfizer COVID vaccine. An estimated 3.5 million residents are eligible for boosters, but only 1.35 million have received one to date.

WSDoH reported the 7 day moving average for new cases is 1,333, and the statewide 7 day moving average new case rate is 83.5 per 100K residents – moderate transmission. The state has been averaging 650 to 700 hospitalized COVID patients a day, with roughly 100 requiring ventilators.

Statewide new admissions for COVID-related illness started increasing on Nov. 27, and through Dec 7. was averaging 92 new admissions a day. On Tuesday there were approximately 642 available staffed acute care and 144 staffed ICU beds throughout Washington.

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Washington watches and waits for the Omicron COVID variant to arrive

Knowledge is the best tool to fight against fear. A wise person chooses to be informed so they can make sound decisions. To join the fight against COVID misinformation, you can share this update through your social media platform of choice.

[KIRKLAND, Wash.] – (MTN) Health officials and researchers are in a race against time to unlock the secrets of the Omicron COVID variant and its potential impact on public health as more nations report discovered cases.

Washington state is one of the leaders in genomic sequencing of COVID tests samples in the United States, led by the University of Washington Medicine. Standard PCR tests can detect a marker for a potential Omicron variant. Omicron shares a mutation with the Alpha variant that the current PCR tests look for, enabling researchers to see if a specific spike protein has a deletion. That would become a probable case that would be tagged for confirmational sequencing.

President Joe Biden addressed the nation on Monday saying, “there are three messages about the new variant that I want the American people to hear. First, this variant is a cause for concern, not a cause for panic.”

The President went on to praise South African officials and their scientific community for, “the kind of transparency that should be encouraged and applauded.”

Currently, in Washington, 99.6% of new COVID cases are the Delta variant, and 0.4% are Mu. The last cases of the Beta, Epsilon, Eta, and Kappa variants were detected in June and the last cases of Gamma and Iota were in August.

“Omicron has an unprecedented number of spike mutations, some of which are concerning for their potential impact on the trajectory of the pandemic,” the WHO said in a statement today.

“The overall global risk related to the new variant …is assessed as very high.”

On Sunday, Dr. Angelique Coetzee told South Africa Today, “Most of these cases are mild whether they are vaccinated or not. There is no increase in our hospital admissions currently.”

Hospital admission for COVID-19 by week, South Africa Gauteng Province, Public and Private Hopsital, through November 28, 2021

Less than 12 hours later, the hospital admission data from the South Africa Department of Health painted a very different picture. In the previous week, COVID hospitalizations had increased 66% nationwide and 210% in Gauteng Province, the epicenter for Omicron cases. Two weeks ago 135 Covid-19 patients were hospitalized in and around Johannesburg jumping to 580 on Monday morning. Hospitalizations at public and private hospitals increased almost equally and officials at Baragwanath Hospital reported moderate to severe symptoms with almost all patients unvaccinated or partially vaccinated with the Pfizer vaccine.

Dr. Coetzee in her interview on Sunday went on to take a more cautionary position, “Two weeks from now we might say something different, but we urge…people out there please get vaccinated, listen, do the right thing, and stop going to big gatherings.”

She also added the unvaccinated should be worried, saying, “especially if you are above the age of 50, we have seen this many times.”

“There is a saying. You’re not safe until everyone is vaccinated.”

The 7 day rolling average for new COVID cases in South Africa grew to 2,275 on Monday, 90% of new cases are Omicron, and 10.8% of tests are coming back positive

The WHO appeared to address the reports from Dr. Coutzee and her reports on the severity of the new variant in a statement last night. “There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.”

The statement added, “Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.”

Dr. Coetzee saw her first suspected Omicron variant patient on November 18 and has based her statement of symptoms being mild on two-dozen patients who are mostly university students and younger, and about 50% vaccinated. In an interview with the BBC on Thursday, she stated all were in good health with no comorbidities.

Although she is credited and has self-proclaimed to have “discovered” Omicron, the first detection of the B.1.1.529 variant was collected on November 9 in Botswana and confirmed by South African scientists on November 11. South African officials notified WHO on November 24, a day before Dr. Coutzee stated she contacted South African authorities on her observations.

Despite a lot of unanswered questions, a clearer picture is slowly starting to emerge. The three riddles scientists need to solve are how contagious Omicron is compared to the Delta variant, can it escape public health measures, preventions, and treatments, and if the symptoms are the same, worse, or milder than previous variants.

Here is what is currently known about the Omicron COVID variant.

Symptoms

For children, adolescents, and young adults there is conflicting information. One doctor is reporting mostly mild symptoms that can be treated at home while hospital officials are reporting cases are similar to Delta.

The WHO stated on Sunday, “There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.”

Transmissiblity

Concern is growing among the CDC, WHO, and a constellation of health officials that Omicron is highly transmissible. At least equal to Delta and possibly higher.

In less than two weeks, Omicron went from almost non-existent to 90% of new cases in South Africa. It appears it can effectively outcompete the Delta variant. However, this introduces bias in the data because the Delta wave had just ended in South Africa. Did Omicron become the dominant strain by outcompeting Delta or due to the absence of Delta? More research needs to be done to answer that question.

There are other variables that could explain the sharp increase in cases that go beyond the simple reproductive number, known as R0. Omicron has so many more mutations than previous strains, it could be benefiting from immune escape. Although the R0 is lower than Delta, its uniqueness compared to previous mutations enables it to reinfect people relying on natural immunity. So overall transmissibility may be lower than Delta, but its ability to escape immunity results in more infections.

Is it in the United States

Cassie Sauer, CEO of the Washington State Hospital Association said on Monday, “I think that there is almost no chance that it’s not [here.]”

The United States does not have a national standard or requirement to genetically sequence some or all COVID tests that come back positive. Those decisions are left up to individual states. It is likely that states with aggressive public health programs such as California, Washington, Colorado, New York, or Massachusetts will identify the first cases.

How long do researchers think Omicron has been circulating

Dr. Trevor Bedford from Fred Hutchinson in Houston, Texas successfully estimated the arrival of the original COVID strain in 2020, using data from the Washington State Department of Health. Using the same methodology, Dr. Bedford’s model indicates that Omicron likely started circulating between September 19 and October 21. There is no evidence to support that the variant originated in South Africa.

Credit – Dr. Trevor Bedford, Fred Hutchinson, Houston, Texas – probability of origin date for Omicron variant

Why are so many travelers testing positive

In total numbers, there aren’t many travelers testing positive. When you consider that in all but two cases the testing of 200 to 250 people on an aircraft has yielded one or two positives, the percentage of breakthrough cases is small. Headlines are blaring two positive cases detected, which is critical to know – they aren’t blaring 248 negative tests on 777 that landed tonight.

Because the people tested are 95% to 100% vaccinated, this creates a false data fallacy. You have an almost exclusive sample of vaccinated people.

In South Africa, the Department of Health has reported almost everyone hospitalized in the last two weeks is unvaccinated or only partially vaccinated. Dr. Coetzee reported 12 of 24 patients she cared for were unvaccinated.

Based on this early data, it appears the current vaccines remain at least moderately effective at preventing infection and remain very effective at stopping moderate to severe COVID.

Are the current vaccines ineffective

There isn’t enough data, and almost every public company making a vaccine announced over the weekend they were testing their current versions against Omicron. Pfizer, Moderna, and Johnson & Johnson announced over the holiday weekend they were testing to see if the current vaccines remained effective.

There is some data out of South Africa that is indicating that vaccines are helping prevent moderate to severe illness and the cases being detected among vaccinated travelers appear to be asymptomatic to mild. However, many of those cases were detected in the last 72 hours and more time is needed to see how these new cases will progress.

In Israel, the first three travel-related cases were fully vaccinated with boosters. One was Pfizer, one was J&J, and one was AstraZeneca. We know that the viral-vector vaccines haven’t performed as well against the Delta variant as the mRNA vaccines.

The evidence suggests that there is more vaccine escape with Omicron, but not outright vaccine ineffectiveness. It still appears to be preventing hospitalizations, which would indicate it would prevent deaths.

Pfizer said they could make a new version if required in 100 days and Moderna said it would take 60 to 90 days. Johnson & Johnson did not provide a timeline but made a statement today they could create an updated version if it was required.

There are some new COVID vaccines in development called subunit vaccinations. There has been no information about the impact Omicron will have on the research.

Is disease acquired immunity still effective

There is growing evidence that immunity gained from a previous COVID infection that isn’t supported by vaccination, is experiencing significant breakthrough numbers.

Researchers are working to determine if the sharp increase in the number of cases and the high positivity rate of tests is due to Omicron being equally or more transmissible than Delta, or if part of the increase is being driven by other factors.

The pattern of mutations found in Omicron is very distant from all previous strains.

Are monoclonal antibodies still effective

There is evidence that Omicron has a significant ability to resist monoclonal antibodies. Specific mutations may have the capability to not only bypass B cells but resist T cells (which isn’t the same as HIV which destroys your T cells).

UW Medicine is evaluating the performance of currently available antiviral treatments and we will know more information in the coming weeks.

Will the new antivirals that are pending approval still be effective

There was a report from Pfizer on Monday morning that Paxlovid is effective against the Omicron variant, which is very good news. This is easy to administer than monoclonal antibodies, easier to distribute, and cheaper.

Nothing has been stated about Monulpiravir from Merck. The FDA will be considering the EUA request this week but there are hints they will label Monulpiravir a Class C drug if the EUA is granted. A Class C drug can’t be used by pregnant women, women actively trying to get pregnant, and nursing mothers because the drug has not been tested to determine if it causes birth defects or pregnancy complications. The FDA has already requested data for Merck to understand the impact better.

What should I do

Health officials recommend you continue to do the same things you are doing now. Get vaccinated if you’re not already. Get a booster shot if you’re eligible, and over 2.4 million Washingtonians are currently eligible. Wear a mask, wash your hands, avoid crowded indoor spaces, and reconsider your short term travel plans if you were planning to fly.

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Updated: FDA and CDC approve COVID vaccination boosters for all adults

Update: CDC Director Rochelle Walensky granted final approval to the FDA amendments of the Pfizer and Moderna EUAs.

[WASHINGTON, D.C.] – (MTN) The U.S. Food and Drug Administration amended the emergency use authorizations (EUA) for the Moderna and Pfizer-BioNTech Covid-19 vaccines authorizing a single booster dose for all individuals 18 and older six months after receiving their second dose. Shortly after, the Centers for Disease Control panel of vaccine scientists unanimously endorsed the FDA’s authorization. CDC Director Rochelle Walensky needs to provide final approval, but that is expected to happen on Friday.

Pfizer requested the Emergency Use Authorization (EUA) for its Covid-19 vaccine to be amended to include booster doses for all adults on November 9 and Moderna made an identical request on November 17. Previously, only adults 65 and over, and people 18 to 64 with certain medical conditions, work in specific jobs, or live in communal areas were authorized to get a booster if they had received an mRNA vaccine from either company.

3.3 million Washington state residents 16 and older were fully vaccinated on May 30, according to the Washington State Department of Health (DOH). By the end of November, almost every person in that group will be eligible for a booster after Walensky gives her approval.

Almost all of these people would be eligible for a booster shot. Despite the mounting evidence that immunity wanes after five to seven months, only 675,000 residents have received boosters through November 7.

Data out of Israel, the United Kingdom, and Germany indicate that the United States is woefully unprepared for a sixth wave. Israel authorized boosters for older residents in July at the beginning of its fifth wave and expanded the program to include everyone 12 and older in September. That program was instrumental in ending the fifth wave.

For 9.2 million Israelis, COVID is now endemic. The government took a unified approach, enabling local councils within individual communities to determine if their city was green, yellow, or red. Almost all of Isreal is in a “green life category.” Masks aren’t required and life, travel, business, and entertainment are normal. Israel has a similar vaccination rate to the United States but a much larger number of people who received boosters.

Multiple studies have shown that infection acquired immunity and vaccine immunity are strong for five to seven months and then start to wane. In December 2020 health officials set expectations that it was unknown how long immunity would last, and many indicated that future booster shots would be likely. Anti-vaccination advocates and disinformation campaigns have used waning immunity as a talking point to sow distrust in vaccination programs.

Last month, the FDA and CDC approved booster shots for anyone 18 and older that received the viral-vector Johnson & Johnson vaccine.

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2.6 million Washingtonians in need of Covid boosters as FDA mulls expanding eligibility

[WASHINGTON, D.C.] – (MTN) The US Food and Drug Administration confirmed that the Vaccines and Related Biological Products Advisory Committee will meet to consider authorizing Pfizer vaccine Covid-19 boosters for all this week.

Pfizer requested the Emergency Use Authorization (EUA) for its Covid-19 vaccine to be amended to include booster doses for all adults 18 and older regardless of comorbidities, vocation, or living situation on November 9. Currently, only adults 65 and over, and people 18 to 64 with certain medical conditions, work in specific jobs, or live in communal areas are authorized to get a booster.

Dr. Peter Marks, director of the FDA’S Center for Biologics Evaluation and Research, told CNN the EUA amendment request was the center’s “highest priority.”

3.3 million Washington state residents 16 and older were fully vaccinated on May 30, according to the Washington State Department of Health (DOH). Under the updated guidelines, almost all of these people would be eligible for a booster shot. Despite the mounting evidence that immunity wanes after five to seven months, only 675,000 residents have received boosters and the DOH told Malcontent News last week the state would not deviate from current federal guidelines.

A growing list of states isn’t waiting for the federal government. Arkansas, California, Colorado, Kansas, Minnesota, New Jersey, New Mexico, and West Virginia have issued guidance or directives for anyone who received their second dose of mRNA vaccine more than six months ago to get a booster shot within the last week.

Sunday on Face the Nation, Colorado governor Jared Polis expressed frustration on information coming from the FDA and CDC on boosters.

“I’ve been very frustrated with the convoluted messaging out of the CDC and the FDA. Everybody should get the booster after six months. The data is incredibly clear that it increases your personal protection level. That’s why my parents got it. I got it. My family members got it.”

Yesterday, speaking at the Reuters Total Health Conference, Dr. Anthony Fauci of the National Institutes of Health (NIH) called for the United States to authorize boosters for all.

“To me, if you want to get to endemic, you have got to get the level of infection so low that it does not have an impact on society, on your life, on your economy,” Fauci said. “People will still get infected. People might still get hospitalized, but the level would be so low that we don’t think about it all the time and it doesn’t influence what we do.”

“To get there,” he said, “would take a lot more people rolling up their sleeves for initial COVID-19 shots and boosters.”

The FDA is widely expected to approve Pfizer’s request but the authorization will require approval by the Centers for Disease Control and must be signed off by CDC Director Dr. Rochelle Walensky to become official policy.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices will hold an emergency meeting on Friday to discuss Pfizer’s request.

Data out of Israel, the United Kingdom, and Germany indicate that the United States is woefully unprepared for a sixth wave. In Germany where cases are exploding only 3% of the population has received booster shots. Most cases continue to be among the unvaccinated in low-vaccinated regions.

Israel authorized boosters for older residents in July at the beginning of its fifth wave and expanded the program to include everyone 12 and older in September. That program was instrumental in ending the fifth wave where life has largely returned to normal. Despite the surge in cases, hospitalizations and deaths were significantly blunted compared to the winter of 2020.

Germany and Israel have similar vaccination rates to the United States and the Delta variant has repeatedly moved through areas with low-vaccinated populations as seasonal changes move people indoors. COVID cases are increasing in 31 U.S. states with Colorado, Minnesota, Wisconsin, Pennsylvania, and Maine are dealing with significant surges.

Multiple studies have shown that infection acquired immunity and vaccine immunity are strong for five to seven months and then start to wane. In December 2020 health officials set expectations that it was unknown how long immunity would last, and many indicated that future booster shots would be likely. Anti-vaccination advocates and disinformation campaigns have used waning immunity as a talking point to sow distrust in vaccination programs.

Moderna has not applied with the FDA to amend the EUA for its vaccine and the FDA did not indicate it would be including Moderna in the discussions. Mixing and matching of COVID boosters were approved on October 21, but there is no indication if boosters for all are approved by the FDA and CDC, that mix and match rules will extend to recipients of the Moderna vaccine.

You can read our special report, Who is eligible for a COVID-19 booster and why should get one now, to learn if you are currently eligible.

Health and Lifestyle, Local, National

Special Report: Who is eligible for a COVID-19 booster and why should get one now

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[SEATTLE, Wash.] – (MTN) During a Facebook Live with Congresswoman Anna Eshoo (CA-D) on Tuesday, Dr. Anthony Fauci M.D., Director of the National Institute of Allergy and Infectious Diseases, recommended Americans who are eligible to get a Covid-19 booster shot to get one as soon as possible due to waning immunity.

With concern growing about a sixth wave in states that finished beating back the Delta surge and states such as Colorado, Michigan, Minnesota, and Vermont having a late fifth wave, questions about eligibility for boosters are growing.

Some states aren’t waiting for direction from the federal government. California Governor Gavin Newsom and California Health Secretary Dr. Mark Ghaly told state residents 18 and older they should “absolutely” sign up to get a COVID booster. On Thursday, Colorado Governor Jared Polis issued a directive that defies current federal guidance on Covid-19 booster shots, permitting all state residents 18 and older to get them.

During a White House briefing on Wednesday, Dr. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention (CDC), said there continued to be a need to prioritize those who are currently eligible for a Covid-19 booster but added, “as you likely know, FDA is currently looking at the data for expanding boosters to all populations.”

Who is currently eligible for a Covid-19 booster

Eligibility depends on which vaccine you received and several other factors.

Janssen/Johnson & Johnson

If your initial vaccine was Janssen/Johnson & Johnson and you’re 18 or older, you are eligible for a booster 60 days after receiving your first dose. There are no limitations for age, comorbidities, living arrangements, or vocation.

The FDA has approved a mix-and-match approach, and you can receive a booster using the Pfizer or Moderna vaccine or a second Johnson & Johnson dose.

The Johnson & Johnson vaccine has a 1:500,000 chance of causing a rare condition called VITT. In the United States, there have been 47 reported cases and four deaths. If you were assigned female at birth and have a family history of blood clots or low platelets, or you are of childbearing age and using a hormone-based form of birth control, and you’re concerned about VITT, talk to your healthcare provider, OB/GYN, or fertility specialist.

If you’ve had a confirmed case of Covid-19 in the last 90 days and you were symptomatic, talk to your doctor or healthcare provider on whether you should wait to receive a booster.

BioNTech/Pfizer and Moderna

Anyone 65 or older and received the Pfizer or Moderna vaccine is eligible for a booster 180 days after their second dose. People 18 to 64 can qualify for a third dose if they have certain medical conditions, work in a high-risk environment, or live in an area where social distancing isn’t feasible.

Medical conditions that put you at risk for severe Covid-19

If you are 18 to 64 and have any of these conditions, you qualify for a booster.

  • Cancer or a prior history of cancer
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic lung disease such as moderate to severe asthma, bronchiectasis, COPD including obstructive sleep apnea, fibrosis or prior lung damage due to scarring, injury, or prior disease, cystic fibrosis, pulmonary embolism or history of, or pulmonary hypertension or history of
  • Dementia or Alzheimer’s
  • Diabetes – Type 1 or Type 2
  • Down Syndrome
  • Heart disease such as heart failure, coronary artery disease, high blood pressure, cardiomyopathies
  • HIV
  • Immunocompromised, auto-immune disease, taking immunosuppressants, or using drugs that suppress the immune system such as steroids both oral and topical
  • Mental health conditions including mood disorders, depression, and schizophrenia
  • Body Mass Index (BMI) over 25
  • Pregnant, trying to get pregnant, or sexually active and could get pregnant and would carry pregnancy to term
  • Sickle cell disease or Thalassemia
  • Smoking or vaping currently or in the past
  • Solid-organ or blood stem cell transplant
  • Stroke or cerebrovascular disease
  • Substance abuse past or present including alcohol, opiods, or cocaine
  • Tuberculosis
Living conditions

If you have any of these living arrangements, you qualify for a booster.

  • Long-term care facility
  • Homeless shelter – short or long term
  • Jail or prison inmate
  • Community living arrangements such as dormatories, halfway houses, group homes, or hostels
  • Live with a high-risk individual with a medical condtion listed above, or live in a multi-generational household, and you are the primary care provider
Work exposure

If you work in an environment where you interact with Covid-19 positive people or have significant contact with the public, you are eligible for a booster.

  • First responders such as healthcare workers, firefighters, police, or congregate care providers
  • Educational staff such as teachers, support staff, athletics staff, transportation, and daycare workers
  • Food and agriculture workers
  • Manufacturing workers
  • Correctional officers and employees who work in jails or prisons including healthcare, educators, and mental health providers
  • U.S. Postal Service workers
  • Public transit workers
  • Grocery store workers and other retail and service employees that have high contact with the public

There have been less than 1,000 mild to moderate myocarditis cases in the United States connected with receiving the mRNA Pfizer or Moderna vaccines. Most of these cases involved adolescents or young men. If you were assigned male at birth and have a history of heart disease, or are worried about myocarditis, talk to your healthcare provider to see if the Jassen/Johnson & Johnson vaccine is a better option.

Just like the J&J vaccine, If you’ve had a confirmed case of Covid-19 in the last 90 days and you were symptomatic, talk to your healthcare provider to determine if you should wait to receive a booster.

I thought the COVID vaccine was forever

The idea that the Covid-19 vaccine would be one and done is a creation of misinformation, misunderstanding, and poor reporting by some news outlets.

As the first COVID wave was winding down in the United States in May 2020, there were discussions about having “immunity passports.” People who had a confirmed Covid-19 case could be permitted to return to work and other activities based on the assumption they possessed natural immunity. Shortly after the discussions started, early evidence began to pile up that natural immunity was short-lived. The journal Nature Medicine shared a report on June 18 showing natural immunity started to fade after three months.

The closest claim that immunity from natural exposure or vaccination would last a lifetime came from former President Donald Trump in October 2020. Still, even then, he never made a complete claim of lifetime protection. On October 11, 2020 during an interview with Maria Bartiromo, Trump discussed his personal battle with Covid-19.

“It looks like I’m immune for, I don’t know, maybe a long time, maybe a short time,” he said. “It could be a lifetime. Nobody really knows, but I’m immune. So the President is in very good shape to fight the battles.”

As Trump was recovering from COVID and considering if he had “long time” immunity, there was more evidence that natural immunity started to fade after three months and a growing number of reinfection cases. For public health officials, an even bigger concern was many people who got reinfected suffered from more severe cases.

In December, when the first Covid-19 vaccines were about to become publicly available in the United States, the medical community was already cautioning the public it was unknown how long immunity would last.

In January 2021, Dr. Kristen Marks M.D., an infectious disease specialist at New York-Presbyterian, said, “We really don’t know whether you’re still immune a year after vaccination. Some of the clinical trials will study adding a booster in a year and comparing whether that’s better or if the immunity is just as good for two years with the two shots. That remains to be determined.”

Data from the United Kingdom and Israel have shown that all immunity wanes. Although cases grew dramatically in both countries, hospitalizations and fatalities did not match the winter 2020 surges. A vast majority of the hospitalized, critically ill, and deaths were among the unvaccinated. In Israel, an aggressive booster program ended their wave where new cases have drifted downward to early July levels.

How long does natural and vaccine based immunity last

Two different studies were released in October 2021, providing insight into how long natural and vaccine immunity last. Neither offer lifetime protection.

On October 1, a study on the durability of immunity against reinfection by SARS-CoV-2 was published in The Lancet. Researchers predicted that natural immunity had a half-life of 142 to 185 days. Half-life means how long does it take for half of the antibodies for a disease to disappear from a person’s blood serum. The study estimated that after 16 months, the average person would no longer have any natural immunity to Covid-19. However, the study also stated that this would vary widely depending on age, overall health, genetics, and risk factors. The half-life could be as short as 45 days or as long as 31 months.

Three days later, the Lancet published a study on vaccine-based immunity titled Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA. That study indicated that immunity waned from 30% to 50% after five months depending on the mRNA vaccine administered, age, and Covid-19 variants. Simply put, vaccine immunity and natural immunity, when accounting for a range of factors, have similar half-lives.

The viral-vector vaccine from Johnson & Johnson has received less research and has been administered to approximately 15 million Americans. A third study indicated the J&J vaccine was the least effective of the three available options in the United States, particularly with the Delta variant.

Why aren’t the vaccines 100% effective

It is a common misconception that vaccines are 100% effective, especially in industrialized nations. Due to a combination of high vaccination rates for diseases such as measles, mumps, and polio, and enough immunized people to provide community immunity, it is easy to believe that vaccines are perfect and forever.

For example, polio still exists in several countries, and the U.S. Department of Defense and the CDC recommend a poliovirus booster for anyone traveling to those regions. Certain members of Generation X have been advised to get an updated MMR vaccination because data shows that protection from measles doesn’t last a lifetime. Even Ben Shapiro complained on Twitter in 2015 that his 13-month old son was exposed to pertussis and became severely ill.

When it comes to the COVID vaccines, no one in the medical community said any vaccines were 100% effective, and the data has always been publicly available.

In Phase 3 studies, the Pfizer-BioNTech and Moderna vaccines were 95% effective in the first few months after vaccination. Put simply, “If there were 100 people who would have gotten COVID, it prevented 95 of them from getting it, but it didn’t prevent all 100,” says Dr. Marks. “It definitely provides some protection, but it’s not perfect.”

The Johnson & Johnson vaccine reported a 72% efficacy rate in preventing moderate to severe disease from COVID-19 in the U.S. and was 85% effective in preventing severe disease.

The good news is that early data found that those who did contract COVID-19 after receiving the vaccine did not develop a severe form of the disease. “So even if it doesn’t completely prevent illness, the study data shows that it does reduce the severity,” Dr. Marks said. Ten months later, the early projections have largely come true.

In King County, Washington, 22% of all confirmed Covid-19 infections since January 17 have been breakthrough cases. Eleven percent of people hospitalized were vaccinated, and 15% died of Covid-19 related illness. When the total number of vaccinated versus unvaccinated residents is considered, the effectiveness of vaccines, even as the need for boosters is increasing, is evident.

PopulationConfirmed CasesHospitalizedDeaths
Fully vaccinated1.633M20,252433115
Partial or unvaccinated319K71,8573,373667
349,000 King County residents are under 12 years old and were not vaccine eligible from January 7 to November 10

Unvaccinated King County residents were 12 times more likely to be hospitalized and 13 times more likely to die of Covid-19 from January 17 to November 3.

Additionally, a comparison of King County, Washington, and Dallas County, Texas, provides additional data on vaccination and public health programs’ impact. King County experienced the first superspreader event in February 2020, the first Covid-19 death, and had the first mass casualty situation at a hospital in the United States. A month later, Texas suffered its first Covid-19 death. Over the next 627 days, King County implemented some of the strictest COVID rules in the nation while Dallas County took a more open approach.

On November 1, Dallas County reported its 5,000 COVID-related death while King County reported 2,022. Simply put, 1 in every 530 residents of Dallas County has died of COVID since March 2020 versus 1 in every 1,137 residents in King County since February 2020.

Will we need to get boosters forever

To answer that question, we need to move away from facts and science and step into the arena of opinion. The short answer is, “maybe,” but it depends on the advancement of medical science, improvements in available vaccines, and our own behavior.

In the short term, the data is clear – peak immunity against current Covid-19 variants lasts 142 to 185 whether it is natural or vaccine-based. A regimen of booster shots will likely be needed every 6 to 12 months over the next few years.

Two antiviral drugs are currently being evaluated in the United States. Molnupiravir by Merck is reported to reduce hospitalizations and deaths by 50%, while Pfizer released a study on a medication they are developing that was 88% effective in early testing. Both drugs are oral and would be game-changers in the treatment of Covid-19.

Another way to get off the booster shot treadmill would be to reach 90% to 95% immunity, reducing the number of available hosts for Covid-19 to a level that the disease can’t widely spread in the population – so-called ‘herd immunity.” Given the resistance of 62 million Americans to get vaccinated, and almost half the world doesn’t have access to the COVID vaccine, that seems unlikely.

A third game-changer would be a new variant that emerges and is far more transmissible than the current dominant Delta strains but with significantly less severe symptoms. A version of Covid-19 that is closer to moderate Influenza in symptoms and lethality and is as contagious as measles would quickly infect the population, run out of hosts, and burn itself out while not overwhelming hospitals. This could also lead to “herd immunity.”

The final possibility is the vaccines themselves get better. The original Salk polio vaccine, authorized in 1955, was 50% effective at preventing infections but 90% effective at preventing hospitalizations. It wasn’t until 1962 when the Sabin oral vaccine replaced the Salk vaccine, that infections dropped 90% after a first dose and 99% after four doses.

If the Covid-19 vaccines follow a similar development path as other vaccines, a more effective version will likely be discovered in the future.

Why didn’t the United States approve boosters for all after the Biden Administration announced its intent

Over the summer, the Biden Administration and the World Health Organization (WHO), FDA, and CDC had a very public disagreement on who should get booster shots. President Biden wanted every adult to be eligible for a booster. The WHO objected, pointing out how some nations had no access to COVID vaccines while the United States was throwing out expired doses. The FDA and CDC also pushed back, arguing there wasn’t enough real-world data to support boosters for all.

While the debate raged, experts had a real-world case study unfolding on the other side of the world. Israeli officials started boosters for anyone over 60 on July 13 and three weeks later dropped the age to 40. On September 25, they dropped the age again to 12 and older. The program was highly effective at controlling deaths and hospitalizations, and when Israel is compared to the United Kingdom, the booster program implemented was an evident success.

On September 22, the FDA approved booster shots for recipients of the Pfizer vaccine, and on October 20 added the vaccine by Moderna. Eligibility was limited to people who were 65 or older or were 18 to 64 and worked or lived in places with a high risk of exposure or had a serious underlying medical condition that increased their chances of severe COVID. The FDA recommended a booster six months after receiving the second dose.

Also, on October 20, the FDA authorized boosters for anyone who received the Johnson & Johnson vaccine. As the Delta variant raged in the southeastern United States during the summer of 2021, it became evident the J&J vaccine offered less protection against hospitalization. Additionally, the viral-vector vaccines created by Astra Zeneca and developed in Russia and China were also low-performing. Anyone who received the Johnson & Johnson vaccine was advised to get a booster 60 days after the first dose.

Unfortunately, the ethical and trust concerns that tainted the debate in the United States have resulted in new COVID cases stuck on a high plateau for the last three weeks. New cases are rising in most states, and the pattern of Covid-19 infections looks eerily similar to the United Kingdom. A vast majority of hospitalized COVID patients continue to be unvaccinated.

The world needs to learn to live with Covid-19 and everyone will eventually have a date with the illness. The question is, will you be effectively vaccinated or not when it happens.