Two graphs again in today's pediatric COVID data for Denton County. I have also included a third graph that compares the hospitalizations per 100,000 people for Denton County against the DFW Metroplex, the State of Texas and the nation as a whole.
Things are still rapidly on the increase and most of the school districts returned to classes today. I have not seen a COVID surge before that has taken off with such rapidity and speed. We are now seeing case prevalence and test positive rates unprecedented since the start of this pandemic two years ago.
Case prevalence (how extensive is COVID in the community) has increased by 3.6 TIMES in the last 7 days.
The test positive rate has TRIPLED since December 20. Nearly 1/3 of all COVID tests done that are reported to Denton County Public Health are positive today. Denton County's previous test positive high water mark was 21% a year ago during the Alpha surge. The Omicron is SIGNIFICANTLY more contagious than the Alpha variant we dealt with last winter.
Hospitalizations are on the increase and while Denton County's increase in COVID hospitalizations is not climbing as rapidly as it is across the entire Metroplex or the entire State, I am anticipating it will increase rapidly now that school is back in session without a mask mandate or remote options.
Most distressingly for me as a parent and physician, Lewisville ISD is not reporting its student absences and cumulative cases on the Denton County Public Health COVID dashboard like it was before the holiday break. This is unacceptable. The students of Lewisville ISD account for nearly 1/4 of the pediatric population of Denton County and a crucial pandemic data stream is longer being publicly shared.
ARE VACCINES STILL WORKING?
Yes, particularly if you are boosted. The overwhelming majority of hospitalizations and severe infections are occurring among the unvaccinated. For Denton County, there are about 360,000 people who are not fully vaccinated. They are at extreme danger for infection and severe disease. While there are those vaccinated who are getting hospitalized, it is not to the same degree as the unvaccinated.
In the ICU setting and those are are needing mechanical ventilation, it is almost exclusively the unvaccinated.
If you are doing the right things, wearing a good quality mask in public indoor spaces, social distancing and are vaccinated and boosted, you can still get infected but your illness will more than likely be mild. There is a reduction in overall efficacy in the vaccines but by and large, they are still doing their job at preventing hospitalization and death among those who are vaccinated and boosted.
BUT WHAT IF I HAD COVID ALREADY?
Makes no difference. Omicron has a sufficient number of mutations in the spike protein that allows the virus to do its dirty deeds that your immune system will not fully recognize it to provide the same level of protection as vaccination.
That’s because the antibodies elicited by prior COVID infection are not all “good quality” antibodies. Some of the antibodies target parts of the virus that will not slow it down or kill it.
The way our immune system works, different parts of the virus after it is essentially chewed up by special cells are “presented” to the immune system to act as templates for antibody production. Those cells are called “antigen presenting cells”.
Having had COVID gives your immune system a bunch of possible targets, some of which are useless, some of which are good. Previous COVID infection was somewhat protective, but that was before the variants emerged like Delta.
With vaccination, we are are focusing the immune system on a very specific target on the virus. These specific targets we call epitopes. So instead of a short range shotgun blast, your immune system now has a precision guided sniper shot.
Instead of your immune system having dozens of targets, some of which will not stop the virus, vaccination now trains the full force of your immune system to focus on the best target for a “clean kill”.
IS OMICRON MILDER?
We cannot say with certainty despite what news reports are saying. The good quality data we have from various locations that have been enduring the Omicron surge are aggregated to include both vaccinated and unvaccinated patients. Hospitalizations and disease courses may be milder simply because more people are vaccinated now than when Delta emerged in the late summer.
The only way we can say with certainty that Omicron is milder is if we were to compare a cohort of unvaccinated hospitalized patients infected with Delta with a similar cohort of unvaccinated hospitalized patients infected with Omicron. We don't have that data yet.
Even if Omicron were milder (and that is a big IF), its much more contagious than Delta. Let's say for discussion purposes that Delta infects 2 people for every infected and 5% are hospitalized with serious disease. Now let's say (again for discussion to keep the math simple) Omicron only lands 2% of people in the hospital but infects 8 people for every infected person.
If we have 100 people with our hypothetical Delta example, 5 are hospitalized. After one cycle, we now have 300 people infected, another 5% of the 200 newly infected land in the hospital, that's 10 additional people in the hospital for a total of 15. If we go a second cycle, those 300 infect another 600, 5% of them is 30 so now we have 45 in the hospital after two cycles.
If we have 100 people with our hypothetical Omicron example, 2 are hospitalized. After one cycle we now have 900 people infected, another 2% of the 800 is an additional 16 in the hospital for a total of 18. If we go a second cycle, those 800 infect another 6400. 2% of that 6400 is 128, now we have 146 in the hospital after two cycles.
A milder variant that's more contagious is a greater threat to the health care system.
We can't say with statistical certainty that Omicron is milder. We can say it is no more severe than Delta. And we can say it is more contagious than Delta.
PARTING THOUGHTS
Choosing to do what is right in the face of milder but more contagious virus is thinking from a community perspective. Choosing a course of action because you feel if infected with Omicron it will be milder so let's not mask, get vaccinated or social distance is thinking from an individual perspective.
As long as we as a nation insist upon assessing dangers and a course of action from an individual perspective, we will continue to have surges and repeated strains of our health care system in the future and never get out of this pandemic.