This week the Omicron wave seems like it has started to turn in the parts of the US where it hit first.

In New England, which saw the initial Omicron wave in the US, case counts are coming down, and the R is near one and dropping. The R seems to have peaked on the West coast, but we won't hit the peak until the R is below 1. We would expect the current wave to crest in a few weeks in the Midwest.

We are still not yet out of the woods. MGH in Boston is postponing over 2,000 surgeries this week due to the Omicron surge. It's a blend of staff shortages and an excess of Covid patients in the hospitals. Hospital delays are occurring all over the nation, with people in some parts being turned away from the ER due to lack of space. We're past the surges from New Year, and I expect the drop post-peak will be faster than it was with Delta.

This week we broke our prior record for hospitalizations for people with Covid. Likely, we will also pass our record for patients in the ICU in the coming week.

In a sense, Omicron is exactly what we thought it was. It's the most infectious pathogen we've seen in the modern era. It is also less severe, on average. But combining the high infectivity and lower severity still gives us a considerable hospital burden that we can't fully handle. Most of those in the hospital are unvaccinated. As I feared when we first learned of Omicron, everyone who hadn't gotten vaccinated is getting Covid this round.

I have had some people ask me if they should just try to get it intentionally. In general, I can't endorse that as a strategy because we just don't know the long-term effects of Covid. As with any virus, the initial viral load matters a lot for the course of your disease, so if you try to get it now when the case count is super high, it'll likely be worse.

This week highlighted that some viruses have extreme long-term effects we don't fully understand. Multiple sclerosis is a disease that has long evaded all attempts to pin down a root cause. This week a paper published in Science shows that the almost certain cause of MS is the Epstein Barr virus. This is a virus that almost everyone is exposed to and causes mono. We don't know why only a subset of people who get it go on, decades later, to develop MS.

Over the last few years, we've repeatedly found that random viruses can cause major diseases at a much later date. In addition to MS, we know that viruses are the root cause of many cancers, and some believe that Alzheimer's may also be caused by a virus. I bring this up only to say that I'm generally not in the business of trying to actively catch Covid during a major surge.

Dr. Bob Watcher from UCSF has been someone I trust and have been following since the beginning. This week he said that after this wave, he's probably mostly done with most precautions for Covid. He'll still mask in certain crowded situations, but he is just going to live life fairly normally. I'm generally in the same boat.

I'm still being careful about what I do and still avoiding indoor bars and restaurants. The daily case rates in SF and LA are still by far the highest they've ever been. However, as I've said previously, this wave just can't last much longer because the virus is running out of people to infect. Over the next two to three weeks, I believe that cases will drop to a level where I feel comfortable going back into bars and restaurants.

This is the messy middle. As R comes down, cases will still increase, but we know we're on the back half of this wave. The daily death rate will still be at near-record levels for some time.

Everyone understands their risks and transmission, so we each get to pick our risk profile and act accordingly.

As always, let me know if you have any questions.