This week the Omicron wave started to really hit the United States.

As it has been for the entire pandemic, New York is our canary in the coal mine, and it looks not great. Omicron is doubling every 2-3 days in NY, and it will likely be ~100% of cases sometime later this week. After Omicron becomes 100% of the cases, that's when it starts to get bad.

London and Denmark have very high vaccination rates, and Omicron is still spreading like wildfire. In Denmark, 1 in 1,000 people are testing positive every day. Both are considering lockdowns to break the chains of transmission. We don't know when it will peak. Some data shows that South Africa is past its peak but still not confident.

What makes Omicron so scary is just how fast things change.

Two weeks ago, NY was still pretty normal. This week, restaurants closed after so many staff contracted Covid they couldn't operate. I know many people in NY who have Covid or have confirmed exposure in the last week. Broadway has started to close shows again.

With Omicron, any event can turn into a super spreader event. We now have multiple events where everyone was double vaxxed, and over 50% of the group got symptomatic Covid. Imagine having an all-hands for your company and over half of the employees are out the following week with Covid. That's what Omicron can do.

In NY, people are waiting 1-2 hours in line outside to get tested, if they can even find an appointment. I know many people who had exposure and now have symptoms and cannot get tested. As of this morning, I can't find Binax rapid tests available on any site to order. The best advice I have if you're trying to get some before the holidays is to contact friends in states that don't take Covid seriously. A friend in Florida was able to walk into a CVS and buy tests to send to their grandmother.

Our government and medical establishments have failed us entirely regarding testing. The FDA / CDC should have sent rapid tests to every person in the country for the last six months. In some European countries, rapid tests are available for free and are delivered the next day.

Over the next two weeks, London and NY will give the rest of us the best view of what we might be dealing with soon. Given the high hospital load in many places, Omicron could push us over the top. Even if it's less severe, some people are still getting hospitalized, and if 5x the number of people get it, then we can end up with an even more significant hospital burden.  Early January could see more rationed care like we saw last winter.

This week we got terrible news from the Pfizer trial on children under 5. Two doses of the vaccine did not produce a meaningful immune reaction. They will try to add a third shot and see if that gets a response. The short story is that this means that there will not be a vaccine for kids under five anytime soon.

As for questions about the severity and South Africa as a bellwether for what's to come, there are still many open questions.

Does South Africa have lower severe infections/death rates because their death rate of Covid to date has been 2x that of England? i.e. Did all the vulnerable people in South Africa already die, or is Omicron just less severe?

What effect does various vaccine deployment have on the growth of Omicron? We know that AstraZeneca and Sinovac are worthless when protecting against Omicron symptomatic infection. Two shots of Pfizer still provide 30% protection. Is that enough to slow the growth curves in parts of the US?

Over the next week, we'll get more data, but in the meantime, it's important to continue to take precautions.

So what to do about Christmas and New Years?

I'm still planning to go home to be with my parents and brother in Long Beach for Christmas. Both my brother and I will be traveling for the holiday, and our current plan is to take a rapid test every morning that we're home and when we arrive. I'm still figuring out my New Years plans, but it won't be a big, crowded blowout.

This year is much more challenging to plan for than last year's holidays. In the end, I don't think anyone should do anything they're uncomfortable with, though I know that family pressure can complicate things. Here are some tips on things you can to do help reduce the chances of your holiday becoming a spread event:

  1. Vaccinate - The data is overwhelming that if you only have two shots or just prior Covid that you are not effectively protected against symptomatic Covid with Omicron. Even today, getting a booster will help decrease the chances you contract or transmit the virus. Anyone at high risk should prioritize getting boosted as soon as possible.
  2. Test - If possible, rapid test everyone as they arrive at any large gathering. Doing it as the event starts will get the best accuracy [vs. having people rapid test the day before]. Rapid tests are only 70% accurate even for symptomatic infections, but they aim to reduce risk, not fully eliminate it. If you can isolate and get a PCR before you travel, that can also help. The reality is that in several of the super spreader events, people had to test within three days, and Covid was undetectable when they tested, but by the event, they were infectious.
  3. Mask - If someone is high risk, they or others may want to ask for all or part of the time. If you are traveling by plane, make sure to have a high-quality N95 on for the trip. Yes, it isn't very pleasant, but it'll protect you and others.  This is probably even less popular than some of the other items on this list, but it still works.
  4. Ventilate - Any additional airflow is meaningful to help prevent the spread of Covid. Having the heater with the fan on helps. If you're in a place where having the windows open is viable, you should do it.
  5. Filter - HEPA filters can physically filter out the virus. They can be loud, but running one probably won't be noticed in a crowded room. Just set one up in the corner and let it go the whole night.

It's been a long pandemic, and I know how many people are looking forward to seeing their families and celebrating the holidays. Omicron is throwing a wrench in all of our plans.

I know that there's a chance I'll test positive in the next week and won't be able to come home. I'll be sad but skipping will be the right choice for me.

Everyone has to make their own choices right now; there is no clear-cut guidance anyone can give. I hope what I've outlined above helps.

Please reach out if you have other questions or just want to talk.

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