Covid Update - 6 Feb 2022

The Omicron wave is coming to a close.

Case counts, hospitalizations, and wastewater data show the same trend. Given the relatively light restrictions in this wave, it appears to be the quick spike and drop I expected. The Omicron variant BA.2 is more infectious, and it might slow the drop, but I doubt it'll cause another surge.

US hospitalizations are dropping faster than they have at any other time of the pandemic. We're currently at a little under 100,000 patients; the low was about 15,000 last June.

This giant wave also took an enormous toll. We matched or exceeded our highest levels of hospitalization nationwide. We are still averaging over 2,300 deaths a day over the last seven days. In the last few weeks, we've had some of the highest death days of the pandemic. Over 900,000 Americans have died of Covid.

Better adoption of complete vaccination and boosters could have prevented about half of this winter's hospitalizations. The US continues to lag other peer countries in vaccination significantly.

The big news this week is that Pfizer submitted for an emergency use authorization [EUA] for kids between 6 months old and five years old.

As parts of the trial are ongoing, they will be submitting it on a rolling basis. The FDA will review the data and, when they have enough, make a ruling on an Emergency Use Authorization [EUA]. That process took about four weeks for the last set for 5-year-olds to 11-year-olds. Moderna has been doing a trial for 2-5-year-olds and will likely submit their application in March.

So what changed? The primary endpoint [what the clinical trial is evaluated against] was a specific amount of infection reduction. For all the original Covid vaccine trials, the bar was set that a vaccine must prevent 50% of infections. The first wave of vaccines was 90%+ effective against the ancestral Covid variant infection.

With Omicron preventing infection at a rate of 50% isn't happening in adults. The logic is that since we know the vaccines are still very effective at preventing severe disease for Omicron, there is a medical benefit to giving kids baseline exposure.

The Pfizer trial will continue with a third dose to see if that can help with reducing overall infection.

Once again, flu season was extremely light in the US. It shows that we can mostly eliminate what was previously the most extensive annual disease with even mild precautions. Suppose we can eradicate flu and get Covid prophylactics more widely deployed. In that case, we will likely end up with a similar annual burden from respiratory diseases.

Denmark announced this week they will be ending all Covid restrictions soon. This surprised some as Denmark currently has one of the highest rates of Covid in the world. The government's logic is simple; they have an extremely high vaccination and booster rate. They feel that their hospital system can more than handle any bump in cases. I expect more countries will follow their lead soon.

This week the CDC announced they are starting a wastewater monitoring program for Covid. It really speaks to their gross incompetence that it's taken them almost two years to set up this program. Wastewater monitoring was a known technique and was identified in the early days of the pandemic as a low-cost, easily scalable way to find cases.

There is some early evidence that having Omicron is less likely to be enduring immunity. Scott Gottlieb is a former FDA commissioner and Pfizer board member and said in an interview, "It's more of an upper airway infection. We see less durable immunities with upper airway infections. Since it's a less severe infection, it's not inducing as robust of an antibody response and an antibody-induced immunity."

Overall it seems that most people are starting to consider this the end of the pandemic. With the approval of vaccines for 6-month-olds - 5-year-olds coming soon, that's the last group for vaccination.

I expect next week will be my last post. As always, if things change, I'll be back.