An ongoing dialogue on HIV/AIDS, infectious diseases,
April 1st, 2022
As the World Around Us Moves On, We ID Docs Just … Can’t
Something quite remarkable happened as Omicron tore through the United States in December and January.
Despite triggering a record number of cases — which should have made people more concerned about COVID-19 — Omicron paradoxically did the opposite. It made most of our country decide to move on, even parts famous (or infamous, depending on your view) for being careful. Just to live with this COVID thing — ending vaccine mandates, leaving the masks at home, going back to restaurants, gyms, large parties.
Hey, I get it. When facing something so contagious, something that easily broke through our vaccines, something that even extremely cautious people ended up contracting, we might start having that “what’s the use?” feeling.
Time to get back to normal. Shrugs. Even as cases (and hospitalizations) increase in Western Europe, this relaxed attitude prevails, prompting Dr. Walid Gellad to wonder, Why is everyone so chill?
I’m convinced a major amplifier of this casual response is the reduced per-case clinical severity of Omicron, largely due to partial existing immunity from vaccination, prior infection, or both. This lower severity on an individual level means everyone knows — or experienced themselves — cases that were quite mild.
Typical statements uttered by patients, colleagues, friends, acquaintances during the Omicron surge:
“Felt like a cold.”
“If it weren’t for my positive rapid home test, I still would have come to work.”
“Had one day of feeling blah, then mostly it was lots of nasal congestion.”
“I can’t believe he [referring to a school-age kid] tested positive, he’s as active and energetic as ever.”
“You’ll never believe this, but she [referring to an older family member in a nursing home] tested positive, and we just got off a Zoom call — she seems fine!”
But here’s the problem — the denominator of cases was so ginormous during Omicron that it still led to a staggering number of hospitalizations and deaths. Way more than from flu, even in a bad flu year. People who had weakened immune systems, had multiple medical problems, were still unvaccinated, or were just unlucky to get a really bad case still experienced severe disease. And some fraction of all these Omicron cases will be left with long COVID, evaluation and treatment of which remains in its infancy.
Some people may not have seen this numerator. But believe me, we sure felt it, as did our hospitals. We still needed the ICU beds for some COVID patients, still adhered to strict infection prevention measures for everyone with a positive COVID test admitted to the hospital, still struggled to clear hospital workers (who came down with Omicron just as much as everyone else) for return to work.
You need no further evidence of how the Omicron surge disrupted patient care than to observe how many hospitals delayed non-essential surgeries. Not only is elective surgery important for good patient care (ask anyone who had their surgery delayed), but also this is the most remunerative service provided by most hospitals in the United States. As a result, I doubt there’s a single hospital in the country that didn’t have a negative balance sheet during Omicron.
Now, as we ID docs watch what happened in Western Europe, we can’t help but squirm. “What happens in the U.K. most certainly DOES NOT STAY in the U.K.” should be public health’s advertising slogan for what comes next in the northeastern USA:
Already we see the trend starting, with the increase in wastewater concentrations of the virus in most regions, a rise in the reported test-positivity rate, and a slow creep up in people testing positive among those hospitalized. All this generates more calls about exposures in the workplace and at home, about how to get nirmatrelvir, about the latest monoclonal antibody taken down by viral evolution, and this week a zillion people asking about whether to get a booster now, wait until just before a fall surge, or wait for a variant-specific vaccine.
You know, the pandemic life of an ID doctor.
So while much of the rest of the population has moved on, forgive us ID docs if we remain nervous Nellies. We can hope that case numbers will be lower during the BA.2 Omicron surge — and they might be — but we can’t count on it.
Now, I just have to get that smell of onions out of my car …