Omicron — the tale of two surges.

The explosive surge of COVID-19 infections caused by the Omicron variant is quickly waning across the United States. New infections have dropped dramatically in all parts of the country including areas that only recently were confronted with variant.

Despite this, hospitals still house large numbers of ill individuals. While a smaller percentage of COVID patients are in the ICU compared to regular hospital beds, the overall numbers are higher than almost any other time in the pandemic.

Disturbingly, deaths from COVID-19 continue to rise as a trailing legacy of the Omicron surge in infections. The uncoupling of severe illness and death from infection numbers seen with Omicron has generally been viewed as good news. However, I think this divergence has masked an important aspect of the global COVID-19 pandemic at this point in time.

In the U.S. we are now seeing basically two different pandemics involving two groups of individuals. 

One group of individuals has minimal illness and is often asymptomatic when confronted with COVID. The severity of infection in this group is so limited that their illnesses result in only a few percent of the current deaths from COVID, despite this group being almost two thirds of the U.S. population.

In the other group, infections with Omicron have similar, severe outcomes to those seen at the beginning of the pandemic. While Omicron tends to cause less deadly illness by its nature, its increased transmissibility means so many more people are infected in this group that deaths and severe illnesses exceed the numbers seen at the beginning of the pandemic.

The difference between these two populations is simply that the first group has been fully vaccinated and boosted for COVID-19 while the second group is unvaccinated and has no exposure to the virus.

Despite having priority access to the best COVID-19 vaccines, the U.S. has lagged almost every other developed country in vaccination. Currently only 63% of the U.S. population is vaccinated. This is lower than most other countries and has not increased significantly over the past 60 days despite the omicron surge.

The lower rates of vaccination are magnified by the fact the U.S. has higher rates of pre-existing conditions and obesity, which make serious disease and death after COVID-19 infection more likely.

This combination has led to large numbers of severe COVID illnesses across the unvaccinated, but it has been devastating to elderly individuals and those with pre-existing conditions. The U.S. leads the world in deaths per capita from COVID.

Only about 88% percent of Americans 65 and over are fully vaccinated according to the CDC and some of that group received one Johnson & Johnson shot, which is useless at this point. (I can’t tell from the C.D.C. website what percent received JnJ). That number trails every developed country. 

Even more concerning, 43% of people 65 and over have not received a booster shot. Most of these individuals were among the first vaccinated, so their immunity is waning. This sets them up for breakthrough infections which can have devastating consequences in this age group.

For contrast, in the UK only 9% of those over 65 years of age do not have a booster shot.

I won’t go into the complex reasons for our failure to vaccinate folks but will address it in a future blog post. There is certainly plenty of blame to go around. But the consequence of reduced vaccination rates in the U.S. is that despite reaching the tail end of the pandemic we are still seeing lots of severe illnesses and deaths.

Conversely, the current United States surge in COVID-19 tragedies from Omicron was totally preventable if we could have gotten more of the at risk population vaccinated. This should be a disturbing thought to every American as we pass 900,000 deaths from COVID-19.