The message that the state sends to citizens, and not only in Israel, is that Omicron is a light variant, which is almost “worthwhile” to catch up with soon, get through the wave as quickly as possible and get our lives back, cleaned of the corona spice that stuck to them. The first part is almost certainly true – Omicron variant is easier in terms of personal risk. But in the huge numbers of the omicron, even a small proportion of them amount to a threat to the health system, and not just to it. Simplified morbidity of risk groups is still with us, and it indirectly threatens even those who are not at risk. Aside from the health care system, widespread morbidity also threatens the stability of the economy itself. And the problem is not only for now but also for years to come.
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The last part of the safe message is not true, it is not worth sticking to Omicron right now, and certainly not worth doing so quickly. Almost all the parameters of caring for those who will need health care services in the near future will improve if the wave is milder, even if longer. The second part – may be true. It is possible that Omicron will bring us to the worlds of flu (which still hospitalized 863 children and 181 pregnant or postpartum women this year). It may be that morbidity throughout the world will provide reasonable herd protection to the population. But there is no guarantee that a more contagious variant will not come that significantly eludes the protection given by Omicron.
A pace seen in the world
True, the chance of a person without risk factors that has occurred in Corona to get to itchy hospitalization from below is 1 in a thousand. And to be hospitalized is not to die. Data from South Africa show that, on average, the duration of hospitalization in the micron is shorter, even for those who have already reached it. Doesn’t sound like something that stops life for him.
But the long-standing problem of collapse threatens the health care system. It’s the huge numbers of Omicron and its rapid multiplication rate that do it. On Wednesday, 12,000 verified people were reported in Corona, and 32 new critically ill patients a day (a number that could further vary in both directions). This is a hospitalization risk of about 2-3 out of every 1,000 verified, and this is also the assessment given this week by Maccabi Health Services, in an event it held to present its readiness for the situation. On Thursday, a new verified record was reported on Thursday, which has already reached 16,000.
In the previous waves 120 new serious patients a day (for a few days at least), was the number that threatened the stability of the health system. So we have a lot of time between 32 verified and 120, no? Well, let’s mention the exponential interest. To get from 32 to 120 new severe patients a day, only two doublings are needed. If each infection infects two people (and we are about there according to the latest data), and the infection occurs within 2-3 days, we are talking about two doublings within about a week. And these are not just scary models of numbers – doubling at such a rate has happened in a number of countries around the world that are ahead of us in terms of Omicron.
The collapse is threatening again
The collapse of the health care system does not mean that there is no medical treatment, but that it is significantly less good. In previous waves, in these numbers we have heard of ambulances roaming for hours looking for a hospital to pick up the patient. We also heard about a man who did not actually fall in Corona, and did not find an Acme device that he needed. It is not known if he could have been saved. There was also an increase in the mortality rate among the hospitalized – the system was no longer able to give them its optimal treatment. Another thing that can happen due to the congestion is the shift of resources devoted today to routine medical activity, to the treatment of corona. This means postponing surgeries and other treatments.
There is a real concern that this number of 120 serious patients a day, this time is just the beginning. While the medical staff are much more experienced in treating patients, they are also more worn out, and many of them are likely to be sick themselves.
Risk groups are exposed
The government’s answer to the problem is to ask risk groups to defend themselves. It will certainly happen, and you can already see people at risk starting to shut themselves in homes. But a disconnect between the risk groups and the rest of the population is unrealistic. In one extreme we have the nursing homes. Even in the first wave, for its harsh regulations, the corona penetrated the nursing homes and from there the road to mass infection was short. Residents of nursing homes are now being vaccinated with a fourth vaccine, but there is no guarantee that it will completely stop the spread of the micron in nursing homes, as did the third Delta vaccine. The bright spot here is that in the meantime, thanks probably to the protection that nonetheless gives the third vaccine, most patients in Corona so far from nursing homes, patients are mild.
On the other hand we have a variety of people at risk who are an integral part of society. Not only retirees are at risk. Every diabetic, every person with significant overweight, patients with lung diseases, organ transplants, people with immunodeficiency, heart patients and many more are in risk groups. Right now if they stop coming to work, there is no plan to compensate them or their employers. And let’s not forget that those same employers are dealing with missing workers anyway because of the morbidity and isolation (unvaccinated and patients with sick children). Will they really release a teacher or a cashier or a bus driver at home?
For those in the risk groups it is more difficult to defend themselves in this wave than in the previous waves, due to the collapse of the PCR testing system, and the dramatic change in the isolation policy. The risk groups will not be able to know who in their immediate environment has been exposed to the verified, or infected himself. And the number of those infected around will be huge. People at risk from a certain age can get a fourth vaccine, but we are still not sure it will be a complete solution to the problem. The fourth vaccine raises antibody levels, but less dramatically than the third vaccine did. In addition, the fourth vaccine has not yet been approved for all risk groups, and not everyone is in a hurry to take it due to the lack of information on its effects.
Long Cubid and Pimps
And what about those who are not defined as at risk? We still do not know how we will experience the omicron in two parameters – persistent corona (Long Cubid) and PIMs syndrome (PIMS). Long cube is the name given to a variety of symptoms resulting from corona, ranging from the negative effects of the soul and prolonged hospitalization, to a mysterious phenomenon of extreme fatigue, loss of physical fitness and cognitive confusion, affecting some verified corona, even if their symptoms were mild. Sometimes these symptoms go away within a few months. But for some patients, they still have not passed even after a year, and this happens to the vaccinated as well.
There is a chance that just as the overall disease in the omicron is milder, the long cube will also be milder or less common. But we still do not know anything about it. There is an estimate that because omicron symptoms do not include damage to taste and smell, it may be a sign that it affects the brain less. But we do not know for sure. If long cobid is still common in omicrons as well (and we will know this only after the wave is in full swing), then many people will be left with a limitation if there is a very wide adhesion. If Long Cubid is no longer weak in the omicron, and the majority of the population is indeed infected, we are talking about a continuing disability of an entire percentage of the population, including children and young people. One can only hope that the weight of the variant and the vaccines will somehow form a buffer against this fate.
Another question mark is regarding PIMS, a response of the immune system that comes a few weeks after coronary heart disease, specifically in children. Maccabi Health Services estimates that in previous waves the syndrome affected about five out of every 10,000 children. This is a low incidence, until we remember that we are already about 10,000 verified a day, close to 20% of them children. If the syndrome behaves in the omicron as in previous waves, we will record four to five PIMS cases each day starting from another week to two weeks.
PIMS is a disease that is usually treatable. But in an encounter with a collapsing health system, the problem is more difficult. Without a set of tests, parents would not necessarily know when their child had Corona and would not be attentive to the symptoms that come a few weeks later. Parents who suspect that their child may have PIMS (much more than the actual number of cases) may not necessarily be able to see a doctor who will diagnose the condition in time. All this is happening at the same time that children are sick and hospitalized even with the flu and other winter respiratory illnesses.
There is still a chance that Omicron will prove to be friendly in these parameters, or that children’s vaccines will protect them. But we still do not know anything about it.
What to do anyway
On Tuesday, Maccabi Health Services presented its preparations for the fifth wave. The emphasis is on hospitalization at home instead of in hospitals, in order to reduce the burden on hospitals (the burden on the community will increase). People without symptoms or with mild symptoms will be treated without contact with a doctor. They will be able to get all the bureaucratic approvals automatically. The other funds are organized in a similar way.
In terms of protecting risk groups, there are preparations for the targeted use of new drugs. To this end, PCR tests have been sacrificed: instead of being used to manage the disease at the entire population level, they will now be used primarily to validate patients in the risk group so that they can be treated pharmacologically as quickly as possible. In addition, there is the fourth vaccine.
So how can I help?
Today there is an aspiration for a strong but fast wave, even if along the way most of us get infected. But such a wave will exacerbate all the problems arising from the enormous point load on the healthcare system. At the beginning of the corona we talked about “flattening the curve” – almost all parameters will improve if the wave is milder, even if longer. It will be possible to give more preventive treatments, more supportive treatments, better care also for children and young people who will be hospitalized.
During this period it is advisable to respect the self-defense attempts of those in the risk groups, who have decided to sacrifice their health and sometimes their lives to keep the economy open. In the end, if the risk groups defend themselves, it will be good for all of us.
On the horizon are dedicated vaccines, improved vaccines, new drugs and possibly infectious variants and even easier ones. And besides, no one has promised that you can not get infected with Omicron twice.
Young vaccinated people become more contagious? What’s going on here?
The number of vaccinated young people who have been vaccinated in Corona has exceeded the number of unvaccinated people in the regulations by population in the past week. In the group of people aged 60 and under, for the first time since the beginning of the epidemic, it was the booster vaccinated who recorded the highest morbidity.
Does the vaccine cause more infection? There are good reasons to think not. In nursing homes, for example, the test does not depend on a person’s choice to be tested, and the lifestyle is quite similar. The latest nursing home survey shows that the unvaccinated constitute 27% of the verified, although 90% of those staying in the nursing homes are vaccinated. In a situation where the vaccine does not prevent infection at all, we would expect only 10% of those infected to be unvaccinated. Laboratory experiments also show greater efficacy of antibodies of vaccines in three doses against omicron in vitro, compared with two-dose vaccination, or no vaccination at all.
But two plausible explanations clearly emerge. One is choice bias: in general, the unvaccinated are going to be tested less than the vaccinated, because of a lack of trust in the system. But right now they need to be tested for most antigen tests to get a green mark, and a positive answer sends them for further testing. So the bias works in both directions and maybe that’s not the explanation.
Another explanation has to do with how the corona spreads in the population. Those who start a wave with the arrival of a new variant are people who came from abroad, usually from a high socioeconomic status, who have a correlation between it and immunization rates. Thus the wave spreads from more vaccinated communities at least. If so, we should see the trend reversed.
According to Prof. Hagai Levin of the Hebrew University, Chairman of the Association of Public Health Physicians: “The dashboard is not a research tool. It gives us data, but does not allow us to neutralize all alternative explanations. The results over a single week can be accidental. They can result from choice bias. There could even be mistakes. “