Our IM Doc chattered in the early days of the Omicron wave because not only was there a continuing lack of treatment guidance, but it also provided clues about how Omicron’s symptoms and progression might differ from the earlier variants, especially considering many hospitals (including his) And now there is a lack of sequencing or even a shortage of testing. As we will discuss, there is more evidence that Omicron is much less likely to produce debilitating and often fatal viral pneumonia compared to earlier variants. However, continuing to claim that it is mild may be a bit too much.

We are not the only ones wondering whether the significantly higher frequency of less frail cases is due to statistical anomalies caused by incomplete data. We are not alone; Yaneer Bar-Yam expressed similar concerns.

Take two populations of 1,000 people.

Suppose 200 people in one group have symptomatic Delta, and 350 people in the second group have symptomatic Omicron. Considering the huge peak of Omicron, this is not crazy in terms of the relative penetration of the two variants.

Assume that 10 people in the Delta group are eventually hospitalized and two die. Assume that 13 people in the Omicron group are hospitalized and two die.

Across the population, Omicron is fatal and leads to higher hospitalization rates.

But this is not what the clinician will observe. They will look at the degree of severe cases among the patients they see or understand. Of course it is only a symptomatic situation.

Using the illustrative numbers above, Omicron doesn’t look so bad. The hospitalization rate for symptomatic cases in Delta is 5%, compared to 3.7% for Omicron, the mortality rate/symptomatic cases for Delta is 1%, and Omicron is 0.6%.

Another factor that may be relieved by doctors is the transformation of viral pneumonia, which means that the cases of hospitalized patients may be resolved more quickly. In the early Covid wave, severely ill patients usually stay in the hospital for 2 to 3 weeks, which is much longer than most diseases. This means that Covid cases will quickly consume the capacity of the hospital.

However, an offset with Omicron is that if a new coronavirus case is detected early, it can be treated with monoclonal antibodies. This is largely irrelevant to Omicron. Most monoclonal antibodies are ineffective against Omicron, and a few effective antibodies are in short supply.

And consider:

New York City

There are 40 to 1000 hospitalizations a day, which is 25 times the number in the past 3 weeks.

The current (total) number of hospitalizations has increased from 360 to 4,500, which is 12 times the number in the past 3 weeks.

It doesn’t look mild now. When will action be taken?https://t.co/EKPIkV0Ucd pic.twitter.com/WcfuZ6VkHN

— Yaneer Bar-Yam (@yaneerbaryam) January 3, 2022

And 30 more stories about children seriously ill from COVID https://t.co/L4UGiIYFzh

— Cleavon MD ? (@Cleavon_MD) January 5, 2022

We have repeatedly pointed out in South Africa from the beginning that Omicron is providing an unprecedented number of babies to 9-year-old children in the hospital. Current vaccines cannot produce enough antibody responses in children under five to justify their use. Therefore, when the media demonizes unvaccinated people, it includes toddlers and school-age children who have not been vaccinated due to lack of vaccinations or their parents are concerned about the limited safety testing of young people.

In order to have a reliable treatment of the severity of Omicron, we need a large-scale, entire population survey and a large number of sequencing to identify the cases of Omicron and Delta. This means that we may have to wait for the UK to complete this work, because they will regularly perform 100,000 tests and large amounts of sequencing.

At the same time, the American test is a mess. Readers describe the difficulty of conducting the test in the comments. From IM Doc yesterday:

Testing supplies and kits are not available at all-except in health departments and hospitals.

So many people are calling-we just assume they are infected with COVID. There is not even enough testing to start dealing with this problem properly.

The ones I am screening and worrying about — we also check for RSV or FLU — but when most people hear that they are not tested for COVID — they are not interested in anything — and can be expensive. I never dreamed that the testing system in two years would be worse than in April 2020. It’s unbelievable.

The anger is obvious, and it gets worse every minute.

IM Doc also saw Covid, probably diabetic ketoacidosis caused by Omicron, and other disturbing symptoms:

Two very unique things have happened in the current wave of COVID –

1). I now have 2 DKA [diabetic ketoacidosis]Occurs in young healthy people who are COVID-positive. It’s just in the past week-I might meet them 3-5 times a year-the 2 times last week are very different. I also admitted 4 patients with type 2 diabetes-not in DKA-but they were in a hyperosmolar coma with very high blood sugar-the lowest in this group was 683. All 6 patients are positive for COVID-4 cases are very mild-I can’t tell you how unusual it is to even see 1 of them in 6 months. They were almost entirely Type 2 DMs. They fell off the truck and started a jingle carnival.

Don’t know what to do-but the timing is worrisome.

2). All 3 people are COVID-positive-2 people are under 30 years old-1 is much older-all 3 people have been in the past few days-the testicles are massively swollen. All I can say is that of course I don’t see this problem often at all-there are 3 in just a few days that are really different. All 3 Sonos have orchitis. I can’t tell you how unusual this is.

It must be pointed out that each of these patients has been vaccinated.

Maybe there is nothing—but maybe Omicron is playing an endocrine game.

Dr. Craig Spencer, Director of Global Health of Emergency Medicine at Columbia Medical School, also reported that he had seen obvious diabetic ketoacidosis caused by the new coronavirus:

It seems that everyone is infected with the new coronavirus today. Like, so much.

Yes, as before, some people are really short of breath and need oxygen.

But for most people, COVID seems to have broken the delicate balance of underlying diseases.

It makes people sick in different ways.

— Craig Spencer MD MPH (@Craig_A_Spencer) January 4, 2022

But there are still many people in need of hospitalization.

There are currently more than 5,000 Covid inpatients in New York City.

Exceeding the peak of last winter.

Higher than any point since May 2020.

Only three times higher than two weeks ago.

And it’s climbing higher every day. pic.twitter.com/xZyKIpwCKT

— Craig Spencer MD MPH (@Craig_A_Spencer) January 4, 2022

Another difference now is that those COVID cases are usually next to the bed, and these patients have done everything possible to avoid contracting the virus, and the infection can cause huge losses to them.

Cancer patients undergoing chemotherapy.

Those with weakened immune function or other diseases.

— Craig Spencer MD MPH (@Craig_A_Spencer) January 4, 2022

The reason we have always emphasized the risk of Covid is that when uncertainty encounters serious consequences, the precautionary principle advocates conservatism. It is maddening to see the force of “we must keep the economy open” to grasp the preliminary data, especially those pleasant data, and treat them as decisive data. It is reasonable to continue to be cautious until we have better information or better remedies.