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Today we’re going to talk about Omicron, and we’re going to talk about Omicron in two different ways feelings and facts.
I’m gonna start with feelings, not because feelings are more important than facts.
But because feelings are real.
And the way we feel about this, pandemic shapes the facts.
We allow ourselves to here in the last few months.
I’ve seen a really interesting Schism among my friends and among people.
I follow online.
It just gives him.
Almost entirely among vaccinated people.
And obviously, I think everybody should be vaccinated and boosted.
There are two camps forming among the vaccinated people that I know to camps with.
Seemingly, strong opinions Camp.
Number one, are the vast and done.
This is the camp that says we just need to move on and Camp.
Number 2 are the vaccine cautious.
This is the camp that says we still need widespread covid precautions.
I recently wrote about this Schism for the Atlantic.
So I’m quoting from my own article here.
But if I had to summarize the VAC stand done perspective, I would put it like this quote for more than a year.
I did everything that public health authorities told me to do.
I wore masks, I canceled vacations.
I made sacrifices.
I got an accident.
I got boosted.
I’m happy to get boosted again.
But this virus doesn’t stop year.
The infections, don’t decrease instead virulence for people, like me is decreasing either because the virus is changing or because of growing population, immunity or both covid is becoming something like the seasonal flu for most people who keep up with their shots.
So, I am prepared to treat this, like, I’ve treated the flu.
By basically, not worrying about it and going on about my life and quote, but there is an opposing Viewpoint here, the VAC stand, cautious Viewpoint.
So, if I had to summarize that perspective as accurately as possible, I think I’d put it like this quote, why on Earth would we, suddenly relaxed precautions now during the largest statistical wave of covid, ever recorded in the u.s.
We should not treat covid or Omicron like any old Us or seasonal flu because it’s not like any old seasonal.
It’s deadlier for those without immunity it several times more.
We have no idea what the effects of Omicron along covid-19.
So, maybe you’re wondering.
Where, do you fall between these camps?
Vac stand, done versus vac stand cautious.
And the truth is I’m torn.
And the reason I’m torn is that even though I know that I am extremely safe as a boosted 35 year old without young kids.
I know so many people in my life, listening to show who are in different situations, I think about the audience here, at some of you have kids under five, some of you have immunocompromised, family, or you are immunocompromised yourself.
Some of you live with 80 or 90 year old, some of you often see 80 or 90 year olds rely on them for childcare.
Maybe some of you are in your 80s or 90s and if any of these things are true for you.
Your feelings about Omicron and covid will be a little bit different than for those of you who can essentially live, what feels like isolated lives as healthy boosted individuals.
The rest of this episode, the bulk of this episode is about data.
I wanted to have an objective conversation about Omicron with someone who had a masterful, understanding of all the Omicron facts in the world cases hospitalizations deaths.
That man is John Byrne Murdock, John is the chief data reporter for the financial times.
One of the best follows on Twitter for it, down the line, objective data, analysis of this disease.
He’s got a kind of God’s eye view of the trajectory of Omicron in South Africa where we first saw it take off in the UK and the US and as much as possible, that is what I’m going to try to accomplish for the rest of this episode.
I have given you my Outlook on Omicron feelings.
What follows is the landscape of Omicron facts.
I’m Derek Thompson.
This is plain English.
John welcome to the podcast.
Thanks for having me.
This variant is so confusing and it is throwing off so much data that I feel.
Gets the confirmation bias variant.
Like anybody can look at this data and come up with any sort of narrative.
So I wanted to have you on, just keep us grounded in the evidence and tell us, what is what?
And what is happening.
Let’s start with South Africa.
Then we’re going to go to your home country, the UK.
And finally, we’re going to get to the situation here in the u.s.
South Africa, is where we have the longest series of high quality data about what Omicron does to a population.
It is the leading indicator of all leading indicators.
Like it’s not a perfect proxy for the u.s.
Its younger different set of vaccinated versus infected.
But I feel like if we’re all riding the Omicron roller coaster together, South Africa is in the front car.
So tell me what has been the story you’ve seen in the data with cases hospitalizations and deaths.
So so yeah, South Africa was has been huge for.
I guess it was tail end of November and then starting December was where it was really kicking off there.
And the whole world’s attention was focused on what we could glean from that and what seemed, now that sort of the Dust has settled, to some extent at least in Houten province, which was at the core of their wave.
What we can see is ago, take Province, just for people who aren’t familiar with set out in geography.
That’s the province in South Africa that includes Johannesburg.
One of the larger provinces in South Africa where this variant really started to take off.
Yeah, and the capital Pretoria as well.
So, so a couple of big cities there and but certainly a large population.
So, So, you know, there’s enough people that it’s a large data set as it were is useful information.
And so what we saw was cases, rocketing.
First of all, you know, that was do the real sign that we were dealing with something concerning here.
And we also saw the fact that it was a particular new variant coming in.
And so, that’s, that’s why, you know, there was all this huge amount of attention the last it was the last few days of November really.
So after that, initial birthing infections, of course, all Focus was on what was going to happen in hospitals, and about a week or two.
After the surgeon cases.
We started hearing these first signs that, these were sort of an testimonies from doctors, working, in hospitals.
In how Tang saying, well, it with some, where we feel that a larger percentages of our patients, this time have mild disease.
Now, a lot of people myself included heard that we thought well that sounds promising but it’s very early in the Wave.
A lot of these cases.
These patients are young people.
Also will obviously, take that on board.
But what we, what we really want to see is how this develops over the next couple of weeks, as they spread into all the more vulnerable populations, and sure enough.
As the, as the hospital staff had suggested this then seemed started been corroborated in the data.
So first of all, we saw things.
Like the percentage of hospital patients, requiring ICU or mechanical ventilation was much lower that perhaps two or three times lower than it had been.
During the Delta wave and now that we’re a couple of weeks further on and essentially that way if has risen and fallen in in that Province, we can see that hospitalizations peaked at roughly 50% of where they had during the Delta wave.
Six months earlier deaths, have peaked around 20% of where they had done in that way.
Whereas cases got right up pretty much to that to the top.
So a strong sign of, you know, some people call this decoupling, some would say it’s a sort of Divergence.
But certainly a very strong indication that to the extent that we see these enormous soldiers in cases, in infections from macron.
The, the ratio of those that develop into very severe disease.
In particular, loss of life does seem to be markedly lower than it has been with previous weights and very quickly.
What are some reasons?
They could explain that.
So this was a really tricky thing because I feel like a lot of us certainly myself went round in circles on those trying to think.
Well could this not just be the result for Bowl of the fact that the level of immunity in the South African population is much, much higher and has been much much higher for the last few months than it was during a Delta wave in the in well, six months ago.
So, South Africa, and that just basically means a bunch of South Africans, got Delta.
So they would be potentially more protected from the next, very, that’s exactly, right.
So going into the Delta wave in the six months ago, somewhere between 30 and 40 percent of South Africans have been infected previously going into the The Omicron wave it was more like 80%.
So we’re talking about four and five people who had had covid and recovered which as we know gives pretty robust protection, especially against abilities.
So similarly, then the South Africa’s vaccine or like really did the bulk of its work during the third quarter of the year and indeed onwards.
So there was a big increase in protection especially against severe disease for the Omicron wave relative to Delta.
So some of us look to that we said well, okay, this is This is great news for the South African population, but it’s not clear to what extent.
Those this will translate to other countries because those countries already essentially to the front loaded that that Rising immunity, both from prior infection and particularly from vaccination.
So, some of us looked at this and said, Granny’s, starfucker, we may see some further reduction in the severity and other countries, but it’s not necessarily going to be as have one-to-one mapping of South Africa, on to other countries, and we’re going to talk about the degree to which South Africa stata has reproduced itself in other countries in just a few seconds.
But I just want to take some time to talk about the speed of this wave.
I’m looking right now at a full chart of South Africa’s for covid.
It looks like a camel with four humps up, down up, down in the previous wave, the Delta wave.
You were just describing.
It took about nine weeks to go from the bottom in new cases to the top.
In new cases with Omicron it took three weeks.
So the Omicron wave appears to my untrained eye to be passing through the South African population about three times faster than Delta to what extent John should, these numbers.
Give us any reason to think that omikron waves might be significantly shorter than past covid waves.
So this is a really interesting question, because as you say, that data from South Africa, from CAO Tang is is very, very clear.
It was, it’s a A short steep rise and a pretty short feet for very soon afterwards.
The, you know, there’s good reason sort of biological reasons for why that happens.
We now have good evidence that the shorter incubation time for Omicron.
So the I just say it a little bit about what that means.
A shorter incubation time for amateur.
So essentially that means the time between becoming exposed to the virus yourself, and then becoming symptomatic, so that you can pass it on to other people.
It does look like that.
It’s slightly shorter for the Omicron variant.
And so that essentially just means that everything will Look what happens, faster.
Both the rise and the fall, but I think the the interesting thing that we’re going to see that we perhaps starting to see in the UK at the moment for example, is that there are also going to be other impacts on that including behavioral ones.
So I know we’ll come onto the UK more detail later on.
So I won’t dwell on this right now, but I think it may be, for example, that in South Africa, the this year and speed, and scale of the spread meant that it sort of burned through susceptibles and then especially faster.
Wait that we may perhaps not see in other countries.
For example, it may though be that it we do see the same pattern everywhere.
And that Omicron is is short and sharp, and intense but also just just more brief than what we’ve seen before.
So, coming out of South Africa.
It would be fair to say that in the front car of the Omicron roller coaster.
We saw something that was crazy.
Transmissible meaningfully milder on a per case basis, for some reason, and also surprisingly fast.
That’s right, right.
Yeah, so let’s fly from Johannesburg to London is a leading indicator for the UK.
The UK is a bit of a leading indicator for the u.s.
What are we seeing with the London, Omicron wave sure.
So, so London has been has been very interesting and continues to be interesting.
This really started taking off in mid-December.
We started hearing case numbers that.
We just haven’t heard any point during the pandemic and it was, you know, it was really palpable.
So, I’m based here in London and you know, social events, just started being Old left right and Center.
I know sort of local Hospitality essentially shuts not because they were compelled to by the government but just because nobody was going out anymore.
This was in sort of the week or ten days leading up to Christmas.
So so in gauteng we were just talking about cases, rose up very quickly to roughly the peak that they had previously seen during Delta in London, cases of far exceeded the previous Peak, which, which here was actually a year ago with the alpha bereans, so cases in London.
Almost got almost double what they were at that point when your earlier, but over the last week or so have have come down slightly from that Peak.
It doesn’t look right now as though London is seeing a stay the same steep rise steep fall, but it is obviously early days and I think as you and the listeners will be aware.
It does get trickier to distinguish between genuine pattern in our the virus is spreading and patterns in reporting or testing Behavior.
So it’s possible.
All that the shape of London’s will look slightly different.
It’s possible that this is being confounded by reporting pattern, right?
You retweeted an analysis of a weakening link between positive cases and Hospital admissions in London.
Like, it looks like maybe compared to the wave.
London was seeing in November the risk of an adult being hospitalized.
If he or she has a positive test is about 50% lower which looks somewhat similar to what we saw in South Africa.
You also Have seen have shown that the number of people in London.
I see use in intensive care, units were really sick.
People go has fallen off in recent weeks, which is pretty confusing.
When you think about London, experiencing record High cases, but also a slight decline in the number of people with covid in in icus.
What what is all of this data put together mean to you?
It’s really, really interesting.
So I think there’s two or three different patterns going.
And here under the surface.
So the most the clearest way I think of looking at this Divergence with the Omicron wave in London, is that a year ago with the alpha variant wave as the number of people in hospital with covid increased?
So did the number of people in ICU and on ventilators.
They that proportionally.
These went up completely in lockstep with one another.
If you if you show them roll it like, as a relative showing the peak, they just, it’s like you’re looking at the same lines.
Whereas what we’re seeing.
Um, now is the number of people in hospital with covid has again, gone up fairly steeply, but the number of people requiring ventilation.
So those who have got really severe lung damage has essentially not moved at all.
So as a proportion, the percentage of coma patients in hospital, who are on ventilators, has been relatively stable throughout the summer and then it was just dropped precipitously.
And let’s a fall that we’ve not seen any other point of the pandemic.
So I when you look under the Surface that there’s two things that seem to be happening.
One, is that the number of covid positive patients in hospital?
This winter is a slightly different number to think about compared to the numbers we’ve seen in the past.
Because we just get so many more people in hospital with cobit, even if they’re not being treated for it, but the second thing is that even among those who are being treated, primarily for covid, and that group is the majority.
Even among that group.
There has been a decline in the share requiring ventilation.
So so we say Actually, it’s that it’s these two sides of the coin.
You’ve got more mild cases than before and of the severe cases.
There does seem to be less risk of progressing to really, really severe lung damage.
So, just to recapitulate what you’re saying because it’s complicated, but it’s really important when you look at the number of people that are in hospitals and an icy use, it’s important to distinguish between the fact that number one.
There’s a ton of people who are going to the hospital for a broken leg.
A separated shoulder some kind of surgery and because Omicron is just everywhere.
A lot of those people are testing positive for covid in the hospital, even though they’re not necessarily presenting with symptoms.
Number one, but number two among people who go to the hospital with an Omicron infection because of the Omicron infection.
They seemed a little bit less likely, to progress to the ICU to really, really severe illness which could again like this either.
Africa data suggests that this thing is just everywhere, Omicron is everywhere but among people who have it.
We do see that the risk of truly severe illness is a little bit lower than it’s been for previous waves, which is probably all things considered, good news.
That’s exactly right.
John among those in the ICU in England.
Do we know what percent of vaccinated versus unvaccinated and how that number compares to the general population?
So we have, we have data here that was published a few days ago, which shows the across the month of December, 61% of covid.
Patients in ICU in England were unvaccinated and that compares to just nine percent of the population.
So, so very disproportionately likely to be an ICU compared to those who’ve had any number of vaccine doses.
That’s a factor of seven, right?
Or a factor.
Almost of seven.
How would you put that in sort of plain?
So so if everyone was equally likely to be end up in ICU regardless of whether or not they’d had a vaccine nine percent of the population being unvaccinated, you’d expect nine percent of people in ICU to be unvaccinated, but instead it’s 61 percent.
So as you say, almost a set, almost seven times more likely.
Whereas if you look at people who have had three doses, for example, they make up 31% of the Adult population in England, but only nine percent of those, you know, I see you.
So completely the other way around.
They’re much less likely to end up in ICU, then if they hadn’t had that protection to the vaccine, my multiplication math is roughly, the 10th grade level, but if I multiply those together, it sounds to me, like, boosted people are something close to 20 to 25 times less likely to go to ICU with covid.
Then people who have no vaccine shots.
At all, that’s exactly right.
Yeah, let’s finally go to the US, tell me one way, the u.s.
Experience is tracing the path John by South Africa, and the UK.
And one way that the u.s.
Seems to be departing from the trends.
We’ve seen in South Africa, and the UK.
So, if I mean, the most obvious parallel, is that we are seeing these same.
Almost vertical increases in infections in cases, right across every state of the u.s., You know, most States now senor Records in cases for the whole pandemic in the last week or so.
There’s still a few Southern States in particular that haven’t yet.
But but it really is just a question of when and not.
If similarly, hospitalization numbers are rising steeply in the same way that we see in other countries including including in the UK, just not the UK.
They have reason to deeply, just not too fast Peaks.
The the slight difference that we’re maybe just starting to see at the moment.
Is that in the US, the numbers of people, with covid in?
I see you all.
So seems to be marching upwards and, and hasn’t sort of diverged from the, from the case raids in the same way that we’ve seen in both South Africa, and the UK.
Now, that it is tricky here because in the u.s.
Omicron has landed to the right on top, right.
On the back of the winter, Delta wave and Delta.
We know was, you know, a very a very dangerous variant in terms of its severity.
It caused a lot of hospitalizations, a lot of severe disease and so So in this the point at the moment where you’ve essentially got Omicron Delta circulating together to some extent, Omicron will be the majority of cases now, but for those people who are in hospital ICU, it may still be that a large number of those, possibly even the majority are still from the previous delta waves.
So I think the next week or so is going to be really key.
In terms of, if we still see covid.
I see you numbers in the u.s.
Increase almost in line with what we’re seeing in total hospital now.
That would be something quite different to what we’ve seen in South Africa, and the UK.
And it would perhaps be indicative of the u.s.
Having slightly lower rates of vaccination and particularly boosters.
But if we do see it start to decouple, start to diverge that, it may be a sign that what we’ve been seeing up to this point was a hangover from Delta and we’ve not yet seen the impact of Omicron and I see use.
So, big picture of the u.s.
Is having a harder time with Omicron in South Africa and the UK in many respects, but it’s hard to determine And exactly why and two theories.
Our number one Omicron is piggybacking on a huge Delta wave that was already Christian to the US.
And number two.
Does not have the same immunity wall.
We have fewer people who are vaccinated.
We have fewer people who are boosted than the UK.
We also don’t have as many people who just got infected young people in particular.
Just got infected by a Delta wave like South Africa had they just got this huge Bank of natural immunity.
Right before Omicron hit, I was reading a report from a doctor in Philadelphia kit.
Delgado, on his first-hand experience in an, ER, with covid.
I want to read this to you and maybe you can tell me how this data matches or how this story matches the data that you’re seeing.
So Delgado, dr.
Delgado is describing the clinical presentation that he’s of disease.
He’s seeing in dizzy are based on vaccination status.
Quote, one boosted individuals.
Hardly, saw any one who had gotten a booster because if they caught covid, they’re likely at home doing fine or having regular cold or flu-like symptoms to vaccinated but on boosted tons of patients like this wiped out hydrated with a fever.
If they were older than 55 or had other medical problems often had to admit for overnight IV, hydration and supportive care, but usually go home within a day or two three unvaccinated.
These are Folks in the ER that get sick and had to be hospitalized and need oxygen and quote John.
What are you seeing in the ICU situation in the u.s.
That matches this data?
That the experience of the unvaccinated in a u.s.
Is diverging from the experience of the vaccinated and the boosted.
So thus as you say that’s just a fantastic bit of bit of reporting from dr.
Delgado that And I think it’s such a brilliant way of framing the current situation because that’s that essentially seems to be what we’re seeing now in the UK as well.
And also this was exactly what was reported from the hospital Wards in South Africa to.
So people who people have had boosters are broadly not requiring hospitalization at all.
There are some people still requiring hospitalization in that category.
But again these tend to be the very old patients and those with other other underlying health issues perhaps immunocompromised as well.
So these are The him boosters are a real help.
Still, you know, that greatly reduce the risk of severe disease, but the other underlying factors May mean that those people still require hospitalization for the people who’ve had perhaps two doses or perhaps a prior infection.
And they do again, have some protection there.
Still much better off than they would be, if they didn’t have those things.
But then the the absolute Lion’s Share of ICU of covid.
I see you in the UK at the moment is from the unvaccinated.
People, despite the fact that that is a group.
Up, that is now less than 10 percent of all adults.
So so really what we’re seeing is that, although that does seem decent evidence.
Now that Omicron is intrinsically less severe than the Delta bereans.
If you’re, if you’re completely immuno, naive, you’ve not been vaccinated and particularly those who have been vaccinated or infected in the past.
This is still a serious, serious virus, a serious disease.
It’s still far more significant than something like flu.
And so in a country like the US, Were, you know, vaccine vaccination rates, broadly are not terrible, but there are simply is a larger number of people who have not been vaccinated.
And that group really, is sort of like, you know, dry kindling for a variant even such as Omicron.
And that is where the bulk of pressure on hospitals, especially on.
I see users going to come from in the coming weeks, right?
So in summarizing all of this data, the South Africa data, the UK data, the US data, it seems to me, there are at least two summary points.
And I want you to tell me if these are correct summary points.
And if you, if you have more summary Point, number one, is that Omicron is unbelievably transmissible, but the share of Omicron cases that are progressing to ICU admissions to ventilators and deaths is meaningfully significantly.
Lower than we’ve seen in past waves.
This could be because of intrinsic properties of the variant.
It could be because of immunity banked up in these populations.
But on a per case basis, we are clearly seeing milder progression of disease, but number two, because Omicron is so ridiculously contagious.
We should worry that, it’s not mild for the Healthcare System.
It’s not mild for society, writ large, the sheer volume of people going to the hospital, with Omicron, or having to miss work, because of Omicron is causing a lot.
Lot of Mayhem that we should hope will be over quickly, because Omicron is progressed.
Pretty fast through South Africa through gout tongue.
But right now we are just dealing with a mess of absences throughout a Health Care system that stressed with cases.
That’s exactly right.
I think that’s those two imperfect.
And calculations of what we’ve got to get used to.
With this way of relative to ones that have come before.
Is there a silver lining about this speed?
Like should we be mildly?
That Omicron is a six-week two-month, hyper wave, that gets tons and tons of people sick, but might leave them with a natural immunity that will spare us from further significant waves in early and mid 20 22.
So, I think, you know, it’s certainly better than the alternative, you know, it’s better than a version of Omicron which which took three four months.
Us to work.
It’s worth as a population, and it’s better of a version of Omicron that didn’t have that kind of cross protective immunity for other variables.
So the fact that those two things are true, the fact that hospitals may have a very challenging time, but it may be a challenging say to three weeks instead of a challenging to three months that is certainly a positive.
And similarly, the fact that yes, you’re like to the extent that this is infecting everyone.
It’s providing a lot of people.
It’s providing a hell of a lot of people with some degree of immunity from From infection with whatever other variants emerged, underlying again.
We don’t know exactly what those variants will be like, but if you, if we have something here, where a lot of people are going to get infected but a smaller proportion of them are going to die and they will get some protection from, whatever comes next.
That’s, that’s better than it could be.
We’ve gone through the evidence and one thing that I’m trying to do in this podcast and others is like separate evidence from interpretation.
I want to like, see the data clearly and then I want to like, you know, put up a wall.
Call and say now.
What should we think about it?
You’re smart guy.
You’re one of the most brilliant chroniclers of the data.
This disease that I know of.
Do you feel comfortable telling us how this is cashing out in terms of your behavior.
How you how you take all this raw data and filter it into?
What the hell should I do in my life?
Should I feel vexed?
Boosted and done?
Where I think this is becoming basically, a Respiratory disease that we’ve dealt with for hundreds of years or do you still feel like there is a case for unusual caution with your behavior.
It’s really trick here today.
And I think it’s trickier than it has been to date with Omicron because up until now it’s been relatively.
Clear that you know, this is a this is that covid is really really dangerous that it can cause large number of people to progress to very very severe disease and indeed to death and the you No, that immediately goes in a category of something that on the societal level as well as an individual level is a really really, really big problem.
What we are potentially looking at with Omicron, which is something that causes something causes real.
Real logistical pressure on the Healthcare System, but both on a sort of societal death to level and on an individual basis for those who’ve had three doses, for example, it’s not necessarily as as sort of risky, as severe as what we’ve seen in the past.
So I think what Place on both as individuals and as societies.
What’s going to be interesting over the next couple of months is how this sort of covid discourse develops because, you know, people will, and I think our it’s reasonable now for people to start asking questions, for example of, okay, how does Omicron in a largely vaccinated population?
Compared to flu?
You know, last winter, the question of how this Kobe compared to flu was a question that had a very easy answer which was covid is far, far far more dangerous and fluid causes.
It’s far more deaths.
It’s far more risky.
What we’re seeing now is something that in terms of debt holes.
In terms of severe disease, may be more in the ballpark of flew again.
We don’t know that yet.
We have to wait for these waves to, to sort of play out before we can get good at estimates on things like the infection fatality rate.
I agree with that.
I think it’s a really, really responsible way to land on this.
I think it’s time to consider a regime change in our attitude toward this disease, but I’m not sure that the time too.
Change regimes is at the peak of the outbreak.
That’s basically where I cash out here.
I think it’s a really, really difficult problem because you put the soil in the beginning of your answer, the gap between individual risk and societal risk has never been jankier, right?
Because you’re dealing with an unbelievably transmissible disease that pretty much presents to a healthy boosted, 35 year-old the risk equivalent to like stepping onto an airplane and that’s the definition.
Death risk equivalent of like stepping onto an airplane.
And that’s a really, really difficult thing to match up against the enormous logistical societal wide risks from a disease.
That’s basically going to infect 23% of the population.
In a matter of weeks.
I think it’s a tricky puzzle, and I think I’m, but I’m ready for the conversation about, how do we manage?
What is hopefully, a transition toward endemic disease.
Thank you, so, so much for this.
I learned so much your command.
This stuff is absolutely masterful and I really appreciate you taking the time.
Thanks very much having me it was real pleasure.
Cleaning this with Derek Thompson is produced by Devon.
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We will see you then.