Is Florida the acid test for Omicron?

AP Photo/Wilfredo Lee

Howard Forman is a doctor who teaches at Yale. He’s been keeping close tabs on Florida on his Twitter account lately, to the annoyance of some righties who are defensive on Ron DeSantis’s behalf. Whenever Forman tweets about Florida’s case counts and hospitalizations, some replies come back: “HOW ABOUT YOU WORRY MORE ABOUT THE WAVE IN NORTHEASTERN BLUE STATES.”

After critics spent the summer tying Florida’s brutal August to the state’s “no mandates” policy, DeSantis fans are touchy about the pro-mandate states being given a pass.

But Forman’s not interested in Florida because he wants to score points on DeSantis. He’s interested in it because the unusual posture of the pandemic there at the moment might give us insight into how severe Omicron is and how much immunity you gain from other variants if you’re infected by it. In the northeast, where Delta was raging before Omicron arrived, it’s hard to draw any firm conclusions about a surge in hospitalizations or deaths. Is Omicron causing those severe cases — or is Delta? We need to know. Scientists will have to isolate the data from each strain to get a sense of how dangerous Omicron is, a laborious process.

Florida is different. After its summer wave finally receded, it experienced the same rock-bottom baseline of cases that New York experienced last year after the initial explosion in March. Delta hasn’t been spreading much there lately, probably because so many Floridians have been infected by that variant and gained immunity from it. That makes Florida a sort of laboratory in which to study Omicron, since the new variant has the run of the place. Scientists don’t need to spend time disentangling hospitalizations caused by Omicron from hospitalizations cause by Delta since there weren’t many of the latter happening to begin with.

Which means if we see hospitalizations in Florida surge, that’ll be alarming evidence that the new variant might be more severe than we thought. And if we see cases explode there at the same rate as elsewhere, that’ll be a clue that natural immunity from Delta isn’t “vaccinating” people against Omicron. Which might in turn mean that being infected by Omicron won’t “vaccinate” a person against Delta either. The variants might co-exist in the population instead of Omicron driving Delta to extinction.

So, how’s it going in Florida? Cases are surging…

…but hospitalizations have inched upwards only slightly so far, posing no threat to capacity yet:

That’s our starting point in watching how this develops over the next month. We can’t assume too much about the spike in cases since those positive tests may be coming mainly from the vaccinated, not from people with natural immunity from Delta. If in a month Florida’s case counts per capita are lower than they are in other states with similar vaccination rates, that’ll be a hint that maybe there is cross-immunity between Delta and Omicron. It’s also too soon to tell about the trend in hospitalizations since Omicron has probably only been spreading in Florida for a few weeks — but as of today the state is seeing less than 10 percent of the hospital admissions it saw during the worst of the summer wave.

There’s encouraging news about Omicron elsewhere today as well. Last night a new study revealed that the risk of hospitalization from the new variant was 80 percent lower in South Africa than it was from Delta. A second study out this afternoon from Scotland broadly confirms those findings: “These early national data suggest that Omicron is associated with a two-thirds reduction in the risk of COVID-19 hospitalisation when compared to Delta.” There isn’t much remaining doubt that Omicron is milder for people who have some form of immunity. The question is whether it’s milder for the unvaccinated too and whether enough people will get infected across the population that even the small fraction who need hospital care will end up producing a gigantic number.

Meanwhile in South Africa’s hot spot, Omicron cases are falling off a cliff:

Deaths there have risen slightly but are still just 12 percent of what they were at the peak of the Delta surge. “All my patients in ICU are unvaccinated,” said one South African doctor to the AP. “So our vaccinated people are doing better in this wave, for sure. We have got some patients who are very ill with severe COVID, and these are unvaccinated patients.”

The data from London also points to a shorter, less severe wave:

Hospitalizations in the UK have been steady for awhile despite the enormous surge in cases:

How about New York? With cases soaring over the past week, what’s the hospital situation there like? So far, so good, reports Gothamist:

Dr. Fritz François, chief of hospital operations at NYU Langone Health, said he doesn’t anticipate having to cut services this time around. But NYC Health + Hospitals announced Tuesday evening that it would ban most visitors to limit the chances of the omicron variant spreading inside medical centers…

Currently, about 40% of patients who have been admitted to NYU Langone facilities who have COVID are “incidental.” That means the patients came in for another reason and happened to test positive for the virus, François said…

François said NYU Langone constructed a special respiratory unit to employ in case COVID cases began to overwhelm the emergency department again, but it has so far gone unused.

South Africa also saw lots of “incidental” positives during its wave, with some admitted to the hospital for reasons unrelated to COVID and discovering they had the virus only when they were tested during admission. That suggests a lot of asymptomatic cases out there, further evidence of mildness.

Still, let me flag the hospitalizations in New York State lately, as they’re worth watching over time alongside Florida’s:

Hospital admissions have doubled over the last six weeks. Cases began rising in New York shortly before that, in late October, and haven’t looked back. I assume most of that is due to Delta, with Omicron having taken off only within the past week or two. But since no one knows precisely where and when Omicron emerged, it’s possible that it was spreading in New York during November as well. See what I mean about the difficulty of trying to separate Omicron-caused cases and hospitalizations from Delta-caused ones? That’s why Florida, a largely Delta-free zone, is important.

Here’s Scott Gottlieb making a similar point. Needless to say, not all hospitals are as well off right now as Florida’s are.