WSJ: The Omicron disconnect between cases and serious hospitalizations is real -- and maybe spectacular

AP Photo/Seth Wenig

Great news if true and it holds up, because the US still finds itself on the upside of a massive increase in both cases and hospitalizations. Whether or not the latter is correlative or causative will be the subject of heated debate, but the Wall Street Journal reports that the UK has seen a clear and large disconnect between cases and causative hospitalizations, as well as more severe outcomes:

The Omicron variant of the coronavirus has fueled the biggest surge in Covid-19 cases in the U.K. since the pandemic began, but the number of people critically ill in hospitals hasn’t increased significantly, a promising sign for countries including the U.S. that are seeing their own rapid run-ups in infections.

Doctors say Omicron is making fewer people seriously sick and the severe respiratory problems that were hallmarks of earlier waves of Covid-19 aren’t so prevalent this time around. The change reflects differences in how the variant attacks the body, booster shots shielding the most vulnerable against the severest aspects of the disease, and better treatments that forestall Covid-19’s progression.

The trend, which is at odds with the rapid rises in seriously ill hospital cases seen in earlier waves of the pandemic, adds to evidence that Omicron causes milder illness than its viral predecessors, especially in populations with some degree of immunity from vaccines and prior exposure to Covid-19.

“We’re waiting for the bombs to fall and they haven’t yet fallen,” said Mervyn Singer, an intensive-care consultant at University College London Hospitals. “We should by now be seeing a big surge in cases. At the moment we’re not seeing that. I’m quietly confident that Omicron won’t be so bad.”

That would be good news indeed, especially since the UK’s case transmission has apparently peaked. Normally hospitalizations, ICU admissions, and deaths lag a couple of weeks behind caseloads, so the lack of significant increases in the latter two measures indicates a far less dangerous prognosis for Omicron than Delta or the original COVID-19 version. Hospitalizations may be a poor measure given the potential for correlative indications — people who are hospitalized for other reasons but come up positive for a COVID presence — but it’s still somewhat better than overall cases.

Unfortunately in the US, the numbers don’t look good on either:

Even here, though, there’s a distinction in the curves between Omicron and previous waves. Cases are three times higher than the previous record wave a year ago and nearly four times higher than the Delta wave in August. Hospitalizations are up too, but not nearly by the same amplitude despite Omicron’s circulation in the US for at least the last several weeks. How much of that increase is due to just the correlation of a much-more-transmissible-but-mild variant to unrelated reasons for hospitalizations?

The CDC’s data on that point is unfortunately not available yet. Hospitalization severity would tell us the impact of the Omicron wave on ICUs and the use of ventilators, but the data only runs to October 2021. Anecdotally, we are hearing of much less need for invasive treatments and COVID-focused admissions, especially among the vaccinated, but anecdotes are not data. Visits to emergency rooms are way up, but there’s a caveat to that, too:

That could indicate a higher impact from the Omicron variant, but there are at least a couple of reasons to refrain from making that assumption. One, it may be that more people are showing up in ERs for other reasons and unknowingly have the Omicron variant; in other words, this could also be just as correlative as the admissions data.

Second, the shortage of available testing has definitely forced people into ERs to get tests needed to determine access to jobs, public services, and so on. That’s one reason to fear even a mild variant. That kind of shortage, and the general panic stoked over COVID infections even with vaccinations, will create a utilization wave for hospitals and clinics that may well create enough shortages to result in excess deaths regardless of COVID status.

That’s really the main concern for health-care experts, as one CNN expert explained today:

Dr. Jonathan Reiner: In the short term, I think January is going to be a difficult month, and we’re essentially in a race to see which happens first — whether the Omicron surge peaks or whether we deplete our ability to care for folks in hospitals. Our hospitals are filled with patients, and at the same time staff are getting ill.

We think the Omicron surge will be relatively short-lived if the experience in South Africa and the experience in the UK is a harbinger of what’s to come in the United States. If you look at the data as of today in London, it does look like cases are starting to decline.

If we continue to follow the UK in the way we have in the past, then I think in some parts of the country, particularly the places where Omicron hit first, we should start to see hopefully a peak sometime in the next couple of weeks.

The near-term is going to be a challenge, and our hospitals are going to continue to fill with patients. We’ll go back to the kind of footing that we were on in the spring of 2020, and then cases will start to drop.

Fortunately, it does appear that the severity of illness in general is a bit lower with Omicron than the other variants, but still the sheer number of people being admitted to the hospital and the number of hospital staff members now getting sick will make the next few weeks very challenging.

The overload concern will be valid if the cases are COVID causative rather than COVID related, and if hospitals are forced to isolated Omicron-positive staff even while the variant becomes all but ubiquitous in the population. The more likely outcome will be that staff will only get isolated if they become symptomatic, and only for their own health benefit rather than over worries about community transmission. There won’t be enough tests available to test everyone on a constant enough basis to enforce the isolation rules as they stand now and treat patients at the same time. The more that the data confirm the mild profile of Omicron infections, the more health-care settings will move to that position — and the faster the rest of us should as well.

Update: Added the word “serious” to the headline for better accuracy.