Rhode Island Is at Significant Risk From COVID Omicron Variant
Nick Landekic, Guest MINDSETTER™
Rhode Island Is at Significant Risk From COVID Omicron Variant
Rhode Island is at Extreme risk – the highest rate of new infections in the country
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Rhode Island now has the highest rate of new COVID cases in the entire country.
We are one of only four states at an ‘Extreme’ level of infection risk, higher than Florida, Texas, and other states with few public health controls and that some consider to have performed poorly. For the past month, Rhode Island has consistently been among the worst-performing states. Over the past two weeks, infections are up 82% and hospitalizations have increased 65%. Most days over the past two weeks have seen over 1,000 new COVID cases each day.
This dangerous rate of growth cannot continue for long before things start falling apart.
Omicron is more transmissible
The Omicron variant is showing to be much more transmissible than the Delta variant, with estimates ranging from 50% to as much as 8 times greater, which is driving a much faster spread than was seen with Delta. The World Health Organization has said that Omicron is spreading faster than has been seen with any other variant.
In South Africa, in less than a month COVID cases have increased from about 250 to 20,000 a day in a month’s time. COVID Omicron cases in both England and South Africa are doubling approximately every 3 days – in a population that was thought to have ‘herd immunity’ against the Delta variant.
A new study found that the Omicron variant reproduces 70 times faster in our bronchial airways than the original Wuhan strain and Delta variant. This may be a mechanistic explanation for why it’s so much more transmissible.
“It is also noted that by infecting many more people, a very infectious virus may cause more severe disease and death even though the virus itself may be less pathogenic. Therefore, taken together with our recent studies showing that the Omicron variant can partially escape immunity from vaccines and past infection, the overall threat from the Omicron variant is likely to be very significant,” said Dr. Michael Chan Chi-wai, who led the work.
Severity of Omicron illness not yet known
It does appear to be less deadly than Delta, according to data from South Africa and comments by Dr. Anthony Fauci.
Hospitalizations and deaths are ‘lagging indicators'. Deaths from COVID come weeks after the initial infection, and the true severity cannot be known for some time. Contrary to some initial reports, as more was learned about the Delta variant, it became apparent that it was actually not only more transmissible and had greater immune escape, but also was more virulent and caused more severe illness as well.
Extrapolations from South Africa to the U.S. are difficult because of significant differences between the populations. South Africa has a much younger population (average age 28) than the U.S. (38). Additionally, the population of South Africa has a much higher community level of antibodies due to extensive prior Delta infection. While this will not directly prevent infection by Omicron, it may well make the illness less severe.
Even if Omicron turns out to be less virulent than Delta, it’s not necessarily good news. Being half as virulent as Delta would still make infection about as serious as with the Alpha or Beta variants. If the number of infections were tripled because of the increased transmissibility, the net result would be far more people hospitalized and dying – which our overworked healthcare system cannot handle.
This is the ‘scary virus paradox’. After clearing a threshold, the less deadly a virus is, the more people it will kill. A variant that is 20% less virulent but 20% more transmissible will cause more deaths, because infections grow exponentially. While the mortality might be less for one variant directly compared with another, a more transmissible variant will cause proportionately more cases and deaths, and also result in an increased risk of death for any individual as well.
"There is a myth out there that it's mild. We need to address this myth now. We need to forget about wishful thinking here with mild disease. We simply don't know,” said Dr. Peter Juni, the head of Ontario's Science Advisory Table.
Fewer options if you get infected
Just as the Omicron variant has greater immune escape and increased resistance to antibodies from vaccines, it is also more resistant to antibody therapeutic drugs. Recent studies have shown that Omicron is able to largely escape neutralization by the currently used antibody drugs.
This means if you get infected, there will be fewer options available to treat and help you. The antibody drugs that were counted on and frequently used against Delta and other variant infections, do not work well against Omicron.
The risk of long COVID after Omicron infection is also unknown. However, as more is being learned about long COVID, it is becoming apparent that it is more common than was previously thought. A recent report in the Journal of the American Medical Association, a meta analysis of over 250,000 COVID survivors, found that 54% - over half - had at least one persistent health problem more than 6 months after their initial infection.
Another study just announced followed COVID patients who were hospitalized for their infections, and found that 92% - nearly everyone – had at least one persistent health problem one year later.
Previous COVID infection does not protect against Omicron
Having previously had COVID has also shown to not provide protection against Omicron. Part of the increased immune escape of the Omicron variant also includes the ability to resist antibodies generated from prior COVID infection, making the risk of reinfection high.
The danger of exponential Omicron infection growth in Rhode Island
Omicron is growing exponentially in South Africa and England, and in Washington, New Jersey, and New York states. The danger to Rhode Island is that Omicron cases might grow slowly at first, then explode so fast as to overwhelm our already stressed healthcare system. For example, with a doubling of cases every three days, 100 infections on day 1 can become –
Day 4 – 200 infections
Day 7 – 400 infections
Day 10 – 800 infections
Day 13 – 1,600 infections
Day 16 – 3,200 infections
Day 19 – 6,400 infections
Day 22 – 12,800 infections
Day 25 – 25,600 infections
Day 28 – 51,200 infections
Day 31 – 102,400 infections
and so on, with 204,600 total infections possible within a month, and still continuing to grow. With over 730,000 Rhode Islanders essentially unprotected, we have the majority of the population vulnerable and susceptible to infection by Omicron.
With 261 COVID patients currently hospitalized and many hospitals already full and at capacity, there is not much room for additional COVID cases. Such a catastrophic increase in cases is already rapidly overwhelming our hospitals and limited healthcare resources. Imagine the nightmare that would happen if hundreds of thousands of Rhode Islanders all became sick in the same month, and the impacts on our hospitals, doctors, nurses, police, and fire departments?
A primary line of defense against COVID infection is the level of antibodies in the blood. Antibody levels peak soon after vaccination, and then decline over the next few months. Omicron requires a higher level of antibodies to neutralize than Delta, making a booster shot much more important and needed sooner than it would have been for Delta or other variants.
Multiple studies have now shown that two vaccine doses do not provide meaningful protection against infection from the Omicron variant, though reduction of risk of hospitalization and death is still expected. Full vaccination against Omicron means receiving three vaccine doses – the original series plus a booster shot.
As of December 15, 2021, 247,845 Rhode Islanders have received both their initial vaccination plus a booster shot. These are the people most protected against Omicron. If one adds to that number the 79,018 Rhode Islanders who completed their primary vaccination series within the past three months and thus have the highest antibody levels, results in 326,863 Rhode Islanders who may have 70-75% effective protection against infection by the Omicron variant. This is only about 31% of our state’s population.
This means 732,137 Rhode Islanders could be at great risk of infection from Omicron. The extremely high contagiousness of the variant means we could be seeing hundreds of thousands of new infections over the next several weeks, with tens of thousands of people needing hospitalization – except Rhode Island’s hospitals are already over-stressed and over-worked.
This is why Governor McKee’s actions this week were absolutely necessary – and were late and did not go far enough. To reduce illnesses and deaths we need to get ahead of the virus, not constantly playing catch up. If we waited any longer, until tens of thousands more people became infected, it would be much too late to do anything about it.
Governor McKee should be given credit for getting our vaccination program on track. At the beginning of the year we had the lowest vaccination rate in the country because of a very troubled rollout, and now are among the top five states with the highest vaccination rates.
As important as vaccination is and will continue to be, numerous medical experts have long been saying that vaccines alone are not enough. We all have ‘pandemic fatigue’, but the virus doesn’t care and it’s going to take more than just getting vaccinated to fight it. Despite Rhode Island’s laudably high vaccination rate, we are the most highly infected and one of the highest risk states in the country. Prior to Governor McKee’s actions this week, other than extending the official ‘state of emergency’ and continuing to require masking in schools, Rhode Island had been doing essentially nothing to safeguard health and lives. It was time for action.
The time remaining to take steps to prepare for Omicron is very short. Even if virulence turns out to be somewhat less than the Delta variant, it would still be an unimaginable catastrophe for a largely unprepared and open Rhode Island if no precautions are taken. Epidemiologist Dr. John Fulton has warned that Rhode Island is in a state of “epidemic free fall.”
Governor McKee demonstrated leadership this week in taking unpopular but live-saving first steps to respond to the surging crisis. Some have pointed to a lack of similar action so far by Massachusetts or Connecticut, but Rhode Island’s rate of infections is dramatically higher than either of those states, or any other state in the country. We must do more because we are in much worse shape.
There are no ‘good’ or easy options with the pandemic. We are in the awful position of having to choose the least bad choices. Some public health measures might have a short-term impact on businesses profits, but it’s past time to decide what is worse: losing a little money, or losing lives. What is more important to you: your life, or someone else’s money?
In Germany Health Minister Jens Spahn has said that by the end of the winter, people will be “vaccinated, cured, or dead.” The same applies to Rhode Island. You can choose to be vaccinated or dead, though ‘cured’ involves luck and chance beyond anyone’s control. Choosing to be vaccinated is the easiest and best choice. It will also take personal responsibility by everyone to not only get booster shots but to wear masks, get tested, isolate if infected, and think carefully about being in crowded indoor situations.
“You cannot outrun the game clock with this pandemic. This virus will find you and, unfortunately, many of the outcomes are very sad,” said Dr. Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Nick Landekic is a retired scientist and biotechnology executive with over 35 years of experience in the pharmaceutical industry.