Will omicron end the pandemic? Some say optimism is premature

After nearly two years and wave after wave of the deadliest outbreak in American history, the hopeful are ready to embrace the belief that the latest COVID-19 virus variant marks the beginning of the end of the pandemic.

Microsoft founder Bill Gates tweeted this week that once omicron subsides, “the rest of the year should see far fewer cases so Covid can be treated more like seasonal flu.”

Closer to home, Ukiah emergency room physician Drew Colfax called omicron “a knight in shining armor” that will mark the end of the pandemic after a “sharp and potentially painful” surge in cases.

Omicron causes less severe illness, results in fewer hospitalizations, fewer patients on ventilators, and it simply comes and goes faster than the deadly delta variant.

And while omicron transmission rates continue to reach unprecedented and nearly incomprehensible levels, the numbers seem to be telling a different story than with previous surges: They include what some are calling “incidental COVID-19” patients — people who test positive for the virus when they enter the hospital for other reasons.

But despite the optimism, infectious disease and public health experts say it’s going to get a lot worse before it gets better, and it’s too early to say whether omicron represents the last gasp of COVID-19 and declare that we’re nearing the end of the pandemic.

The experts agree that with 2 million people across the globe becoming infected every day, omicron is not likely to be the last mutation, and the next one could be even more virulent.

What’s more, even though omicron reportedly causes less severe illness, a small sliver of omicron’s tidal wave of infections — nearly 1,000 a day in Sonoma County — has the potential to overwhelm local hospitals and health care providers.

“There’s a lot of hyperbole and conjecture that omicron is somehow not as deadly or disease causing,” said Dr. Michael Vollmer, an infectious disease specialist and regional epidemiologist for Kaiser Permanente in Northern California.

“What remains is that we’re seeing a higher number of people coming into the hospital right now,” he said. “Our numbers are still going up. We’re at a level that’s getting closer to what we experienced over the summer with our delta surge.”

During press briefing Thursday, Carmela Coyle, president and CEO of the California Hospital Association, said that omicron poses a “math problem” when assessing its impact on the health care system.

Coyle said that last winter, the number of patients in hospitals across the state peaked at 54,000 on any given day, with about 40% or 22,000 being COVID-19 patients. Today — with the omicron surge yet to peak — there are about 51,000 patients in hospitals statewide, but only about 13,000 who have tested positive for the virus.

“Hospitals are just as full today as they were last year during our winter peak,” she said. “This is just as we are beginning to see the COVID hospitalization surge.”

The good and the bad of omicron

The obvious good news about omicron is that it apparently causes less severe illness than the previous delta strain. In South Africa, a mostly omicron-driven surge of cases plateaued after six weeks, the shortest-lived surge to date in the region, according to the World Health Organization.

Though deaths across the African continent did rise significantly in the seven days ending Jan. 9, the omicron surge caused fewer deaths than previous COVID-19 waves, and hospitalizations have remained low, the WHO said.

Scientists say omicron may also be peaking in Great Britain and in parts of the United States. Meanwhile, a study in South Africa also found that the immune response among people infected with omicron appeared to increase protection against delta.

With omicron seemingly causing less severe illness and offering protection against the deadlier delta strain, many have started to regard omicron as a sort of godsend, particularly those who are weary of public health measures.

But Dr. Lee Riley, infectious disease expert at UC Berkeley, said it’s too early to make that call.

“I think people are giving too much credit to the Omicron variant,” Riley said in an email. “As we have seen throughout this pandemic, variants come and go.”

Riley said the omicron surge is beginning to flatten in places like New York, but he said omicron will not usher in “an endemic state” because not enough people in the United States have been infected with it.

“Omicron will gradually disappear regardless of vaccination status or infection rates, only to be replaced by a new variant,” he said. “It will take many more waves of variants for us to reach an endemic phase of this pandemic.”

Riley said that because omicron can transmit even among the vaccinated, it’s conceivable that it will mutate to become resistant to people who have protective immunity to it and earlier variants. There are only a few countries with high vaccination coverage, so new variants are likely to appear in nations with low vaccination rates, and from there spread again to the United States.

“The short answer is that we are still many months if not years away from reaching endemicity,” Riley said.

The omicron tsunami

As of Saturday, the rate of virus transmission in Sonoma County now averages about 224 daily cases per 100,000 people. That’s an increase of 500% from two weeks ago, when the virus was spreading at a rate of 37 new daily cases per 100,000 residents.

For unvaccinated residents the virus spread is even more prolific, at 413 new daily cases per 100,000 people. For vaccinated residents, it’s 178 cases per 100,000.

These numbers are difficult to comprehend when compared to the worst infection rates of a year ago, during the first winter surge. At that time, transmission peaked at just over 58 new daily cases per 100,000 residents.

And yet, the number of deaths has remained low since the summer delta surge. November and December each saw five COVID-19 deaths, and thus far two local residents have succumbed to the virus this month. On Friday, three new deaths were reported, but because case reports often lag, it could not immediately be determined whether those people died in December or January.

Last year, the winter surge in Sonoma County started around mid-November, about two months earlier than this year. Confirmed cases this year started increasing around mid-December and then skyrocketed after Christmas.

This time last year, hospitalizations had already peaked at 104 patients on Jan. 7. By mid-week, hospitalizations reached 93 before coming down to 89 on Friday.

Rising infection and hospitalization rates in Sonoma County prompted the latest public health order, which bans large public gatherings of 50 people or more indoors and 100 or more outdoors. County health officials also made an appeal for residents to refrain from leaving their homes except for school, work and essential errands, such as going to the grocery store or the doctor’s office.

Though not an official mandate, the request drew the ire of some community members and business owners who regarded it as a “shelter-in-place” order that could further damage the economy.

Incidental COVID-19

With news that omicron causes less severe illness than delta, there has been greater scrutiny of COVID-19 hospitalization data. The county’s pandemic hospitalization numbers include those who enter with COVID-19, the disease caused by the SARS-CoV-2 virus, as well as those who enter the hospital for some other ailment but test positive on admissions.

That distinction has given rise to the term “incidental COVID-19.” This week, county public health officials released the latest data on those hospitalized for COVID-19 and those with it. The county said the share of COVID-19 patients who incidentally test positive is increasing.

During the delta surge last year, COVID-19 hospitalizations peaked at 61 during the week beginning Aug. 8. Of these, only seven were considered incidental cases of COVID-19. By comparison, in the week that began Jan. 2 this year, nine of the 32 COVID-19 hospitalizations were deemed incidental.

The share of patients who enter the hospital for COVID-19 illness has declined from 95% in late October to 68% earlier this month, according to public health analysis using a three-week rolling average.

But public health and hospital officials said the number of COVID-19 patients, incidental or not, is an important indicator for hospital bed capacity. Kathryn Pack, health program manager for the county’s epidemiology team, said COVID-19 patients sometimes cannot be discharged or transferred to other facilities because of their coronavirus status.

“When patients are COVID-positive, hospitals have to take special precautions to avoid (virus) spread and outbreaks,” Pack said. “And it also increases risk for hospital staff themselves becoming infected, creating staffing shortages.”

A recent analysis of the new infections broken down by occupational sector shows that health care workers suffered the highest rates of virus spread in the past month. Sales and service employees also saw a significant increase in new cases.

Coyle, the president and CEO of the state hospital association, said even though omicron may be milder, hospitals are “bracing for the worst-case scenario.”

“Omicron is infecting so many more people, even if it’s a narrower slice (hospitalized), it’s still overwhelming in terms of the numbers,” said Coyle.

Triaging infections

As bad as it is right now for local hospitals — and it’s expected to get worse — it could be a lot worse were it not for local community health centers acting as a buffer between emergency rooms and the thousands of county residents who are testing positive every few days.

Gaby Bernal-Leroi, chief operating officer of Santa Rosa Community Health, said her consortium of health centers is receiving about 2,000 calls a day, many of them from people who have tested positive using at-home test kits. The volume is double what SRCH clinics received just a couple of weeks ago, she said.

Bernal-Leroi said SRCH has had to add triage nurses to its call center to handle the increased volume of calls from people who might otherwise seek care at an urgent care center or local emergency department.

SRCH, the largest of about a half-dozen federally supported health centers in Sonoma County, serves roughly 40,000 patients. As with many other health care providers, the omicron surge has whittled away at SRCH’s staffing levels, which are down 25%, she said.

“During the full pandemic, we’ve seen it as our responsibility to do as much as we can to support the hospital so that they are seeing the patients that truly need to be seen,” Bernal-Leroi said. “We’re doing our best to keep people at home, limit exposures, bring them in when they really need to be seen and just being available ... it’s been a rough couple of weeks.”

Nearing the peak?

The big question on Dr. Chad Krilich’s mind is whether the winter surge has peaked or is nearing its peak. Krilich, who is chief medical officer for Providence Sonoma County, which runs Santa Rosa Memorial, Petaluma Valley and Healdburg hospitals, keeps a close watch on daily COVID-19 patient numbers.

Last Tuesday, there were 43 COVID-19 patients at Memorial Hospital with four receiving intensive care; 10 at Petaluma Valley, with two in ICU; and three at Healdsburg hospital with none in ICU. On average, Providence’s local hospitals are now seeing more COVID-19 patients than during the delta surge.

Krilich said that Providence recently did a systemwide analysis of its COVID-19 patients across all 50 of its hospitals to better understand the number of patients admitted for COVID-19 vs. those who are admitted for something else but test positive for the virus. As a proxy for zeroing in on those being treated for COVID-19 illness, Providence focused on patients being given antiviral or steroid treatments.

It found that during last year’s winter surge, 64% were receiving these medications; during the delta surge 69% were receiving them; and today 41% are on antivirals or steroids. He pointed out that the large number of people vaccinated is likely playing a key role in this reduction.

“When you compare it to the previous surge, we have today less patients who are in the hospital and have COVID that are being treated for COVID,” he said.

“The question that we’re all asking ourselves, is this the beginning, middle or end of this,” Krilich said.

Dr. Vollmer, the Kaiser infectious disease specialist, said the share of Kaiser’s COVID-19 tests that are coming back positive, about 20%, is much higher today than in previous surges. Vollmer echoed Krilich’s point that vaccinations and boosters have prevented an even worse crisis.

“Even though there’s a lot of transmission going on, we know that there’s data that backs up that the vaccines are still effective at preventing more severe disease,” he said. “We may be seeing that phenomena, but the next two to three weeks are going to really parse that out.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.