22 Comments

Prepare? I already GOT sick. The worst part wasn't the one day of feeling shit, it was being quarantined for the better part of the last 3 weeks.

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Dec 24, 2021Liked by Noah Smith

Feels like there should be laxities on booster spacing given Omicron — was rejected from 2 clinics as my second dose was in July, making it 5 months, not 6 months. By the time I can boost seems the worst of this wave will be over.

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Dec 24, 2021Liked by Noah Smith

Hi Noah,

As far as I'm aware, the observed decreased severity of omicron conditional on infection (which is undeniable at this point) is still consistent with being the effect of prior immunity only. It might be innately less severe as well, but this still seems up for grabs. Even in NSW where it looks like the comparison with delta is like-for-like there's a selection bias: among omicron cases, a larger fraction are vaccinated than delta, due to omicron's immune escape. With this effect alone an omicron wave will have fewer severe outcomes per case compared to delta in a highly immune population, but only because in the same population the equivalent delta infections were prevented outright by immunity. So anyone unvaccinated and who hasn't been infected before I think should be pretty concerned still.

The evidence about omicron reproducing more poorly in lungs is good, obviously, but I'm under the impression that none of the analyses of hospitalisation data etc are yet showing a decrease in severity *when controlling for prior immunity*. This seems to me like an important distinction that has been lost in the messaging. I mean, actually I've seen the point made constantly, but it seems like there are enough bare headlines just saying it's mild that people have started to assume this has been shown in the innate sense as well. Even metaculus seems to have forgotten this point:

https://www.metaculus.com/questions/8766/omicron-variant-less-deadly-than-delta/

(Though disagreeing with the metaculus community *and* Noah Smith definitely makes me reconsider if I'm missing something!)

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Dec 24, 2021Liked by Noah Smith

Have to hope that the lower rate of cases requiring hospitalization per infection isn't outweighed by the rapidity of caseload increase where healthcare system capacity is concerned.

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Dec 24, 2021Liked by Noah Smith

There’s also this in the good news category:

https://pbs.twimg.com/media/FHV35I8UYAIURzh?format=jpg&name=large

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Hey Noah,

Not sure you'll still check this thread, but I would love someone to look into how the Paxlovid roll out is going.

Unfortunately I tested positive for SARS-CoV-2 today, I have 2 risk factors but am otherwise middle-aged, vaxxed+boosted, and in decent health.

I managed to get a script for Paxlovid by the end of the day, but there were a ton of hoops to jump through - 2 virtual visits, a trip to an ER for blood work to check kidney/liver levels, and lots of self advocacy. The prescribing Dr (at one of NYC's top hospitals) commented that he believed I was the first script that they've written in that hospital. They also made some side comments that their EMR system made the prescribing confusing and difficult. If I hadn't been a loyal "This Week in Virology" listener throughout the pandemic there's no way I would have gotten through this process.

What makes me worry Paxlovid is not being deployed widely is they warned me that while they would write the script, it would go to some central prioritization machine where I would likely get downgraded as I am young and vaccinated/boosted. Instead, the prescription was filled immediately and is getting delivered tomorrow.

Are we potentially making the same mistake (https://noahpinion.substack.com/p/the-vaccine-war) we made with overly restrictive vaccine requirements again?

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"The first piece of good news is that vaccine boosters offer substantial protection against Omicron. Studies are showing that a third dose of mRNA vaccine (Pfizer or Moderna) restores a substantial amount of immunity."

One of the major problems with pro-vaxxer's is that they refuse to acknowledge that having a reduced chance of getting SERIOUSLY sick after taking your shots isn't "immunity".

Because of this misuse, people were led to believe that if they took the vax shots, they were going to get total protection from infection by the Covid virus.

Now with many still getting sick from Covid via breakthrough infections, they are coming to realize that they got snookered.

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I appreciate the case you make for medium / long-run optimism, but what do you think of this? https://www.washingtonpost.com/outlook/2021/12/24/merck-molnupiravir-antiviral-covid-fda/

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Any thoughts on long covid with Omicron?

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