Consider This Approach to Your Behaviour As Omicron and Christmas Approach

As the holiday family gatherings and celebrations approach we are in a very confusing time, bombarded with daily news of increasing COVID-19 cases, of the rapid rise of a new viral mutation, Omicron and struggling with decisions on booster vaccinations.

Where I live in St. Louis County 70% of individuals have received at least 1 shot of vaccine but cases and hospitalizations have surged again, most likely related to more indoor gatherings.

The skeptical cardiologist has found Bob Wachter’s tweetorials throughout the pandemic to be useful summaries of the current situation with advice for everyman that is science-based, yet easy to read. Dr. Wachter is the chief of medicine at UCSF. . Yesterday he posted a helpful tweetorial on how the new information is changing his thinking and behavior.

Here are his words with some of mine in between:

I’ll start with a few general principles & observations (to save space & time I’m largely going to omit primary data – it’s out there; follow @EricTopol to keep up):
1) Things are uber-dynamic. We have far more clarity now than we had 3 wks ago, but many unknowns remain…(2/25)

E…More infectious: yes, not sure by how much. Immune evasion: definitely. Severity: conflicting data from UK & So. Africa, even today. Could mean it’s same as Delta, could mean it’s moderately less. Doubt it’s more severe or massively less severe. We’ll learn more soon.(3/25)

The risk of our behaviors is not binary but nuanced and affects those we come into contact with.

Prior to Omicron I, like Wachter, had become comfortable taking some calculated risks but Omicron has changed that calculus for us and “hunkering down” may again be wise in the short term

5) Speaking of calibrating behavior, a few mnths ago, I shifted my attitude – Covid will be with us for the long haul, & thus I was personally more comfortable taking calculated risks (ie, visiting family over holidays), in part because “if not now, when?” In other words…(7/25)

.in my risk/benefit calculation, I removed my “Remain Extra Careful; Covid Will Go Away” temporal factor. But now, w/ Omicron cases skyrocketing, I’ve added back that “hunker down” variable – I see the next few months as a time to fortify one’s safety behaviors. Why?…(8/25)

1st, Omicron looks to have peaked in So Africa; we’ll likely see a familiar surge-then- plunge pattern, just with a much steeper upslope. Second, I’m quite worried about an overwhelmed healthcare system – we’ll rapidly hit capacity limits in meds, beds, ICUs, testing…(9/25)

… and most importantly people (many MDs/RNs out sick too). Trust me, you want to avoid getting sick when the system is stressed. Third, I see the Pfizer oral anti-viral as a very big deal, and it won’t be available for 4-6 weeks (even then it’ll be in short supply).(10/25)

6) Hunkering down means trying to limit risky activities. We now appreciate the negative impact of shutting schools. We need to do everything humanly possible (vaxxing, ventilation, testing, incl. test-to-stay) to keep schools open even in the face of a large surge.(11/25)

7) Even if Omicron proves to be less severe, don’t get lulled: it’s unlikely to be massively less severe. If (let’s say) Omcrn is 30% less severe but cases go up 5-10x (both plausible), that’s still awful, w/ far more hospitalizations & deaths than comparable Delta surge.(12/25)

8) In your own decision making, on top of weighing personal risk (age, comorbidities) & risk of exposure (activities, masking, case rates in your community, incl. fraction of Omicron), we now need to be more nuanced about level of immunity. It’s no longer Immune: Y/N?…(13/25)

What factors should go into calculating our risk of certain behaviors?

9) We all should have paid more attention in 4th grade when we were taught to calculate multiple fractions. Why? Because thoughtful decision making now requires you to multiple (brace yourself):
Personal risk (age, comorbidity) x activity (indoor, crowded?) x # of Covid cases in the region (cases/y/100K) x risk-reduction by you & others (masking, ventilation, etc) x fraction of Omicron in region x your level of immunity (zero to super) x how important activity is to you (visiting kids/grandparents vs. seeing a movie.

Such calculations are exhausting. What has Wachter calculated for himself?

I find myself struggling with many of the same decisions.

I (long three-time vaxxed) am traveling (flying) to visit my wife’s relatives for Christmas and I will wear my new (Kimberly-Clark PROFESSIONAL N95 Pouch Respirator (53358), NIOSH-Approved, Made in U.S.A) N-95 masks for the trip. We will test ourselves prior to leaving. My wife will have received her booster before we leave.

We dined indoors in a restaurant last night but after more thought I wish we hadn’t. Outdoor dining in St. Louis in the winter is rarely a possibility, unfortunately.

Whatever decisions you make I hope you have a COVID-free holiday and remain safe, sane and sassy.

Superlatively Yours,

-ACP