The End of the Beginning

As this most recent wave subsides, are we entering a messy new phase?

Whew . . . that was rough.

The last two months have been a really tough time for all of us working in hospitals. The Omicron wave was everything we had feared it would be with respect for volume of patients. ERs, then ICUs, filled up, again with unvaccinated patients who missed their chance to get immunized against severe illness. Most of them survived, some did not, and a few are still on my census because they have infectious complications of their COVID-19 infection—what we call superinfections.

But over the last two weeks, the volume of COVID-19 patients in the hospitals has dropped sharply, as have case numbers in our state’s Situation Update. Many states and local authorities are dropping the mask mandates that helped limit the spread of infections, primarily in indoor locations.

Dorothea Lange, Storm cellar on the Texas plains, West Texas panhandle. Library of Congress, Image Number: 01di1342 & CD8174-342

So is it over? Is that it? All clear now? Can we come out of our storm cellars into some bright, clear day to survey the damage wrought by the storm? (Of course, many people were dancing in the rain, surfing in the hurricane—I met some of them in the ICUs).

Yes, it is likely the end of the beginning. At this point, so many people have been immunized, or successfully recovered, that barring the emergence of another new variant, even more infectious and immune evasive (is that you, Omicron, BA.2?), we are OK, at least until 4- 6 months from now, when immunity again fades and the weather turns cold. Will there be another booster shot waiting for us in September or later? I wouldn’t be surprised. One problem with synchronous waves of infection, especially large ones like the Omicron wave, is that immunity may fade synchronously as well.

We have the National Hurricane Center looking out for hurricanes. The COVID-19 equivalent is the World Health Organization Variant Tracker. Variants Under Monitoring (VUMs) are like the tropical depressions in the eastern Atlantic Ocean that get monitored to become potential storms. Variants of Interest (VOI) are the Greek-lettered variants that are akin to named storms. Will they hit land? Too early to say. Variants of Concern (VOCs) are the storms expected to make landfall and cause serious damage. At the time of this writing, there are no new VOI/VOCs—Omicron was the last.

So with no new VOIs/VOCs, and the current wave rapidly receding, conditions look favorable for a quiet spring and summer. I think we could all use a break.

Except . . .

If you are immunocompromised, or live with someone immunocompromised, or work with patients who are immunocompromised, you may still want to keep those storm cellar doors open, ready for a quick retreat if transmission amps up quickly again, as it has in Denmark, when all restrictions were lifted.

For all those people who don’t have reliable immunity against COVID-19, the next few weeks to months are going to be, hmm, “messy”. Transmission rates will go up, their only protection either self-isolation (if that is even possible) or an N95 mask (or equivalent) against the hyper infectious Omicron strain. Until there is proven reduction in transmission, the risk of transmission to immunocompromised people remains as high as it was last fall or during the Delta wave.

So I will continue to wear a mask indoors, as I have during this whole pandemic. I am still reluctant to eat indoors in restaurants. I am avoiding large social gatherings where food is served. There is still too much activity of COVID-19 to declare the pandemic is over—yet.