18 Comments

Any thoughts on proactively taking fluvoxamine for the immunesurpressed (triple vaccinated, zero detectable antibodies)?

Expand full comment
author

It's an SSRI and has major side effects. Not to be taken lightly.

Expand full comment

The way we choose to learn, understand, and react might be appropriate for chronic diseases—though I have my doubts—but is comically (and tragically) mismatched to evolving health threats.

Expand full comment

Is there any good evidence so far about Omicron severity for children under 5?

My prior is “about the same as Delta”, but good data for this sub-population is sparse.

Obviously many people care quite a bit about the answer to that - even if the rest of a household is vaccinated, it’s hard not to worry about small children who can’t get the vaccine yet.

Expand full comment
author

No data yet. But I see no reason to worry about them.

Expand full comment

> You’re more likely to be admitted to the hospital and happen to have Covid, then for Covid to send you to the hospital.

>If that’s true, then that seems like a very mild disease indeed. Anyone else want to take a shot at interpreting the data here?

Is this not true for young people and covid in general? Or, let me rephrase that: what is the age below which this is true? Is this boundary less than 40 years old even for non-Omicron variants?

A statistic like this also works for deaths: if excess deaths double, then the probability of dying in that time period is double the "usual" probablity of dying. If 100% of people had been infected, and excess-deaths had doubled, we could have concluded that you'd be more likely to die in 2020 and have happened to have covid, than to die of covid.

The real-world maths is more involved, but: given that excess deaths in 2020 were barely noticeable relative to long-term trends in most age groups in the West, but O(20%) of people were infected, I would conclude that the risk of death from corona is neglible in most age group relative to the background risk. It's hard to quantify this, because it would require statistics for individual places, but I'd be surprised if the "you're more than likely to die and have happened to have covid, than to die of covid" weren't true in most places in the West. Now I don't see why we shouldn't expect something that is true for deaths not to be similar for hospitalization unless covid has an unusual death to hospitalization ratio.

I believe Michael Levitt has pushed arguments like these, they seem eminently reasonable. I would be interested in hearing what you think of them.

Expand full comment

Sorry, typo in the second paragraph, should read "equally likely" as opposed to "more likely", but deform by an epsilon here or there to make the statement true.

Expand full comment

>If that’s true, then that seems like a very mild disease indeed. Anyone else want to take a shot at interpreting the data here?

I tried to do that in this post: https://abritdifferent.substack.com/p/a-notable-report-from-omicrons-ground

There are reasons to have hope Omicron is quite a bit less severe. There are a lot of caveats to that statement. I also am not an expert nor follow this issue as closely as you.

Expand full comment

Re the South African hospital stats, do we know that a PCR on admission means literallly prior to entering the hospital? Given how infectious it is and our experience of spread inside crowded hospitals it seems ver likely that they might have been infected post admission. This would make complete sense of the data.

Expand full comment

I love your pieces. This is some thoughtful writing. But I can't agree with you when it comes to the idea that Omicron will be intrinsically "milder" than Delta. I'm afraid that at this point, based on the evidence we have, this may be wishful thinking. The reason is that so far, Omicron is behaving exactly the way it would if it both the morbidity and mortality rates *and* the population severely affected were basically the same as Delta, no better, no worse. Take this quote after the analysis of hospitalizations, for instance: "The thread that was in gives some caveats on the hospital numbers, they get revised upwards later and lag cases, but still. " They were revised upwards later, and they do lag cases. But that doesn't cover the issue with this. Because right after this, you reprint a tweet stating that the cases are trending very young, just as South Africa's population is very young (average age 26.) If Omicron behaves like Delta in terms of mortality and morbidity, we would 100% expect to see milder cases in the young... and we're seeing milder cases in the young. If Omicron acts like Delta in terms of vaccines providing protection against severe outcomes, then we'd see exactly what we are seeing, which is vaccines providing protection against severe outcomes. Most cases of Delta are mild; most cases of Omicron are mild. Many countries have unhooked the number of cases from the number of deaths, like the UK; there's no reason to think it will be different with the new variant. Omicron is doing nothing to date that is consistent with the theory that it is intrinsically milder than Delta, only that under specific circumstances, it is *as* mild as Delta-- but only under those circumstances. There is nothing indicating that the virus itself has become "milder."

I understand feeling hopeful about it (and I think it's significant that "hopeful" is the word you use.) But a number of factors are going to have to change before it's at all possible to say that the virus itself has become any milder, and they have not changed yet. The vast majority of all the confirmed cases with Omicron being identified and discussed are in one of two groups: the fully vaccinated, or the very young. In those populations, Omicron is behaving just like Delta did. The cases were mild then; the cases are mild now. Once this new variant really gets its teeth into a population like the US, with significant numbers of people who are both unvaccinated and in the risk groups that would have had serious problems with Delta, we're going to see if this continues to be the case or not. We will need to compare the young and/or vaccinated cases vs. young and/or vaccinated hospitalizations and deaths *and then* older/lots of pre-existing conditions/unvaccinated cases vs. older/lots of pre-existing conditions/unvaccinated cases hospitalizations and deaths. They can't all be lumped together, or it will make no sense at all. But based on the current facts as they stand, the facts that we actually have, I think that it just can't be claimed that the virus has itself become any milder than Delta.

Expand full comment
author

I agree that what we're seeing would be broadly compatible with Omicron=Delta in terms of what happens if a given person catches it. I also think it's broadly consistent with it being milder, and it's unclear what answer you would get if you controlled for all that stuff properly (and thus, what the ultimate answer will be), and I would be very unsurprised by either outcome. I don't think we get the luxury of 'can't be claimed' (or the similar 'no evidence') here, and I notice that the news does seem better on this front than I expected after accounting for all these factors as best I can.

And of course, I stand very ready to change my tune in either direction very quickly when new data comes in.

Expand full comment

Thanks for the reply! I really do love your posts. I just feel that right now, we cannot compare apples to apples with the young patients who are being hospitalized in South Africa at the moment vs. the much older population in the US. Time will tell, and in a few months, the picture will be much clearer.

Expand full comment

I am a big fan of your updates, and I also find the conversation in the comments interesting. I did not mind too much when it was split over two locations, but now it's three. And it's probably not just my convenience, but the quality of the conversation. Have you considered closing the comments at one of the locations and pointing potential commenters elsewhere?

Expand full comment
author

I don't love the split but for now I think we are stuck with it. I consider WP the main conversation.

Expand full comment

>Will Omicron be >1% of all cases by the end of the year? 70% → 93%.

>The market on this is trading too low. There’s very little chance this does not happen given the new timelines. There’s still some uncertainty here, but it’s declining rapidly, and it’s mostly model uncertainty.

I mean, it's 91%, not that far off from 93%. Sad I only bet $50usd on this (when the predicted chances were 86%). Tho I bet 125 USD on "Will Poland or the United Kingdom report a higher 7-day COVID-19 case average per capita on Christmas Eve?" -> Answer: UK. It seems _more_ obvious, yet, even now it's only 64% for the UK. Given UK's superior testing, vaccination rates, much higher population... it seems obvious. Actually I'll put some more $ there.

-----------

Okay, I've put additional $500 there, hopefully I won't regret this...

Also, now Omicron 1% US cases has fallen to 89%, weird.

Expand full comment
author

It's been bouncing around. When I made the statement it was too low it was in the 80s.

Expand full comment

Worth noting that “Vaccine requirements” doesn’t necessarily mean mandatory vaccination, it may be requiring vaccination to do particular things, which is different.

This would explain seemingly small difference in support between encouragement and compulsion.

Expand full comment

I will point out that the fast-food business is more about real estate than food. Getting the best locations for your stores is something of a moat.

Expand full comment