Plain English with Derek Thompson - Omicron: Feelings vs. Facts

Episode Date: January 11, 2022

Derek talks about the rise of the "Vaxxed and Done" movement before reviewing the latest omicron data with John Burn-Murdoch, data superstar at the Financial Times. Host: Derek Thompson Guest: John Burn-Murdoch  Producer: Devon Manze Learn more about your ad choices. Visit podcastchoices.com/adchoices

Twice a week, Van Lathen and Rachel Lindsay dissect the biggest topics in black culture, politics, and sports on their show, Higher Learning. They discuss the most important and timely conversations while also frequently inviting guests on the podcast and occasionally debating each other. Check out Higher Learning on Spotify or wherever you get your podcasts. Today we're going to talk about Amacron, and we're going to talk about Amacron in two different ways. Feelings and facts. I'm going to start with feelings. not because feelings are more important than facts, but because feelings are real.

And the way we feel about this pandemic shapes the facts we allow ourselves to hear. In the last few months, I've seen a really interesting schism among my friends and among people I follow online. It's a schism that's happening almost entirely among vaccinated people. And obviously, I think everybody should be vaccinated and boosted.

There are two camps forming among the vaccinated people that I know, two camps with increasingly strong opinions. Camp number one are the vaxed and done. This is the camp that says, we just need to move on. And camp number two are the vaxed and cautious. This is the camp that says,

we still need widespread COVID precautions. I recently wrote about this schism for the Atlantic. So I'm quoting for my own article here, but if I had to summarize the vaxed and done perspective, I would put it like this. Quote, for more than a year I did everything

that public health authorities told me to do I wore masks I canceled vacations I made sacrifices I got vaccinated I got boosted I'm happy to get boosted again but this virus doesn't stop

year after year the infections don't decrease instead virulence for people like me is decreasing either because the virus is changing or because of growing population immunity or both

COVID is becoming something like the seasonal flu for most people who keep up with their shots So I am prepared to treat this like I've treated the flu by basically not worrying about it and going on about my life. End quote. But there is an opposing viewpoint here, the vaxed and cautious viewpoint. So if I had to summarize that perspective as accurately as possible, I think I'd put it like this. Quote, why on earth would we suddenly relax precautions now during the largest statistical wave of COVID ever recall?

court in the U.S. We should not treat COVID or Amacron like any old serious or seasonal flu because it's not like any old seasonal flu. It's deadlier for those without immunity. It's several times more transmissible. We have no idea what the effects of Amicron and long COVID will be. Moreover, look at the health care system, look at hospitals. They're already worn down and at risk of being overloaded. For all these reasons, we have to continue doing what we can to throttle the spread of this virus. end quote. So maybe you're wondering, Derek, where do you fall between these camps,

vaxed and done versus vaxed and cautious? And the truth is, I'm torn. And the reason that I'm torn is that even though I know that I am extremely safe as a boost of 35-year-old without young kids, I know so many people in my life listening to this show who are in different situations. I think about the audience here. Some of you have kids under five.

Some of you have immunocompromised family or you are immunocompromised yourself. Some of you live with 80 or 90-year-olds. Some of you often see 80 or 90-year-olds rely on them for child care. Maybe some of you are in your 80s or 90s. And if any of these things are true for you, your feelings about Omicron and COVID will be a little bit different than for those of you who can essentially live what feels like isolated lives as healthy,

boosted individuals. Now the rest of this episode, the bulk of this episode, is about data. I wanted to have an objective conversation about Amicron with someone who had a masterful understanding of all the Ammigran facts in the world. Cases, hospitalizations, deaths, vaccination status. That man is John Byrne Murdoch.

John is the chief data reporter for the Financial Times, one of the best follows on Twitter for down-the-line objective data analysis of this disease. He's got a kind of God's eye view of the trajectory of Amicron in South Africa, where we first saw it take off in the UK and the U.S. And as much as possible, that is what I'm going to try to accomplish for the rest of this episode. I have given you my outlook on Amicron feelings. What follows is the landscape of Amicron Facts. I'm Derek Thompson.

This is plain English. John, welcome to the podcast. Thanks for having me. This variant is so confusing, and it is throwing off so much data that I feel like it's the confirmation bias variant. Like, anybody can look at this data and come up with any sort of narrative. So I wanted to have you on, just keep us grounded in the evidence and tell us what is what and what is happening.

Let's start with South Africa. Then we're going to go to your home country, the UK, and finally, we're going to get to the situation here in the U.S. South Africa is where we have the longest series of high-quality data about what Amicron does to a population. It is the leading indicator of all leading indicators. Like, it's not a perfect proxy for the U.S. It's younger, a different set of vaccinated versus infected.

But I feel like if we're all riding the Omicron roller coaster together, South Africa is in the front car. So tell me what has been the story you've seen in the data with cases, hospitalizations, and deaths. Sure. So, so yeah, South Africa has been huge for, I guess it was tail end of November and then the start of December was where it was really kicking off there. And the whole world's attention was focused on what we could glean from that. And what seemed, now that sort of the dust has settled to some extent, at least in Houteng province, which was at the core of their wave, what we can see is... And Gauteng Province, just for people who aren't familiar with

South African geography, that's the province in South Africa that includes Johannesburg, one of the larger provinces in South Africa where this variant really started to take off. That's right, yeah. And the capital Pretoria as well. So a couple of big cities there and certainly a large population. So, you know, there's enough people there. There's a large data set, as it were, it's useful information. So what we saw was cases rocketing, first of all. That was the real sign that we were dealing with something concerning here. And we also saw the fact that it was a particular new variant coming in. And so that's why, you know, there was all this huge amount of attention. It was the last few days of November, really.

So after that initial burst of infections, of course, all focus was on what was going to happen in hospitals. And about a week or two after the surgeon cases, we started hearing these first signs that these were sort of testimonies from doctors working in hospitals in Houteng, saying well, we feel that a larger percentage of our patients this time have mild disease. Now, a lot of people, myself included, heard that and we thought, well, that sounds promising, but it's very early in the wave. A lot of these cases, these patients are young people. So we'll obviously take that on board, but what we really want to see is how this develops

over the next couple of weeks as this spreads into all the more vulnerable populations. And sure enough, as the hospital staff had suggested, This then started being corroborated in the data. So first of all, we saw things like the percentage of hospital patients requiring ICU or mechanical ventilation was much lower, perhaps two or three times lower than it had been during the Delta wave. And now that we're a couple of weeks further on, and essentially that wave has risen and fallen in that province, we can see that hospitalisations peaked at roughly 50% of where

they had during the Delta wave six months earlier. Deaths peaked at around 20% of where they had done in that wave, whereas cases got right up pretty much to the top. So a strong sign of, you know, some people call this decoupling. Some would say it's a sort of divergence, but certainly a very strong indication that to the extent that we see these enormous surges in cases in infections from Omicron, the ratio of those that develop into very severe disease and particularly loss of life does seem to be markedly lower than it has been with previous waves.

And very quickly, what are some reasons that could explain that? Yeah, so this was the really tricky thing because I feel like a lot of us, certainly myself, went round in circles on this, trying to think, well, could this not just be the result, for example, of the fact that the level of immunity in the South African population is much, much higher and has been much, much higher for the last few months than it was during the Delta wave in, well, six months ago. So South Africa... And that just basically means a bunch of South Africans got Delta.

Exactly. And so they would be potentially more protected from the next variant. That's exactly right. So going into the Delta wave six months ago, somewhere between 30 and 40 percent of South Africans had been infected previously. Going into the Omicron wave, it was more like 80%. So we're talking about four in five people who had had COVID and recovered, which, as we know, gives pretty robust protection, especially against severe disease.

Similarly, the South Africa's vaccine rollout really did the bulk of its work during the third quarter of the year and indeed onwards. So there was a big increase in protection, especially against severe disease for the Omicron wave relative to Delta. So some of us looked at that and we said, well, okay, this is great news for the South African population. But it's not clear to what extent this will translate to other countries, because those countries already essentially sort of front-loaded. that rise in immunity, both from prior infection and particularly from vaccination. So someone has looked at this and said, great news to South Africa. We may see some further reduction in severity in other countries, but it's not necessarily going to be a sort of one-to-one mapping of South Africa onto other countries.

And we're going to talk about the degree to which South Africa's data has reproduced itself in other countries in just a few seconds. But I just want to take some time to talk about the speed of this wave. I'm looking right now at a full chart of South Africa's four COVID waves. It looks like a camel with four humps. Up down, up down. In the previous wave, the Delta wave you were just describing, it took about nine weeks to go from the bottom in new cases to the top in new cases.

With Amacron, it took three weeks. So the Omicron wave appears to my untrained eye to be passing through the South African population about three times faster than Delta. To what extent, John, should these numbers give us any reason to think that Omicron waves might be significantly shorter than past COVID waves? Yeah, so this is a really interesting question, because as you say, that data from South Africa, from Cal-Tang is very, very clear. It's a sharp steep rise and a pretty sharp steep fall very soon afterwards. There's good reason, sort of biological reasons for why that happens. we now have good evidence that it's a shorter incubation time for Omicron.

So the... I just say a little bit about what that means, a shorter incubation time for Omicons. So essentially that means the time between becoming exposed to the virus yourself and then becoming symptomatic so that you can pass it on to other people. It does look like that. It's slightly shorter for the Omicron variant. And so that essentially just means that everything with Omicron happens faster, both the rise and the fall. But I think the interesting thing that we're going to see,

that we're perhaps starting to see in the UK at the moment, for example, is that there are also going to be other impacts on that, including behavioural ones. So I know we'll come on to the UK in more detail later on, so I won't dwell on this right now. But I think it may be, for example, that in South Africa, the sheer speed and scale of the spread meant that it sort of burned through susceptibles at an especially fast rate that we may perhaps not see in other countries, for example. It may, though, be that we do see the same pattern everywhere, and that Omicron is short and sharp and intense, but also just more brief than what we've seen before.

So coming out of South Africa, it would be fair to say that in the front car of the Amicron roller coaster, we saw something that was crazy transmissible, meaningfully milder on a per-case basis for some reason, and also surprisingly fast. That's all of that, right? Yeah. So let's fly from Johannesburg to London. London is a leading indicator for the UK. The UK is a bit of a leading indicator for the US.

John, what are we seeing with the London Omicron Wave? Sure. So London has been very interesting and continues to be interesting. This really started taking off in mid-December. We started hearing case numbers that we just hadn't heard at any point during the pandemic. And it was, you know, it was really palpable. So I'm based here in London. And, you know, social events just started being canceled, left, right, and center.

I know sort of local hospitality essentially shut, not because they were compelled to by the government, but just because nobody was going out anymore. This was in sort of the week or 10 days leading up to Christmas. So in Gauteng, we were just talking about cases rose up very quickly to roughly the peak that they had previously seen during Delta. In London, cases have far exceeded the previous peak, which here was actually a year ago with the alpha variant. So cases in London have got to almost double what they were at that point, one year earlier. But over the last week or so have come down slightly from that peak. It doesn't look right now as though London is seeing the same steep rise, steep fall. But it is obviously early days. And I think as you and the listeners will be aware,

it does get trickier to distinguish between genuine patterns in how the virus is spreading and patterns in reporting or testing behaviour. So it's possible that the shape of London whether looks slightly different. It's possible that this is being confounded by reporting patterns. Right. You retweeted an analysis of a weakening link between positive cases and hospital admissions in London. It looks like maybe compared to the way of London was seeing in November, the risk of an adult being hospitalized if he or she has a positive test is about 50% lower, which looks somewhat similar to what we saw in South Africa. You also have shown that the number of people in London ICU's in intensive care units where really sick people go has fallen off in recent weeks,

which is pretty confusing when you think about London experiencing record high cases, but also a slight decline in the number of people with COVID in ICU's. What does all of this data put together, mean to you? Yeah, it's really, really interesting. So I think there's, there's two or three different patterns going on here under the surface. So the most, the clearest way, I think, of looking at this divergence with the Omicron wave in London is that a year ago with the alpha variant wave, as the number of people in hospital with COVID increased, so did the number of people in ICU's and on, on, on, on ventilators. Proportionally, these went up completely in lockstep with one another.

If you show them as a relative share of the peak, it's like you're looking at the same lines. Whereas what we're seeing now is the number of people in hospital with COVID has again gone up fairly steeply, but the number of people requiring ventilation, so those who have got really severe lung damage, has essentially not moved at all. And as a proportion, the percentage of COVID patients in hospitals, who are on ventilators, has been relatively stable throughout the summer, and then it has just dropped precipitously, and it's a fall that we've not seen at any other point of the pandemic.

So when you look under the surface there, there's two things that seem to be happening. One is that the number of COVID-positive patients in hospital this winter is a slightly different number to think about compared to the numbers we've seen in the past, because we just get so many more people in hospital with COVID, even if they're not being treated for it. But the second thing is that even among those who are being treated primarily for COVID, and that group is the majority, even among that group, there has been a decline in the share requiring ventilation. So essentially, it's that it's these two sides of the coin. You've got more mild cases than before. And of the severe cases, there does seem to be less risk of progressing to really, really severe lung damage. Right. So just to recapitulate what you're saying, because it's complicated, but it's really important. when you look at the number of people that are in hospitals and in ICU's, it's important to distinguish between the fact that, number one,

there's a ton of people who are going to the hospital for a broken leg, a separated shoulder, some kind of surgery. And because Amicron is just everywhere, a lot of those people are testing positive for COVID in the hospital, even though they're not necessarily presenting with symptoms, number one. But number two, among people who go to, to the hospital with an amicron infection because of the amicron infection, they seem a little bit less likely to progress to the ICU,

to really, really severe illness, which could, again, like the South Africa data, suggest that this thing is just everywhere. Amicron is everywhere, but among people who have it, we do see that the risk of truly severe illness is a little bit lower than it's been for previous waves, which is probably all things considered. good news.

That's exactly right. John, among those in the ICU in England, do we know what percent are vaccinated versus unvaccinated and how that number compares to the general population? We do, yeah. So we have data here that was published just a few days ago, which shows that across the month of December, 61% of COVID patients in ICU's in England

were unvaccinated, and that compares to just 9% of the population. So very disproportionately likely to be ICU compared to those who've had any number of vaccine doses. Right. That's a factor of seven, right? Or a factor almost of seven, meaning how would you put that in sort of plain mathematical English? Yeah, exactly. So if everyone was equally likely to end up in ICU, regardless of whether or not they'd had a vaccine, 9% of the population being unvaccinated, you'd expect 9% of people in ICU to be unvaccinated. But instead, it's 61%. So as you say, almost seven times more likely.

Whereas if you look at people who've had three doses, for example, they make up 31% of the adult population in England, but only 9% of those in ICU. So completely the other way around there, much less likely to end up in ICU than if they haven't had that protection to the vaccine. My multiplication math is roughly of a 10th grade level. But if I multiply those together, it sounds to me like boosted people are something close to 20 to 25 times less less. to go to ICU with COVID than people who have no vaccine shots at all. That's exactly right, yeah. Let's finally go to the US. Tell me one way the US experience is tracing the path drawn by South Africa and the UK,

and one way that the US seems to be departing from the trends we've seen in South Africa and the UK. Sure. So, I mean, the most obvious parallel is that we're seeing these same almost vertical increases in infections in cases right across every state of the US. Most states now have set new records in cases for the whole pandemic in the last week or so. There's still a few southern states in particular that haven't yet, but it really is just a question of when and not if.

Similarly, hospitalisation numbers are rising steeply in the same way that we've seen in other countries, including in the UK, just not the UK they have risen steeply, just not to pass peaks. The slight difference that we're maybe just starting to see at the moment is that in the US, the numbers of people with COVID in ICU also seems to be marching upwards and hasn't sort of diverged from the case rates in the same way that we've seen in both South Africa and the UK. Now, it is tricky here because in the US, Omicron has landed sort of right on top, right, right on the back of the winter delta wave. And Delta, we know, was a very, a very dangerous

variance in terms of its severity. It caused a lot of hospitalizations, a lot of severe disease. And so in this, the point at the moment where you've essentially got Omicron and Delta circulating together to some extent, Omicron will be the majority of cases now. But for those people who are in hospital and ICU, it may still be that a large number of those, possibly even the majority, are still from the previous Delta wave. So I think the next week or so is going to be really key in terms of if we still see COVID-I-U numbers in the US increase almost in line with what we're seeing in total hospital numbers, that would be something quite different to what we've seen in South Africa and the UK. And it would perhaps be indicative of the US having slightly lower rates of vaccination and particularly boosters. But if we do see it start to decouple, start to diverge, then it may be a sign that what we've been seeing up to this point was a hangover front.

from Delta, and we've not yet seen the impact of Omicron and ICU. Right. So big picture, the U.S. is having a harder time with Amacron than South Africa and the UK in many respects. But it's hard to determine exactly why. And two theories you have are, number one, Amacron is piggybacking on a huge delta wave that was already cresting to the US. And number two, the U.S. does not have the same immunity wall. We have fewer people who are vaccinated, we have fewer people who are boosted than the UK, but we also don't have as many people who just got infected, young people in particular, just got infected by a delta wave like South Africa had. They just got this huge bank of natural immunity right before Omicron hit. I was reading a report

from a doctor in Philadelphia, Kit Delgado, on his firsthand experience in an ER with COVID. I want to read this to you, and maybe you can tell me how this data matches, or how this story matches the data that you're seeing. So Delgado, Dr. Delgado is describing the clinical presentation of disease he's seeing in ZR based on vaccination status. Quote, one, boosted individuals, hardly saw anyone who had gotten a booster because if they caught COVID, they're likely at home doing fine or having regular cold or flu like symptoms. Two, vaccinated but unboasted. Tons of patients like this, wiped out, hydrated with a fever, if they were older than 55 or had other medical problems,

often had to admit for overnight IV hydration and supportive care, but usually go home within a day or two. Three, unvaccinated. These are the folks in the ER that get sick and had to be hospitalized and need oxygen. End quote. John, what are you seeing in the ICU situation in the U.S. that matches this data, that the experience of the unvaccinated in the U.S. is diverging from the

experience of the vaccinated and the boosted. Yeah, so that's, as you say, that's just a fantastic bit of reporting from Dr. Delgado there. I think it's such a brilliant way of framing the current situation, because that essentially seems to be what we're seeing now in the UK as well. And also this was exactly what was reported from the hospital wards in South Africa too. So people who've had boosters are broadly not requiring hospitalisation at all. There are some people still requiring hospitalisation in that category. But again, these tend to be the very old patients and those with other underlying health issues, perhaps immunocompromised as well.

So these are people for whom boosters are a real help still, you know, that they've greatly reduced the risk of severe disease. But the other underlying factors may mean that those people still require hospitalisation. For the people who've had perhaps two doses or perhaps a prior infection, they do, again, have some protection. They're still much better off than they would be if they didn't have those things. But then the absolute lion's share of COVID ICU in the UK at the moment is from the unvaccinated people, despite the fact that that is a group that is now less than 10% of all adults. So really what we're seeing is that although there does seem decent evidence now that Omicron is intrinsically,

less severe than the Delta variants. If you're completely immunono-naive, you've not been vaccinated, particularly those who've neither been vaccinated or infected in the past, this is still a serious, a serious virus, a serious disease. It's still far, far more significant than something like flu. And so in a country like the US, where, you know, vaccination rates broadly are not terrible, but there simply is a larger number of people who've not been vaccinated. And that, group really is sort of like, you know, dry kindling for a variant, even such as Omicron. And that is where the bulk of pressure on hospitals, especially on ICUs, is going to come from in the coming weeks.

Right. So in summarizing all of this data, the South Africa data, the U.K. data, the U.S. data, it seems to me there are at least two summary points. And I want you to tell me if these are correct summary points and if you have more. Summary point number one is that Omicron is unbelievably transmissible, but the share of the share of Omicron cases that are progressing to ICU admissions, to ventilators and deaths, is meaningfully, significantly lower than we've seen in past waves. This could be because of intrinsic properties of the variant. It could be because of immunity banked up in these

populations. But on a per case basis, we are clearly seeing milder progression of disease. But number two, because Omicron is so ridiculously contagious, we should worry that it's not mild for the health care system. It's not mild for society writ large. The sheer volume of people going to the hospital with Amicron or having to miss work because of Amicron is causing a lot of mayhem that we should hope will be over quickly because Amicron has progressed pretty fast through South Africa, through Gautung. But right now we are just dealing with a mess of absences throughout a healthcare system that's stressed with cases. That's exactly right. Yeah, I think those two are perfect encapsulations of what we've got to get used to with this wave relative to ones that have come before.

Is there a silver lining about this speed? Like, should we be mildly optimistic that Omicron is a six-week, two-month... hyperwave that gets tons and tons of people sick, but might leave them with natural immunity that will spare us from further significant waves in early and mid-2020. So I think, you know, it's certainly better than the alternative. You know, it's better than a version of Omicron, which took three, four months to work its way through the population. And it's better of a version of Omicron that didn't have that cross-protective immunity for other variants. So the fact that those two things are true, the fact that hospitals may have a very

challenging time, but it may be a challenging, say, two, three weeks instead of a challenging two, three months, that is certainly a positive. And similarly, the fact that, yes, to the extent that this is infecting everyone, it's providing a lot of people, it's providing a hell a lot of people with some degree of immunity from infection with whatever other variants emerged down the line. Again, we don't know exactly what those variants will be like, but if we have something here where a lot of people are going to get infected, but a smaller proportion of them are going to die, and they will get some protection from whatever comes next, that's better than it could be. We've gone through the evidence. And one thing that I'm

trying to do in this podcast and others is like separate evidence from interpretation. I want to like see the data clearly and then I want to like, you know, put up a wall and say now what should we think about it? You're a smart guy. You're one of the most brilliant chroniclers of the data of this disease that I know of. Do you feel comfortable telling us how this is cashing out in terms of your behavior, how you take all this raw data and filter it into what the hell should I do in my life? Should I feel vaxed, boosted, and done? where I think this is becoming basically a respiratory disease like we've dealt with for hundreds of years?

Or do you still feel like there is a case for unusual caution with your behavior? It's really tricky, isn't it? And I think it's trickier than it has been to date with Omicron. Because up until now, it's been relatively clear that COVID is really, really dangerous, that it can cause a large number of people to progress to very, very severe disease and indeed to death.

And that immediately goes in a category of something that on a societal level as well as an individual level is a really, really, really big problem. What we're potentially looking at with Omicron, which is something that causes real, real logistical pressure on the healthcare system, but both on a sort of societal death toll level and on an individual basis for those who've had three doses, for example, it's not necessarily as as sort of risky, as severe as what we've seen in the past. So I think what

both as individuals and as societies, what's going to be interesting over the next couple of months is how this sort of COVID discourse develops. Because people will, and I think it's reasonable now for people to start asking the questions, for example, of, okay, how does Omicron in a largely vaccinated population compare to flu? You know, last winter, the question of,

of how does COVID compare to flu, was a question that had a very easy answer, which was, COVID is far, far, far more dangerous than flu. It causes far more deaths. It's far more risky. What we're seeing now is something that in terms of death tolls, in terms of severe disease, may be more in the ballpark of flu. Again, we don't know that yet. We have to wait for these waves to sort of play out before we can get good estimates on things

like the infection fatality rate. I agree with that. I think it's a really, really responsible way to land on this. I think it's time to consider a regime change in our attitude toward this disease. But I'm not sure that the time to change regimes is at the peak of the outbreak. Like, that's basically where I cash out here. I think it's a really, really difficult problem because you put this so well in the beginning of your answer. The gap between individual risk and societal risk has never been jankier, right?

Because you're dealing with an unbelievably transmissible disease that pretty much presents to a healthy, boosted, 35-year-old, the risk equivalent to, like, stepping onto an airplane. And that's the death risk equivalent to, like, stepping onto an airplane. And that's a really, really difficult thing to match up against the enormous logistical, societal-wide risks from a disease that's basically going to infect 20, 30 percent of the population in a matter of weeks. I think it's a tricky puzzle. And I think, but I'm ready for the conversation about how do we manage what is hopefully a transition toward endemic disease. John, thank you so, so much for this. I learned so much. Your command of this stuff is absolutely

masterful, and I really appreciate you taking the time. Thanks very much having me. It was real pleasure. Planning this with Derek Thompson is produced by Devin Manzi. Thank you so much for listening to this show. If you like us, follow us on Spotify, rate and review on Apple Podcast. We will be back with our second episode this week on Friday. We will see you then.