Omicron fuels unprecedented spike in COVID-19 cases

The omicron variant is fueling an unprecedented spike in COVID-19 cases and placing a strain on hospital capacity, but experts say the spike could play out in the shape of an “ice pick” — a sharp but fast increase — that may leave the U.S. on better footing as soon as next month.  

The U.S. health care system is in for significant pain in the short term, but the fast surge could even help defeat the pandemic in the longer term by conveying broader immunity.  

Some experts are calling for people to buckle down for a last stretch of diligent precautions like mask-wearing in public, indoor settings to spread cases out and get hospitals through the next few weeks before the situation improves.   

“We need to have sort of the last effort so that we can make it to the spring,” Janis Orlowski, chief health care officer for the Association of American Medical Colleges (AAMC), said in a press briefing.   

Some experts predict that cases could peak in the U.S. later in January or in early February, though because of the large size of the country, certain areas will have localized spikes after currently hard-hit areas like New York have already peaked.  

Centers for Disease Control and Prevention Director Rochelle Walensky said Friday the experience in South Africa indicates a “precipitous increase and then a precipitous decline,” in the shape of an “ice pick,” though she noted that pattern could be one that “travels across the country” at different times.   

Carlos del Rio, an infectious diseases professor at Emory University School of Medicine, predicted the national peak could come “between the third week of January and the first or second week of February.”  

Once the highly transmissible omicron variant burns through the population, the outlook will be improved.   

“At this rate we may actually really be able to reach herd immunity because we’re going to get so many people in the population infected that at some point in time this may be sort of the beginning of the end of the pandemic, at least in this country,” del Rio said, during a discussion hosted by Emory University. “Because omicron is really going to infect pretty much everybody who hasn’t been infected so far.”  

Experts still stress that it is far better to get your immunity from vaccinations and boosters without getting sick, rather than from getting the virus, which can have lingering effects even if it is not bad enough to require hospitalization.  

The symptoms of omicron are milder on average, and people who are vaccinated and boosted are especially well-protected against severe disease. But even with only a small percentage of cases requiring hospitalization, the sheer number of total cases means overwhelmed hospitals.   

“We are overrun,” said Orlowski, of AAMC, which represents teaching hospitals across the country.   

The U.S. is recording more than 700,000 new cases per day and climbing, an unprecedented number, though between the protection from vaccinations and omicron’s diminished severity, many are mild or asymptomatic.   

Still, hospitalizations from COVID-19 are spiking to over 128,000, according to a New York Times tracker, though deaths have so far stayed relatively steady at about 1,400 per day.   

Orlowski and del Rio said about a third of patients in the hospital with the virus are not sick solely because of COVID-19, but have other conditions that in some cases are exacerbated by having the virus, too. Some hospitals reported as many as roughly half of patients testing positive were not primarily in the hospital because of COVID-19.   

Del Rio said that among patients solely in the hospital for COVID-19, about 80 to 90 percent are unvaccinated, or in some cases have received two doses of vaccine (without a booster shot) and also have an underlying condition.   

Hospital staffing shortages, from workers having burned out and left over the past two years, or from workers currently being home with the virus themselves, are adding to the strain.   

“The percent in the ICU is much lower [than previous surges], but that doesn’t mean that we’re not getting overwhelmed,” del Rio said.   

While the broad immunity provided after the omicron wave could improve the outlook going forward, potential new variants can always pose a curveball.   

For unvaccinated people infected with omicron, Leana Wen, a public health professor at George Washington University, said it is unclear “if there’s a new variant that arises in six months or a year, will they still be protected if they refuse to get vaccinated?” 

Advocates have long pushed the Biden administration to step up its efforts to vaccinate the world to help cut off the development of new variants.   

Few experts are calling for shutdowns like there were in the early days of the pandemic, but steps like mandating vaccination to eat in a restaurant or go to a concert, as several large U.S. cities have already done, would help, Wen said. Better availability of rapid tests has also been a major pressure point on the Biden administration.   

There is currently a split, Wen said, between the “very low” risk to individuals who are vaccinated and boosted, on one hand, and the “existential, very high societal risk,” of the “collapse of our health care system,” largely fueled by unvaccinated people.   

But even vaccinated people are harmed by overwhelmed hospitals, if they have a life-threatening medical event such as a heart attack or bodily trauma from a car crash. 

“It may have a long-term beneficial effect for a combination of reasons, leading with the fact that the spike is going to be quick,” said Ross McKinney, chief scientific officer at AAMC. “And then secondarily going to the fact that people may be protected having been exposed.”