Omicron and our healthcare workforce
Another SARS-CoV2 variant and its implications
Back in March I wrote what I hoped would be my last post on the pandemic. But as several of you and/or your families were lining up at TSA checkpoints on Thanksgiving, news broke of the Omicron variant. I got a few texts from people, ranging from “what does this mean?” to “should I cancel my flight and drive?” to “what is Omicron?”
Re: the last one: omicron is the 15th letter of the Greek alphabet. That means Omicron, a.k.a B.1.1.529, is the 15th WHO-designated SARS-CoV2 variant.
“What does this mean?”
We found another distinct variant of the original virus that has a lot mutations. Before I say more, here’s a quick primer on SARS-CoV2 variants I wrote last winter.
Nature has done a very good job of reporting COVID19 news and, more importantly, communicating the science needed to understand what’s being reported. Their initial report on Omicron is a great digest of what we know so far (spoiler alert: it isn’t a lot). If you’re listening to The Daily, cable news, or NPR for science news and commentary, I strongly recommend moving away from them and putting Nature in your rotation. They have a great print edition and a decent podcast as well (10-20 minute episodes).
In short, this new variant was born in southern Africa and in a matter of weeks has been spotted in Hong Kong and northern Europe. It’s safe to say that it’s already cleared customs somewhere in North America at this point and it’s only a matter of days before you see the headline “CDC reports confirmed Omicron cases”. But no one knows yet how Omicron will affect vaccinated and unvaccinated people. How often do people in either group end up in the hospital? We’re still waiting for health systems to report that information. In the meanwhile, labs in South Africa and Europe are throwing all of our known SARS-CoV2 anti-virals, synthetic antibodies, and antibodies from vaccinated people into a petri dish to see if any of them can stop or slow down Omicron.
“Should I cancel my flight and drive?”
This is my favorite. The classic risk-benefit question that we’re tempted to believe has a right / wrong answer. There’s a lot of nuance here and I want to message this in a way that takes into account the context and situation you might be in. So, here are a few points to consider:
Vaccines may slow down the spread and they will keep people out of the hospital (compared to unvaccinated people), but they will NOT prevent the detection of B.1.1.529 in swabbed people. This variant, like the past 14 variants, will spread and people will have positive swabs. The important thing is that they will very very likely NOT end up in the hospital needing oxygen through a nasal cannula…or worse.
The vast majority of people admitted to US hospitals for severe COVID19 symptoms are unvaccinated
Of the relatively few vaccinated people being hospitalized, the vast majority of them did not respond to the vaccine due to an immuno-suppressive condition or medication.
I have heard of no medical case reports of healthcare workers in COVID ICUs with proper N95 masks getting. From my own personal experience and from unpublished data at the two health systems I’ve worked for during this pandemic, these masks protect healthcare workers at very high risk.
So, as you’re bouncing around Kayak and AirBnb, be mindful of your own risk factors and those of others you might be traveling with / to see. While inside the airport or your plane, I’d recommend a N95 be worn 100% of the time (eating and drinking outside of an airport is cheaper anyway). Oh, and please tell anyone who wants “to do my own research” before getting the vaccine to consider who’s being hospitalized today and who’s not.
“We’re short-staffed for the new COVID unit”
I think the most under-reported story during the pandemic has been how much our healthcare providers have suffered. Nurses, physicians, physicians in training, medical students, lab technicians, pharmacists - pretty much everyone on the wards of a hospital. You’ve probably heard about the burnout already, and maybe you’ve heard about a bunch of doctors and nurses are leaving healthcare and not looking back. We’re losing a lot of good people and this will impact you, me, and everyone else who wants empathetic, high-quality care.
Ed Yong and the Atlantic do a great job capturing why this is happening and what it’s going to mean 6 months to 1 year from now when you’re trying to desperately get on a doctor’s schedule or wondering why one over-worked nurse is taking care of your mom and 8 other patients at the same time on a hospital ward.
Yes, COVID was stressful and some people burned out and left. But hospitals and healthcare systems have done very little to ease the burden. At a time when the remaining nurses and doctors have asked for more compensation and support, health systems are investing in their administration and back offices instead. Yes, hospitals need to stay afloat, and they need people to manage finances to do that. But, talk to any physician or physician-in-training at a major healthcare system and ask them about how their employer supported them through the pandemic. Ask them if they felt their needs were understood. Ask them how their administration responded as they had to do more to meet daily demands.
Hot Takes
Get vaccinated and keep calm. We’ll learn more about the omicron variant in December.
Pay attention to the hospitalization numbers. As omicron spreads and the next variant comes along, I imagine we’ll see spikes in hospitalizations from the unvaccinated. The real news will be how many of the hospitalized were vaccinated (even 1 dose)
Omicron’s impact on unvaccinated people is going to determine whether our hospitals fill up even more. Delta already hit hospitals pretty hard.
I think healthcare systems respond to public pressure. If you’re an insured person over the age of 35 who has an existing relationship with a healthcare system, I guarantee you there is someone sitting in an office of that system’s admin building, wondering how they’re going to retain you. If you’ve been hospitalized, they care about your reviews of the experience. If they’re treating you for a chronic condition, they want to know what you think of their staff. And if you’re planning a pregnancy and looking for a hospital for your delivery, they will listen to anything and everything you have to say. So, if you’re in this position, just casually ask them sometime: “hey, so what are your patient-to-nursing ratios? What are you doing to bring that number down?”, or “how long on average has your primary care doctor and hospitalist been employed with you? Oh that seems really short. Why don’t they stay longer?” They might raise an eyebrow at your question. But I promise that if enough of you start asking those questions, they’ll have to respond. There’s some wishful thinking there, but not a lot.