The United States is facing an acute COVID outbreak, fueled by the new highly infectious, Omicron variant. Countrywide, more than 200,000 cases per day are now being logged. In addition, record rates of infections are being reported across major metropolitan areas including New York City, the epicenter of the first large COVID outbreak at the beginning of the pandemic in America. Nationally, hospitalizations are up ~50% since November, albeit from a low base. In locations where vaccination rates lag, many hospitals are quickly becoming overwhelmed (the United States has a good healthcare system, but very little spare capacity). Regrettably, the rolling 7-day average for deaths is 1,656 per day.

Indeed, as the number of positive COVID cases goes parabolic, fear has gripped the nation. People can be found snaked around corners in cities across America, waiting to be tested. Holiday parties have been canceled, colleges have closed campuses and migrated back to remote learning, businesses have told their employees to work remotely, Broadway has shuttered its curtains - again - and Christmas excursions have been shelved. Might all this be…good news?

Before arguing why we believe the answer is “yes,” we want to preface our arguments by clearly stating that we take COVID seriously. We encourage all Americans to get inoculated, be prudent around higher- risk citizens and wish those who are ill a swift recovery. Our thoughts go out to the unfortunate victims who succumbed to COVID.

From Pandemic To Endemic

With the risk of ending up with an egg on our face, we believe COVID cases will peak in the United States over the next few weeks and then drop precipitously. Even more encouraging, though far from experts on virology, from what we can discern, COVID is behaving similarly to other viruses that have morphed from pandemic to endemic: it is becoming more infectious but less deadly.

According to the National Institute for Communicable Diseases in South Africa where the Omicron variant was first identified, patients are 80% less likely to be hospitalized if they catch the Omicron compared with other strains. In a recent Scottish Study, Omicron hospital risk was ~66% lower than Delta. Another study from the U.K showed similar results.

Over the next 12-24 months, we suspect mortality rates for COVID and how we co-exist with COVID will converge with that of another endemic virus, the flu.

A Good Host

Unlike bacterial infections, viruses need a host - animal or human - to survive. When the host dies, the virus dies. Some viruses, including other coronaviruses like SARS (mortality rate ~10%) and MERS (mortality rate 40%), do not tend to become pandemics because they are too deadly. Specifically, too many hosts die before the viruses can reach escape velocity and infect hordes of people. Other coronaviruses, such as the common cold, are not thought of as pandemics because while they are highly infectious – every year, hundreds of millions of people “catch a cold” - most cases are mild.

COVID was right in the “sweet spot.” A virus that was infectious enough to pass the baton exponentially to new hosts, deadly enough to kill 2%-3% of (initially) infected people, but not so lethal that it eliminated too many hosts to enable it to reach escape velocity.

Perspective

By now, we have all read the daily headlines about rapidly increasing COVID cases, hospitalizations, and deaths. Those data are true and the headlines unnerving. However, data in a vacuum lacks perspective and is of little use. It is imperative to examine these statistics in the appropriate context.

Because we believe COVID is morphing from pandemic to endemic, we believe it is appropriate to compare COVID data with that of the most dangerous endemic virus currently circulating, the flu.

The flu can rear its ugly head at any time, but typically stalks its prey during “flu season,” between December and March of each year. According to the Centers for Disease Control and Prevention (CDC), the flu kills ~36,000 Americans per year and is responsible for ~650,000 annual hospitalizations; millions of others become symptomatic and recover at home.

Considering the aforementioned data, the math equates to the following: on average, each and every day during “flu season,” influenza will kill ~300 Americans, put ~5,400 in the hospital, and infect ~200,000. These are indeed sobering statistics and a reminder of how dangerous and deadly the flu can be.

But keep in mind, a reminder is only needed in the first place because unlike for COVID, daily infection, hospitalization, and death rates for flu are not plastered on television and across social media.

COVID is dangerous and at present still more deadly than the flu. We must remain prudent and responsible, but not hysterical.

We Cannot Beat This

After getting inoculated, some recipients post on social media that they “got vaccinated” and that “we can beat this.” At TQC, we are proponents of and highly encourage people, to get vaccinated. That said, the idea that COVID can be “beaten” is nonsensical.

(Only two viruses, smallpox, and polio have been completely eradicated. And those diseases had very different properties than COVID. For one, they were materially more lethal. Secondly, in America ~95% of children are vaccinated against polio; smallpox vaccinations stopped in 1972 after the disease was officially eliminated.)

Indeed, just as we cannot “beat” the flu, we cannot “beat” COVID. Both viruses mutate faster than vaccines – even the MRNA kind - can be tweaked. And depressingly, the uptake of COVID vaccines in America is pitifully low (~65%). For the flu, it is even lower (~50%).

(There is an inverse correlation between how deadly a virus is and vaccine uptake. The less lethal a virus becomes, the fewer people will choose to get vaccinated. The lower the vaccination rate, the higher the probability a virus will continue to mutate, re-circulate, and so forth.)

We Can Co-Exist

Fortunately, we can leverage our rapidly expanding toolbox of treatments and co-exist with COVID, just like we do with the flu.

This week the FDA granted emergency authorization for the first oral (pill-form) antiviral treatments to combat COVID, greenlighting medication from Pfizer (Paxlovid) and Merck/Ridgeback (Molnupiravir). Both drugs are efficacious in reducing the risk of hospitalization and death.

Gilead Sciences antiviral therapy (Remdesivir) has also proven effective, as has Dexamethasone, a cheap steroid. Antibody therapies from the likes of Regeneron are now readily available and can be administered intravenously.

Scientists at the Walter Reed Army Institute of Research are working on a vaccine that is effective against many different coronaviruses including COVID-19 and its variants, SARS, MERS, etc.

Existing vaccines from Pfizer/BioNtech, Moderna, Johnson & Johnson, and others are somewhat effective at mitigating the spread of COVID and very effective in preventing death and severe disease, even for the new Omicron variant. To be certain, many vaccinated people have gotten COVID, however, COVID deaths and hospitalizations are disproportionately represented by unvaccinated people.

(For COVID, MRNA vaccines are preferred over traditional inoculations because they can be modified more quicky than traditional vaccines. This is important when combating a rapidly mutating virus. Misinformed antivaxxers make dubious claims that MRNA technology is so new that it cannot possibly be trusted. Nonsense. The scientific miracle that enabled MRNA vaccines to go from lab to arms in 24 months took ~20 years to perfect. We all must remember; decades of research are typically needed to create overnight successes.)

At TQC, we are cautiously optimistic that in relatively short order, the combination of more infectious but less deadly mutations, vaccinations, general knowledge, and an ever-expanding toolbox to combat COVID, will render it analogous to flu, an endemic virus that is manageable. That would be fantastic news indeed.

Preparation

Hospitals across the nation are bracing for an influx of covid patients. In areas of the country with low vaccination rates, certain facilities are already overwhelmed. However, this week, Michael Dowling, CEO of Northwell Health in New York - where case numbers are breaking records but vaccination rates are well above the national average - said the Omicron surge was not overwhelming his hospitals:

“We're doing very, very well, very manageable.”

In response to a surge of demand for testing services, the Federal Government has instructed FEMA to:

• Set up federally administered testing sites across the country.

• Purchase 500 million at-home testing kits to be distributed via mail, free of charge.

• Send 1,000 military doctors and nurses to provide additional support to hospitals, as needed.

• Deploy ambulances and support teams to transport patients to alternative health care facilities if a hospital reaches capacity.

When the Federal Government actually prepares for a calamity they claim is coming, the worst-case scenario rarely materializes. When FEMA is finished enacting the bullet points listed above, more than likely the COVID wave we are currently experiencing will already be in the rear-view mirror.