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Tuesday, December 28, 2021

12.27.2021 Summary of COVID-19 (and Omicron) Developments

 

A Review of Recent Research Regarding COVID-19

(with a Focus on the Omicron Variant)

(with comments on potential economic impacts)

As of December 27, 2021 

Compiled by Ron A. Rhoades, JD, CFP®[1]

DISCLAIMER: The following should not be considered medical advice. The author of this compilation is neither a physician nor an epidemiologist nor a medical researcher. The information set forth is compiled from numerous sources, including (in many instances) recent “preprint” medical research that has not yet been peer-reviewed. The following isprovided for informational purposes only. If you possess questions about COVID infections, vaccinations, booster shots, treatments, etc., please consult with your physician.


The Research is Ongoing, But Here Is a Summary:

Omicron Continues to Spread Fast

*       There is no doubt that Omicron is spreading much faster than prior variants have done. One recent projection suggests that 60% of the U.S. population will likely contract the Omicron variant in the coming months, with infections peaking at 400,000 per week in early February.[2]

*       Cases of COVID are surging in the U.S. and internationally, per The New York Times’ Interactive COVID tracker, with the vast majority of those cases being of the Omicron variant. “The highly transmissible Omicron variant is sending daily caseloads in parts of the United States soaring to levels higher than last winter’s pandemic peak.”[3]

*       New cases in the U.S. from Omicron may peak by late January or early February, according to the Institute for Health Metrics and Evaluation (IHME), although uncertainty in the projections is acknowledged.

Omicron is Much More Infectious than Delta

*       Omicron appears to reproduce more effectively in the bronchial passages. In turn, this likely increases the transmissibility of the virus, as it is expelled by breathing..

*       Obtaining a booster shot (Pfizer or Moderna) appears to boost antibodies and reduce risk of infection, at least for a period of time.

The Severity of Infection for Many Who Catch the Omicron Variant of COVID May (On Average) Be Reduced

*       Some studies (including those based upon real-world observations) indicate that Omicron is less likely to cause severe illness (i.e., hospitalization, and deaths), on average, among those infected, in comparison to prior variants.

o   Omicron may be less likely to reproduce in the lung tissue (other than bronchial passages), at least for those who are already vaccinated.

*       While the rate of hospitalization from Omicron is likely to be lower, the number of hospitalizations is likely to be higher, given the very high number of cases that will occur.

o   While IMHE projects an additional 172,000 deaths from December 13, 2021 to April 1, 2022, due to Omicron, IMHE acknowledges a great uncertainly exists as to how severe Omicron infection is.[4]

*       Note, however, that there exists questions as to whether there is sufficient research to reliably estimate whether the Omicron variant causes (on average) less severe illness. For example:

o   The New York State Department of Health reported that in New York City, an epicenter of the Omicron outbreak, it "identified four-fold increases in COVID-19 hospital admissions for children 18 and under beginning the week of Dec 5 through the current week" with about half of the admissions are younger than five, an age group that is vaccine ineligible.[5] “On average, 262 children have been in the hospital with Covid-19 on any given day over the week that ended Dec. 24, according to data from the US Centers for Disease Control and Prevention and the US Department of Health and Human Services.”[6]

*       Hope exists. “[E]pidemiologists point out that one common trajectory for viruses is for them to become less lethal but more transmissible over time.”[7]

Impacts of COVID (and the Omicron variant) on the U.S. Economy

*       Restaurant reservations fell over the week ending December 27, 2021, and are now down 27% from 2019 levels, according to OpenTable.[8]

*       Hotel occupancy rates were up 7.7% for the week ending Dec. 18, 2021, compared to 2019 levels, according to Hotel Online.[9] However, several sources cite somewhat lower hotel room searches or bookings were made in past few weeks for future travel.

*       K-12 schools are unlikely to shut down for prolonged periods, as research indicates that younger children are less at risk for serious illness from COVID, and vaccinations are available now for students over the age of 5 years of age. Also, research has demonstrated the detrimental effects of school shutdowns, and the quality of learning appears to be diminished for many students when quick transitions to online learning are undertaken.

*       The prior variants of COVID-10 impacted manufacturers in Asia, leading to factory shutdowns in many countries. This was a major cause of supply chain disruptions, which also caused in large part by a significant rise in U.S. consumer demand). Supply chain disruptions have in turn led to higher prices in 2021 for many parts and goods and transportation, thereby leading to a significant rise in the rate of U.S. inflation.

o   The risk of supply chain disruptions exists with Omicron. While high levels of vaccination in Japan, South Korea, and Vietnam exist currently,[10] Omicron has demonstrated its ability to infect persons despite prior vaccinations (although less severe illness is usually the outcome).

o   Japan, South Korea and Vietnam are detecting initial cases of Omicron in late December, in small clusters. In contrast, China has already shut down one city, with people barred from leavIng their homes except to buy necessities.[11]

*       Unlike March and April of 2020, Omicron is unlikely to lead to shutdowns of most businesses in the United  States, although many businesses may require vaccinations and booster shots for workers (either by choice, or government mandates). Some businesses will require proof of vaccinations (and in some cases booster shots) for customers, as will some universities and colleges. Other businesses (by government mandate or choice) may require staff and customers to be masked.

*       The surge in the number of hospitalizations will put additional strains on health care systems in the U.S., and around the world.

*       The recent approval by the Food and Drug Administration of Pfizer’s pill (“Paxlovid”) to treat COVID-19, which pill “reduced combined hospitaliztions and deaths by about 89% among high-risk adults,”[12] may assist in reducing the severity of the Omicron infection. Pfizer’s lab results indicate the pill remains effective against the Omicron variant.[13]

o   Only 65,000 courses of Pfizer’s pills will be delivered in late December,[14] with another 200,000 courses available and delivered in the United States during January.[15]

o   The U.S. “will also have 3 million of Merck & Co.’s Covid pill, developed with partner Ridgeback Biotherapeutics LP, by the end of January.”[16] However, Merck’s pill appears to be less effective, as the “data showed it cut the risk of hospitalization or death by 30% among high-risk adults.”[17]

*       Long COVID continues to be a drag on the level of employment in the U.S. (although other factors exist, such as substantially higher costs for child care since COVID emerged, early retirements by many workers, and fear of COVID preventing some from returning to work). Shortages of workers in the U.S. persist, which in turn tends to stoke wage-driven inflationary pressures and increases the danger (still somewhat low) of a wage-price spiral occurring.

o   For those with long COVID, cognitive and physical deficits persist many months after discharge in people previously hospitalized with acute COVID-19. However, there is considerable variation in the severity of symptoms and their persistence.[18]

o   Long COVID can occur following a “mild COVID” infection (not requiring hospitalization).

o   According to one research study, more than half of those who contract COVID will experience post-COVID symptoms, such as fatigue, shortness of breath, chest paid, and sore joints, up to six months after recovering.[19]

o   “[B]ased on published studies and their own experience treating patients, several medical specialists said 750,000 to 1.3 million patients likely remain so sick for extended periods that they can’t return to the workforce full time.[20]

Vaccines and Booster Shots – Bottom Line Recommendations

*       If you are eligible for the booster shot, it is highly advisable to obtain same. Being vaccinated and boosted is your best line of defense against severe illness from COVID-19.[21]

*       If you have had COVID, but have not yet been vaccinated, please talk to your physician about the benefits and risks of vaccines, as various studies have indicated that the Omicron variant much more easily evades the antibodies achieved from a prior infection alone.

*       If you have never had COVID, and if you have also never been vaccinated, please consult with a physician about the benefits and risks of vaccines. In general, you remain the most at risk from the Omicron variant, including the most at risk for severe illness, hospitalization, and death.

Consumer Resources for More Information About COVID-19:

*       The John Hopkins “Frequently Asked Questions” page is very helpful in answering a very broad range of questions about COVID-19, its avoidance, symptoms, treatments, vaccinations, and much more.

*       The New York Times’ Interactive COVID Tracker provides global, national and state-by-state data on the number of cases.

*       Dr. John Campbell, a former nurse educator, provides a video explanation daily on COVID and developments. While his explanations are easy-to-understand, be aware that his often-criticisms of health departments’ data releases, and his support for an unproven treatment, have been widely panned, and be aware that John Campbell is neither a physician nor an epidemiologist.

Now, excerpts from a few recent research studies …

1.      Omicron is likely to lead to more infections; many of the infections are likely to be less severe as Omicron less able to infect

The following is from a discussion of a preprint study posted on Dec. 21, 2021.

“The omicron variant of SARS-CoV-2 may be less efficient at infiltrating the lungs and spreading from cell to cell, compared with other versions of the coronavirus, early studies of human cells in a lab dish suggest.

This may help explain why some early data from countries such as South Africa and England suggest the strain causes less severe disease. But although omicron may not invade lung cells efficiently, the new study, posted Tuesday (Dec. 21) to the preprint database bioRxiv, confirmed that the variant dodges most of the antibodies made by fully vaccinated individuals.

And similar to other research, the team showed a ‘booster’ dose of the Pfizer vaccine significantly increased the neutralization power of vaccinated people's antibodies, ‘though we'd still expect a waning in immunity to occur over time ….’ "[22]

2.      Less Likelihood of Hospitalization Exists for Many of Those Who Become Infected with Omicron Variant

From a Dec. 23, 2021 article in The Wall Street Journal summarizing several (pre-print) studies.

“People infected with the Omicron variant of coronavirus are between 50% to 70% less likely to be admitted to the hospital than those who caught earlier strains, according to a new U.K. study that adds to a growing body of evidence of Omicron’s reduced severity in populations with high levels of immunity.

The analysis from England, published Thursday by the U.K.’s Health Security Agency, follows studies in Scotland and South Africa that also pointed to a substantially lower risk of hospitalization with Omicron than with more established variants, including Delta.

Scientists are still unsure how these encouraging findings around hospitalizations will stack up against Omicron’s much increased transmissibility, and ability to partially evade the protection of vaccines. The risk, they say, is the variant could still cause a big wave of hospital admissions simply by infecting many more people.”[23]

3.      Antibodies from vaccines, prior infections, and monoclonal antibodies are not as effective against infection from the Omicron variant compared to prior variants. However, receipt of a booster shot leads to much greater effectiveness, and rapid administration of Booster shots is recommended.

The following is an excerpt from a study was posted to a preprint server for health sciences, medRxiv, on December 24, 2021.

“Researchers in Botswana and South Africa identified a new and heavily mutated SARS-CoV-2 variant (B.1.1.529, Omicron) in late November 2021, with 30 amino acid mutations in the Spike protein that are distinct compared to other variants of concern (VOC) Alpha, Beta and Delta. Omicron is characterized by fast spreading in previously vaccinated populations, suggesting Omicron’s ability to evade vaccine-induced immunity and therapeutic monoclonal antibody therapy. Several recent pre-print studies have indeed confirmed a substantial reduction in neutralising antibody activity against Omicron in small-scaled studies including previously infected individuals, fully vaccinated individuals, recipients of third booster doses of BNT162b2 [the Pfizer-BioNTech COVID-19 vaccine] or mRNA-1273 [the MOderna vaccine] and individuals with hybrid immunity (infection followed by vaccination). The common trend from these first laboratory-based assessments is that the potency to neutralise Omicron is reduced by approximately 40-fold (20-200-fold depending on the study) compared to the original Wuhan D614G virus.”[24]

The study further noted a 7.2-fold reduction of the Pfizer-BioNTech COVID-19 vaccine against the Delta variant, compared to the original virus.  However, the study noted that three doses of the Pfizer-BioNTech COVID vaccine results in high neutralizing antibodies for the Wuhan, Delta and Omicron variants. “The observation that a 2-dose schedule of BNT162b2 is not sufficient to neutralize Omicron warrants for rapid administration of a booster vaccine dose to counter infection and limit disease caused by this variant.”

The study further noted that vaccine-induced immunity significantly outperformed naturally-acquired immunity.

4.      The risk of myocarditis following vaccination are small but not insignificant, but overall risks from COVID are far greater for those who are unvaccinated, in comparison. And COVID can cause myocarditis, as well.

The following is an excerpt from study posted to a preprint server for health sciences, medRxiv, on December 25, 2021, and it appears to confirm several previous studies finding similar conclusions.

“Altogether, the rate of developing myocarditis or myopericarditis within 28 days of any SARS-CoV-2 mRNA vaccine was 1.7 per 100,000 vaccinated individuals.

Among those who had received the Pfizer vaccine, the researchers noted, the rate of myocarditis or myopericarditis was 1.4 cases per 100,000 individuals — with 1.5 cases per 100,000 males, which was not significant, and 1.3 per 100,000 females, which was significant.

Meanwhile, those who had received Moderna vaccines were significantly more likely to develop myocarditis or myopericarditis in the 28 days after vaccination, compared with unvaccinated individuals. Altogether, there was an average of 4.2 cases per 100,000 people.

When looking at incidence rates for men and women, the researchers found that Pfizer and Moderna vaccines were linked to 1.3 and 2 cases per 100,000 among women, and 1.5 and 6.3 cases per 100,000 among men, respectively. [The article noted the difficulty in diagnosing myocarditis, however.]

The team noted, however, that people who had received either mRNA vaccine had around half the risk of cardiac arrest or death, compared with unvaccinated individuals at follow-up …

The researchers stress that although mRNA vaccines are linked to an increased risk of myocarditis and myopericarditis, vaccines against COVID-19 are still extremely beneficial when COVID-19 case rates are still high. This is because the absolute rate of these side effects is still very low …

The vaccinations are not perfect, but they are working to save lives, a stark contrast to the risks of infection…

People should not be too concerned about this adverse event. It is rare, and it is most likely mild. The individual and societal benefits of vaccination still clearly outweigh the risks. Especially when the alternative is infection, which in itself may cause myocarditis, severe COVID-19 disease, and long COVID…”[25]

5.      Long COVID: The Virus Can Remain in the Body for as Long as Eight Months

From an article in Forbes citing a study from the National Institutes of Health.

“Though it's long been known to linger in respiratory tracts for weeks after infection, the coronavirus that causes Covid-19 can quickly spread to the entire body and remain in the heart, brain and other organs for as long as eight months, according to new research from U.S. scientists – shedding light on so-called long Covid infections as experts warn the highly contagious omicron variant could spur a surge in U.S. hospitalizations.”[26]


[1] Ron Rhoades is an Associate Professor of Finance at Western Kentucky University, where he serves as Director of its Personal Financial Planning Program. He is also a financial advisor in ARGI’s Bowling Green office. He can be reached via bear@argi.net.

[2] IHME COVID-19 Results Briefing (Dec. 22, 2021). “[Our reference scenario suggests that over the next two months, 60% of the population will likely be infected with Omicron. Because of a much greater fraction of asymptomatic infections (likely over 90%) and thus a lower infection detection rate, we expect diagnosed cases will increase to a peak of 400,000 in the first week of February. Based on the data from South Africa, the United Kingdom, Denmark, and Norway, we expect that the infection-hospitalization rate (IHR) for Omicron compared to Delta will be 90%–96% lower. Despite the lower IHR, the pressure on hospitals is likely to be similar to last winter, with considerable variation across states. Likewise, based on the available data, we expect the infection-fatality rate (IFR) will be 97%–99% lower than for Delta. Huge numbers of infections and moderate numbers of hospitalizations may still translate into a peak of daily deaths over 2,000 in early February … While we believe our reference forecast reflects the available evidence on Omicron, huge uncertainties remain for key assumptions …The most important uncertainty is how severe Omicron infection is.”’ Id.

[4] IHME COVID-19 Results Briefing (Dec. 22, 2021).

[5] “New York sees increase in hospitalised children as Omicron hammers US,” Channel News Asia (Dec. 27, 2021).

[6] Virginia Langmald, “Pediatric hospitalizations continue to rise in the U.S., CDC and HHS data show.” CNN (Dec. 27, 2021).

[13] Id.

[15] Id.

[18] Deep Shulka, “Long COVID: 3 in 10 COVID-19 patients not fully recovered after 1 year,” Medical News Today (Dec. 22, 2021). Another study has lower figures - “The Lancet medical journal says 57% of hospitalized patients and 26% of non-hospitalized patients show post-Covid symptoms months after infection.” Lisa Beilfuss, “Where Are the Workers? Millions Are Sick with ‘Long Covid’,” Barron’s (Dec. 8, 2021).

[20] Christopher Rowland, “Long covid is destroying careers, leaving economic distress in its wake,” The Washington Post (Dec. 9, 2021).

[21] John Hopkins Bloomberg School of Public Health, Dec. 21, 2021.

[23] Jason Douglas, “New U.K. Study Reinforces Conclusion That Omicron Causes Less Severe Disease,” The Wall Street Journal (Dec. 23, 2021)

[26] Jonathan Ponciano, “Covid Can Linger In Body For Months, Study Finds, As Fauci Sounds Alarm On 'Extraordinarily Contagious' Omicron Variant,” Forbes (Dec. 26, 2021), located at https://www.forbes.com/sites/jonathanponciano/2021/12/26/covid-can-linger-in-body-for-months-study-finds-as-fauci-sounds-alarm-on-extraordinarily-contagious-omicron-variant/?sh=3380d80d2c42, citing research article published at https://assets.researchsquare.com/files/rs-1139035/v1_covered.pdf?c=1640020576

Sunday, December 19, 2021

Reflections on the Destructive Tornado Hitting Bowling Green

Having lived in Bowling Green, Kentucky, for just six years, I have only experienced a handful of tornado warnings, none of which led to actual damage, injuries, or deaths near us. The early morning hours of Saturday, Dec. 11th led to an experience which was altogether different.

Shortly before 1:00 a.m., our phones buzzed loudly with the warning from the National Weather Service. My wife and I awoke our other family members. Within moments a loud tornado siren could be heard, echoing through the darkness.


Less than a minute went by. The winds seemed to pick up, to the level of a low roar. The four of us huddled in the small area underneath our stairs. As the storm was moving across our area at highway speeds, some five minutes later the news channels reported that we were in the clear as the tornados moved far past us and northeastward.


The Devastation is Revealed


Later that Saturday morning, as the sun arose, the world still seemed dark. The terror of the night had morphed to a cold day revealing countless personal tragedies. The fear just a few hours before was displaced by sadness, despair and hopelessness.


Incredulity was felt not just throughout Bowling Green, but also in Mayfield, Kentucky and in dozens of small communities and hamlets in western Kentucky and several surrounding states.


News reports cautioned us to stay away from the affected areas, to permit rescue activities. As the short daylight hours progressed, the full scale of the disaster became apparent. The tornado had driven a long path through Bowling Green. Over five hundred homes and one hundred businesses were destroyed. Sixteen individuals from Bowling Green lost their lives, most from just two families. Over a hundred persons were injured physically, and the emotional toll was even greater.


The Search and Recovery Efforts


In our close-knit community, everyone personally knew someone who was affected. We began our search for the dead and injured, and our outreach to those who lost their homes or businesses.


Those who suffered less, or not at all, emerged into the day to provide immediate support to those who had lost so much more. A small army of volunteers bearing chain saws emerged to clear roads to enable rescue and utility vehicles to access devastated neighborhoods.


First responders and volunteers were joined by members of the Kentucky National Guard, along with members of Team Rubicon Disaster Response.


Construction companies provided, at no cost, their equipment to assist with search and rescue and the necessary removal of debris. Skilled workers, many of whom had seen wind damage at their own homes, emerged throughout the cold morning to assist in the search and recovery efforts, often lifting entire sides of buildings up with heavy equipment to empower the search for any persons who may have been underneath.


Others assisted families to recover personal items and furnishings that could be salvaged from hundreds of homes. Citizens joined together to assist business owners in recovering and storing what inventory and equipment could be salvaged from the wreckage.


Initially Sheltering and Providing for the Displaced


Hundreds of additional volunteers converged on the affected areas, and in the shelters set up to house the many families that had been displaced. Each call for needed supplies was met with an overwhelming response. Clothes, food, and other necessaries were received, sorted, and handed out – a time-consuming process that continues to this day.


Food trucks and nearby restaurants opened to feed the army of first responders and volunteers thousands of free meals. Tents emerged in the heavily damaged areas to provide a place to hand out free drinking water and sandwiches, as well as a place to listen and console. Other volunteers cooked and furnished meals at the nearby schools that were opened as shelters to assist those hundreds displaced. Cots, inflatable beds, and blankets were donated to afford those who sheltered greater comfort.


Still more volunteers distributed meals to those whose homes had suffered damage, or who had lost water or power. And many families opened their own homes to those families who, in what seemed like the blink of an eye, had lost their own.


Community leaders organized the volunteers and recovery efforts. Western Kentucky University’s Center for Research and Development provided a central location from which to coordinate the army of volunteers, and the University provided housing to first responders. Churches both locally and dozens of miles away collected and distributed food and other donated supplies.


Days Later, the Search Ends. The Recovery Efforts Continue.


The search for survivors ended six days after the storm. The last of the missing, a 13-year-old girl, was sadly found lying dead a few hundred yards from her home, in an adjoining neighborhood.


Into our welcoming community of Bowling Green, refugees from many places in the world – such as Mexico, Bosnia, Myanmar, Iraq, Ghana, Zaire, Kenya, El Salvador, and Afghanistan – have been accepted with kindness and compassion. As the recovery efforts continued, no one cared about another’s political affiliation, religion, race, nationality, or creed. Those most affected were provided with an arm to lean on, hugs, and helping hands.


Anguish began to be replaced by hope.


All those who have personally witnessed, or participated in, this outpouring have been rewarded. By a restoration of faith in mankind.


We Tour the Damage.


Today, for the first time, more than eight days after the tornado hit, I ventured out with my wife to survey some of the damage.


We saw many homes stripped to their foundations. So many other homes were simply damaged beyond repair. Local businesses, some of which were passed down from generation to generation, simply stand no more.


A piece of wood pierced completely through the side of one car. The roofs of many houses were penetrated by trees and other debris. Small groves of trees that once stood to veil neighborhoods were gone, revealing the wholesale destruction of residences beyond.


After more than an hour of driving through affected areas, we could not go on – despite the fact that we had likely only surveyed less than one-quarter of the damaged areas. We drove home in silence.


The clearing of debris continues, as Bowling Green and many other communities seek to repair and reopen its streets and other infrastructure. Power and internet service are still being restored, with progress made each day.


Feelings of Gratitude, Yet Scars Remain


We are grateful for the hard work of the utility crews, public servants, and the many volunteers. In the weeks and months ahead, we will seek to rebuild. Our collective community spirit, and the ongoing support from both near and far, provides fuel the hard work ahead.


Yet, no tragedy such as this comes without leaving lasting wounds. Not just physical marks, but also the emotional scars that may reach into the very depths of the soul.


Such scars can be ameliorated with hope, with love, and with sustained care. In the process of adhering to the wounds our fellow citizens suffered, we may yet find a new awareness and appreciation for the heroes around us in our everyday lives. We praise those who carry on in the face of their tremendous personal adversity.


The tornado hit Bowling Green very hard, and its memory will follow us in the decades to come. But also enduring, through the passage of time, will be the memory of the tremendous outpouring of love and assistance from all those who have aided our community in its recovery.


The Need Continues


It is less than a week now, before Christmas Day. It is hard to even hear, much less sing along, to the carols we hear on the radio. For we know that the need remains tremendous, as Bowling Green and other communities in western Kentucky continue to bury the dead, care for the wounded, clear the debris, and begin to rebuild.


If you desire to help, even from afar, here are just a few of the many ways:

·       Governor Beshear has established the Team Western Kentucky Tornado Relief Fund to assist those impacted by the tornados.

·       First Lady Britainy Beshear is seeking toys, books and gift cards for the children affected by the tornados through her Western Kentucky Toy Drive.

·       Western Kentucky University’s Food Pantry continues to provide meals throughout the holidays (including Christmas Day) to those in need.

·       To assist Western Kentucky University students who have been adversely affected, monetary donations can be made to WKU’s Emergency Student Assistance through the Opportunity Fund website.

#BGStrong


Dr. Ron Rhoades is an Associate Professor of Finance at Western Kentucky University, where he serves as Director of its Personal Financial Planning Program. He is also a financial advisor in ARGI’s Bowling Green office. He can be reached via bear@argi.net.