What does it mean for Omicron to peak? Health officials in New York and Boston, two of the first places in the United States to experience Omicron epidemics, voiced cautious optimism this week that record-breaking COVID case counts were beginning to fall.
This pattern parallels the experience of countries such as the United Kingdom, Denmark, and South Africa, which were all severely affected by the rapidly spreading COVID strain but had the outbreak subside within three or four weeks.
Most forecasts of Omicron’s spread currently concur that the surge will likely reach its peak before the end of January. However, health officials in Michigan and Idaho are warning that instances are increasing faster than they can track. What does it imply, then, for a pandemic wave to peak, given this patchwork pattern of statewide spiking and declining cases?
A peak, in the simplest sense, is the point at which day-over-day COVID infections begin a persistent drop. That is not something epidemiologists can directly observe, as they cannot count each and every case. However, based on past waves’ experience, Spencer Fox, associate director of the COVID Modeling Consortium at the University of Texas at Austin, argues that by examining case counts, it is possible to gauge in advance if infections are falling.
When case counts grow at a slower rate, it indicates that infections are slowing which leads us to answer the question “What does it mean for Omicron to peak?”. (Consider a surge as a car speeding down the highway—a foot must be taken off the accelerator before the automobile slows.)
According to Fox’s team’s model, “the peak is actually the point in time when the population has developed sufficient protection as a result of the spreading virus to begin self-limiting.” Consider this to be temporary herd immunity.” This is not the herd immunity that some believed would stop the epidemic, as it will not last, but it does mean that the virus has less fuel to burn for the time being.
However, case counts alone can be an imprecise guide to determining a peak. Fox cautions against placing undue reliance on them during Omicron, owing to the high number of persons who were unable to get tested during the holidays. “Obtaining a test is quite difficult.
Thus, if we reach the point where the country’s testing capabilities are saturated, we may see a reduction in case counts that is not due to an epidemiological component,” he says. If test capacity is reached, cases may continue to grow unnoticed. Additionally, as some observers have noted, health authorities frequently delay the release of complete case counts by a few days, giving the illusion of a reduction.
Water testing for the pathogen can provide additional evidence: Biobot has contracts with a number of counties around the country to measure SARS-CoV-2 levels in sewage and other effluents, which can be used to more accurately estimate the scope of an outbreak. “Wastewater data covers all infected individuals who shed the SARS-CoV-2 virus in their feces,” Nour Sharara, a Biobot public health expert, writes in an email to Popular Science. “By being comprehensive, health officials can ascertain the extent to which illnesses spread across a community.”
Significantly, a true peak is still discernible only in retrospect. In response to a question about how long he would need to wait to be certain that a surge had peaked, Sharara replies, “There is no magic number of days.” What we’re looking for are results from consecutive days’ worth of wastewater samples that all confirm a downward trend.”
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The Omicron outbreak has shattered COVID case records on a daily basis. Centers for Disease Control and Prevention (1/13/22)
Biobot has begun to observe a continuous drop in SARS-CoV-2 infections in the Boston area, indicating that the number of new illnesses has begun to decline.
“Thus far, the pandemic has demonstrated substantial geographical parallels, with nearby cities and states exhibiting similar regional trends,” Sharara says. “While not all communities in the Northeast have publicly available wastewater tracking data, it is possible that the Greater Boston area’s peak is indicative of a regional peak in some circumstances.”
Susan Hassig, an epidemiologist at Tulane University, is likewise optimistic that cases have peaked in Louisiana—another early Omicron transmission site—based on recent drops in weekday case counts. However, she is not positive that further hospitalizations will follow the same pattern.
Hospitalizations have followed instances in prior waves, although Fox thinks the wait isn’t as significant as people believe. Individuals develop symptoms over a few days, so if they wait to get tested, they may be only days away from potentially severe illness. According to Fox, based on data from forthcoming research, “hospital admissions are not that far behind case counts.” Our research indicates that case counts correlate with hospital admissions by a couple of days, but not by the week that we thought at the start of the pandemic.”
The question, Hassig says, is whether the association between case numbers and hospitalizations will continue to remain true in light of the large number of instances that have gone unnoticed. “The hospitalizations we’re seeing should definitely not be associated with cases, given the instances aren’t indicative of infections,” she says.
Fox’s team predicted last week that the national peak for Omicron cases would occur between January 9 and 18. That prognosis was based on an incomplete understanding of the variant’s infectiousness and severity, and Fox reports that more recent analysis has moved that estimate to the end of January. Another model developed by the Institute for Health Metrics expected a surge in cases around January’s third week.
Although COVID waves are frequently reported nationally, local epidemics define pandemic surges. Regional epidemics can take on a variety of forms, depending on factors such as housing density, vaccination status, and prior infections. While the Delta variation was responsible for the pandemic’s harshest conditions in many places, Hassig notes that it did not result in a distinct statewide peak in cases.
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The entire country is currently experiencing Omicron at the same time, owing to the variant’s appearance during the Christmas travel rush. However, this does not guarantee that it will look the same elsewhere.
When Omicron began to spread, hospitals in the Upper Midwest and Northeast were still overwhelmed by Delta patients. “When Omicron appeared, their hospitals were not cleaned,” Hassig explains. And even once cases reach a national peak, they may continue to rise in states such as Texas and California, where Omicron took longer to catch on.
Individuals have the ability to sculpt peaks. “If we as a community alter our behaviors today, wearing masks, socially isolating ourselves, and avoiding some non-essential activities, we will witness an unpredicted peak this week,” Fox adds. “We have the means and the ability to take action to prevent the peak from reaching the heights projected.”
In all, we have been able to answer the question “What does it mean for Omicron to peak?”.
