Well, here we are once again… we are now in the midst of the largest COVID wave yet. One year ago I stuck my neck out and made some predictions about COVID during 2021. I’ll review what I said last year and offer my thoughts for 2022, but first a look at where we stand today.
Here is what I’m modeling for known active cases at year end in the United States.
This latest wave (I’ll call it the Omicron Wave) is more than twice the size (so far) of the Delta Wave in late summer. Now that home testing is commonplace, I’m sure that these numbers are underreported, perhaps by ½. As of new year’s eve, nearly 1 in 100 Americans were know to currently have COVID. If we add in those that tested positive at home and not counted in the official numbers, it might be twice that, or 1 out of every 50 Americans. This dwarfs anything we’ve seen in the past two years.
But, you ask, isn’t Omicron far less deadly? Let’s look at that. Here are daily deaths together with my daily death projection.
My model shows deaths reaching over 4,000 per day by January 21st. However, this model was fit to data during last winter’s Alpha Wave, and may not prove true with Omicron. Right now it’s just too early to know. Below are the daily deaths per 1,000 known active cases with a 21 day lag. The red line is the trend, and it looks pretty stable. So I’m not seeing any indication yet that deaths per known case are declining. I expect that they will, however, based on current hospitalization rates. Even if the death rate per known case doesn’t decline, this still speaks to a decline in overall mortality rate, because a growing proportion of positive tests go unreported.
How many positive tests are we missing in the reported data? I wish I knew, but we can make a reasonable assumption. We know that as of early December we were testing about 1.5 million people a day at official testing sites. That’s about 45 million tests per month. I can’t find reliable data on home tests (Rapid Antigen Tests). However, Abbott, with the largest market share in the U.S., said a couple of weeks ago that they hope to ramp up test delivery to a rate of 70 million per month by the end of December 2021. Ellume, another significant supplier, quoted similar numbers. Adding the other 10 home tests currently approved, I think a reasonable guess is that we’re at a run rate of at least 150 million home tests per month. That’s significant – I believe that home testing is significantly larger than PCR testing at testing sites (the reported testing). I know that the CDC recommends getting an official PCR test if you show positive on a home test, but even if half of those testing positive at home confirm it with a PCR test, we’re still missing ½ of all COVID cases in the count. From this I’m expecting the overall mortality rate from Omicron to be about 50% of Alpha and Delta.
Predictions From a Year Ago
Media this time of year is full of predictions for 2022. Lots of people make predictions about this stuff and they’re generally wrong. So let’s see how I did. This is from my report at year end 2020:
“So what does this mean for 2020? Of course, the biggest news is the vaccine rollout. My math tells me that we will need far less vaccine deployment to contain COVID than most of the experts are claiming. I think somewhere less than 100 million inoculated will do it. For more, see my December 9th discussion below. However, any additional inoculated people slows down COVID transmission. To see real declines, we don’t have to reach herd immunity – we just need the transmission rate (Rt) below 1.0. Every person who gains immunity, either through contracting COVID, or through inoculation, slows down the transmission rate. As a result, I predict that we’ll see COVID in rapid decline in 2 months’ time, by the end of February, and life will more or less return to normal by spring 2021. After springtime, we’ll still see breakouts in certain communities based on vaccine acceptance, but it will be even more geographically localized than it is now, and these clusters will burn out quickly. “
So… the first part of my prediction did in fact, come to pass: As a result, I predict that we’ll see COVID in rapid decline in 2 months’ time, by the end of February, and life will more or less return to normal by spring 2021. We did see COVID in rapid decline by the end of February, and life did largely return to normal by spring. I did not, however, foresee further mutations rapidly spreading on top of a vaccinated population. My working assumption was that those vaccinated would not carry and spread COVID to any significant degree, and this turned out to be erroneous. During the Delta Wave, this was a point of great debate, but now it seems clear that Omicron circulates among those vaccinated and unvaccinated alike. We don’t know the numbers, as the CDC made a policy decision last spring NOT TO TRACK BREAKTHROUGH INFECTIONS. I think this was a policy mistake, but that is where we are. Now, before you compose that angry email, I am not saying that vaccinations are not useful or protective – but since vaccinations do not prevent contracting or transmitting COVID, they will not eradicate the disease.
My COVID Predictions for 2020
I’ll leave you with my thoughts for 2022:
- COVID is not going away. One year ago I assumed that the vaccines would be the end of COVID. My working assumption was that vaccinations prevented the hosting and transmission of the disease. We now know that this is not how the vaccines function. I do think that COVID will be less deadly with each wave as society builds up higher levels of resistance, either through vaccine refinement or natural immunity. Eventually we’ll think of it like the flu. Yes, also a deadly disease, but we don’t live in fear of it.
- The Omicron Wave will peak this month, and be substantially over by February. Each of the previous waves lasted about 90 days from emergence to end, and peaked roughly 8 weeks from the beginning. Since Omicron is materially more infectious than Alpha or Delta, this wave will be shorter.
- Deaths from the Omicron Wave will be as high as the Delta Wave, but the mortality rate will be much lower. Case counts for Omicron are higher than Delta, but these numbers are certainly underreported. I’m modeling that the mortality rate for Omicron will be something like 50% of the mortality rate for Delta. Keep in mind that this wave is huge, and that will still be a lot of COVID deaths. I believe we peak this month anywhere from 2,000 to 5,000 deaths per day. I know that’s a big range, but we just won’t know for a couple of weeks, since death reports lag cases by about 21 days.
- Data quality around case counts will continue to erode, and become nearly useless. With the advent of home testing, a growing proportion of COVID cases will go unreported. Of those reported, we no longer know what we are counting. How many of those are serious illness, and how many are asymptomatic or mild? Monitoring hospital stays and deaths will continue to be useful, but it’s not possible to track cases any longer. The CDC uses a survey and extrapolation method to estimate flu cases, and that’s where we’ll need to go for COVID before long.
- The White House plan to distribute 500 million home tests will make test shortages worse. At current distribution rates, 500 million home tests is about a 3 month supply. If the program proceeds, the government will pull 500 million units from the national supply and dole them out in typical slow and inefficient government fashion. I’m imaging having to go to a clunky website, set up an account, go through some sort of verification, and then wait for the mail. I’ll be surprised if the first test sees a mailbox by the end of January.
- The narrative that “this is a pandemic of the unvaccinated” will fall apart. Now that we know that many fully vaccinated (and boosted) people are contracting and transmitting COVID, the idea that if only we had 100% participation in vaccination we eradicate COVID has lost credibility. I do believe that the unvaccinated will continue to be overrepresented in hospitalizations and deaths. As of today, 86% of adults have had at lease one vaccine, and 73% are fully vaccinated. Vaccinating the remaining minority will not arrest COVID in my opinion.
- The uptake in booster shots will be much slower than the adoption of initial vaccines. When the vaccines were introduced, much was made of the 90+% efficacy. This was widely understood to mean if vaccinated you had a 90+% chance of avoiding symptomatic disease. We saw a material decline in effectiveness against Delta, and another material drop with Omicron. At this point, the vaccines are not nearly as effective as against the original strain, and as such, the value proposition has declined, and people know it. At the margin, the incentive to maintain vaccination status has diminished. Ultimately, I believe the COVID vaccination will reach an equilibrium in society similar to the flu shot (interestingly, not colloquially thought of as a vaccine). Many will be diligent about the vaccines, and many will not. Those most vulnerable will have the highest uptake. As of today, 1/3 of the U.S. population has had a booster. I don’t think we’ll ever get to the level we see with initial vaccinations.
- Over 2022, much of the population will coexist with COVID and return to normal life. Over the past 2 years, we’ve not seen any obvious impact on COVID from the various public policy measures (social distancing, lockdowns, cancellations, etc.). Each of the various jurisdictions has treated this differently, and it’s not lost on people that the results have not been materially different. We’re already seeing this in large parts of the country. Here in North Carolina, for example, you don’t see much evidence in everyday life that a pandemic is still afoot, while in parts of the northeast people are in large part still very cautious. TSA data shows that December 2021 airline travel is about 80% of pre-COVID levels – quite high actually. Skepticism about government measures will tie the hands of politicians going forward.
- The quarantining of those testing positive but without symptoms will fade. If we continue to see mutations that are as infectious as Omicron, it won’t be practical to remove millions of people from functional society. We’ve already seen the quarantine recommendation cut in half last month. More of this to come.
Well, that’s it. These prognostications are sure to be controversial, but remember this is just my opinion, albeit informed through tracking and modeling this disease for 2 years. Omicron is awful, but it will be in rear view mirror soon. There won’t be a defining moment when it’s all over – we’ll all just gradually get back to life.
–Shane Chalke, FSA