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** Omicron may produce fewer serious illnesses, but this wave is far from ‘mild’
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Registered nurse Rachel Chamberlin, of Cornish, N.H., right, steps out of an isolation room where where Fred Rutherford, of Claremont, N.H., left, recovers from COVID-19 at Dartmouth-Hitchcock Medical Center, in Lebanon, N.H., Monday, Jan. 3, 2022. Hospitals like this medical center, the largest in New Hampshire, are overflowing with severely ill, unvaccinated COVID-19 patients from northern New England. (AP Photo/Steven Senne)

We are doing a disservice when we emphasize the “mild” nature ([link removed]) of the omicron variant.

It’s true, no doubt, that a lower percentage of people who are infected with omicron end up getting seriously ill compared to previous COVID-19 infections. And it seems to be true that people who are hospitalized are not as sick, on the whole, as we saw with the delta variant.

But they are still hospitalized. In the United States, 97,364 people are hospitalized with or because of COVID-19, and the number is growing.
(CDC)

Should anybody consider 2,366 daily COVID-19 deaths to be a reason for relief? Those are the same death figures as September 2020. We are going backward.

The red line representing new cases is dragging hospitalizations with it like a magnet. Within a few weeks, deaths will most likely inch upward, too. Again, we are going backward.

If this is “mild,” then your neighbors and family members are mildly filling hospitals beyond capacity.
[link removed]
(The New York Times)

Because so many people are being infected, it is not percentages but raw numbers that matter now.

Let’s look at this passage from the New York Times ([link removed]) :

An analysis of patients in Houston, for example, found that Omicron patients were only about one-third as likely to need hospitalization as Delta patients. In Britain, people with Omicron were about half as likely to require hospital care, the government reported. The pattern looks similar in Canada, Emily and Azeen note.

Hospitalizations are nonetheless rising in the U.S., because Omicron is so contagious that it has led to an explosion of cases ([link removed]) . Many hospitals are running short of beds and staff, partly because of Covid-related absences. In Maryland, more people are hospitalized with Covid than ever.

“Thankfully the Covid patients aren’t as sick. But there’s so many of them,” Craig Spencer, an emergency room doctor in New York, tweeted on Monday, after a long shift. “The next few weeks will be really, really tough for us.”

Inside Medicine also added this context: ([link removed])

Another important problem is that, unlike previous waves, United States hospitals entered the Omicron wave already facing pressure from high demand for non-Covid-19 care. In addition to other “typical” problems that seem to mount in winter ([link removed]) , flu is back ([link removed]) after a hiatus last year. Entering the Delta wave, on July 1st, 2021, around 67% of staffed hospital beds in the United States were full. Leading up to the Omicron wave, around 79% of staffed beds in the US were full. That 12% is important buffer territory that we desperately need. Things get dicey in hospitals the closer to full we get.

Emergency room doctor Jeremy Faust writes:

62 US counties likely at or over 100% hospital capacity. “Circuit breakers” may be needed ([link removed]) in those areas. A circuit breaker is a temporary move that hospitals make to just focus on COVID-19 cases such as restricting or stopping non-emergency surgeries.

[link removed]
(Inside Medicine)

* Circuit breakers are designed to achieve a narrow and achievable goal: identifying when the combination of local case rates and real-time hospital capacity indicates that hospitals have or will soon exceed their capacity, and therefore ability to provide even routine life-saving care.
* Circuit breakers shouldn’t take long to work (days, not weeks).
* Circuit breakers are not shutdowns. They are limitations in high-risk exposures, like indoor dining and other large indoor gatherings.
* Circuit breakers are designed to direct local action. Just because one county needs a circuit breaker does not need others do. So, they are far nimbler than our past responses.
* Circuit breakers do not merely rely on case counts but on hospital capacity. That means that circuit breakers do not need to happen in every place where case counts are rising, as long as the region has adequate hospital capacity to keep up.


** CDC defines ‘up to date’ versus ‘fully vaccinated’
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The Centers for Disease Control and Prevention has come up with a new phrase that you will hear more often. “Up to date” on vaccinations is the new way of referring to having two doses and a booster dose of the mRNA vaccines or one dose and a booster of the Johnson & Johnson vaccine.

There was a conversation among people who care about such things ([link removed]) that the phrase “fully vaccinated” should maybe be changed to include two doses and a booster. But the CDC said ([link removed]) Wednesday that, for now, “fully vaccinated” is still defined as having gotten two doses of the mRNA vaccines or one dose of the Johnson & Johnson vaccine.

This is how the terminology is being used by CDC Director Dr. Rochelle Walensky: “Consistent with how public health has historically viewed or even talked about how we recommend vaccines, we are now recommending that individuals stay up to date with additional doses that they are eligible for.”

This is more than a dispute over language. Businesses, schools and government agencies all have different requirements that students and employees be “fully vaccinated,” so a change in definition would affect millions of people.


** Mayo Clinic fires hundreds of unvaxxed workers
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The prestigious Mayo Clinic gave workers until Monday to get their COVID-19 vaccination. 99% of employees complied. But Mayo’s clinics and hospitals fired 700 workers ([link removed]) who chose not to get the vaccine. In a statement, Mayo said, “If individuals released from employment choose to get vaccinated at a later date, the opportunity exists for them to apply and return to Mayo Clinic for future job openings.”


** ‘Supersonic’ rise in cases
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A man gets a nasal swap at a mobile COVID-19 testing site at the Champs Elysees avenue in Paris, Wednesday, Jan. 5, 2022. (AP Photo/Michel Euler)

French authorities are using words like “supersonic” and “stratospheric levels” ([link removed]) to describe the rise in COVID-19 cases there. President Emmanuel Macron said he wanted to “piss off” unvaccinated people by making their lives so complicated they would finally get vaccinated. That statement did not go over well ([link removed]) .


** Welcome to 2022, your homeowners insurance rates are going up. COVID is an underlying factor.
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The Washington Post documented ([link removed]) what you may have already noticed: It costs a lot to insure your home in 2022.

Across the country, homeowners renewing their policies are discovering that rising material costs, supply chain disruptions and climate change are combining to drive premiums up by an average 4 percent to an average annual premium of $1,398, according to the Insurance Information Institute, a nonprofit organization known as Triple-I that provides information on the insurance industry. Triple-I uses data from Standard & Poor’s Global Market Intelligence for its analysis.

Since 2017, premium rates are up 11.4 percent on average, which means they are rising faster than inflation — and insurance experts expect that the rates will stay high.

“From everything I know about homeowners’ risk, I expected those numbers to be higher,” said Dale Porfilio, the chief insurance officer at Triple-I. “Honestly, I would say they still should go up further.”

Most mortgage lenders require borrowers to carry a homeowners insurance policy. According to a recent analysis by Bankrate.com ([link removed]) , the average homeowner spends about 1.91 percent of their household income ([link removed]) on home insurance.

The underlying causes are as varied as climate change and construction material costs linked to pandemic interruptions. A report by the American Property Casualty Insurance Association ([link removed]) says these factors are the main contributors to higher insurance premiums:

* Home repairs now cost more — a lot more. The 2008 recession put a deep dent in the home building industry. Major contractors still can’t keep up with demand, particularly at a time when people have moved to the suburbs to escape Covid and crime in the cities. New construction is competing for both workers and materials with those who need their damaged homes rebuilt.
* Construction costs are soaring. At one point this past summer, lumber prices were up 400% year over year. While it’s come down a bit, other materials such as steel, copper and cement are still high and hard to find. There’s an ongoing global shortage of the semiconductor chips that are now part of every modern home.
* The product supply chain is damaged, with backlogs at major ports, coupled with accidents such as the recent oil spill at Huntington Beach, California. Freight rates have “spiked.”


** Auto insurance rates are rising, too. Pandemic driving is a factor.
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The American Property Casualty Insurance Association also warned ([link removed]) that a number of pandemic-era factors are conspiring to make auto insurance more expensive. For one thing, the insurers say, we have gotten into some awful driving habits during the pandemic that hiked the number of traffic fatalities in 2021. The report says we are driving faster, not wearing seat belts and the costs of medical care and car repair are going up, too.

Insurance companies say car theft rates are rising, too, so don’t be surprised if your next car insurance bill reflects all of these increased risks.


** Half of states have no plans to start 988 emergency hotlines: deadline soon
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A man jogs past a sign about crisis counseling on the Golden Gate Bridge in San Francisco, Aug. 3, 2021. People in crisis and those trying to help them will have a new three-digit number, 988, to reach the national suicide prevention network starting in July. (AP Photo/Eric Risberg, File)

Don’t feel left out if you have no idea what 988 emergency hotlines are. Half of the states that are supposed to have the emergency number up and running in six months don’t have a solid plan to get the quick-dial suicide hotlines running by July 16, 2022.

The goal is for each state to have a 24/7/365 hotline that suicidal people can call rather than 911. Lifeline call centers are supposed to have advanced training to help someone experiencing a mental health emergency. The vision behind the law was to send mental health providers to help callers, rather than sending police, since such police calls often end with tragic consequences ([link removed]) .

The National Suicide Hotline Designation Act ([link removed]) became law in October 2020. The bill had three main parts:

* This bill requires theFederal Communications Commission (FCC) to designate 9-8-8 ([link removed]) as the universal telephone number for a national suicide prevention and mental health crisis hotline.
* A state may impose and collect a fee for providing 9-8-8 related services. However, this fee must be held in a designated account to be spent only in support of 9-8-8 services, and the FCC must submit an annual report on state administration of these fees.
* The Department of Health and Human Services (HHS) and the Department of Veterans Affairs must jointly report on how to make the use of 9-8-8 operational and effective across the country, and HHS must develop a strategy to provide access to competent, specialized services for high-risk populations such as lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth; minorities; and rural individuals.

Harvard medical professor Margarita Alegría wrote for Stat ([link removed]) that a handful of states have made solid plans to get their 988 systems running. But most have not:

To date, only a handful of states have passed or introduced legislation for building a 988 system. According to the most recent data the American Foundation for Suicide Prevention shared with me, Colorado, Nevada, Virginia, and Washington have enacted legislation that includes user fees for the 988 system. Four states have enacted 988 infrastructure legislation without calling for fees. Three states have created commissions or task forces to study implementing a 988 system. Other states are still debating legislation and California has appropriated limited funds. In short, more than half the states haven’t made any progress at all.

Establishing an easy-to-remember crisis phone line in every state that’s staffed 24 hours a day every day comes at a critical time for a nation grappling with a behavioral health epidemic. Suicide is the second leading cause of U.S. deaths ([link removed]) for people between the ages of 10 and 34; more and more ([link removed](21)01365-4/fulltext) Black youths ([link removed]) are dying by suicide ([link removed]) . Mental health issues among youths have become so dire, made worse by the toll of the Covid-19 pandemic, that three leading pediatric groups have declared kids’ mental health to be a national emergency ([link removed]) . Drug overdose deaths are also at record levels ([link removed]) .

The American Foundation for Suicide Prevention says “a collaborative of 15 of the nation’s leading mental health professional organizations, advocacy groups and funders have published A Consensus Approach and Recommendations for the Creation of a Comprehensive Crisis Response System ([link removed]) , a roadmap to guide mental health crisis response mandated by the National Suicide Hotline Designation Act of 2020.”

The National Suicide Prevention hotline surveyed callers to find how effectively the Lifeline works. “As reported ([link removed]) by the FCC, callers to the Lifeline were ‘significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls.’ What’s very promising is that 76.2% of those who called the Lifeline felt that their call contributed ‘a lot’ to their decision to not end their life. Implementing 988 will only increase the Lifeline’s positive effects for those struggling with suicide or depression.”

KING-TV in Seattle reported on the state’s newly launched 988 system ([link removed]) :

“For most people, the only number they know to call is 911. This may end up having an officer come to their house. Officers are not social workers, nor do they want to be,” said Rep. Tina Orwall (D-Des Moines), who introduced a bill to establish and fund the 988 system.

The state is spending $95 million to build the system over the next several years.

A small tax on phone lines will pay for an expansion of mental health response services and better training for people answering crisis calls.

“You can't make it hard for people, you have to make it easy, and you have to make them trust the response that's behind calling that number,” said Jenn Stuber, a UW professor who studies suicide prevention efforts.

She said Washington's 988 system will be much more robust than the current suicide prevention hotlines.

“It would be a bad outcome to just have people bounce to a national call center to be assessed to be told they need help. That's not what we're looking for. We're really looking to connect people to services they need when they're in crisis, and then longer-term,” Stuber said.

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here ([link removed]) to get it delivered right to your inbox.
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