April 5, 2022 - Don't Stop Thinking About Tomorrow

Don't Stop Thinking About Tomorrow

April 5, 2022

If you live in Alabama, you may be forgiven for thinking the pandemic is over. Over the last 7 days, Alabama has averaged 209 new reported cases per day. There are now just 195 statewide Covid patients, compared to 231 patients last week. And only 27 of those patients now occupy intensive care beds.

Okay, I’ll admit to humming a few bars of “Sweet Home Alabama” when I saw those numbers. Then, I noticed that our 7-day average of daily cases actually increased 8% compared to last week, when we averaged 192 cases per day (net of a data dump on March 28). What’s more, though hospitalizations declined 15% compared to the same day last week, hospitalizations actually rose 20% over the last 5 days (we had 163 patients on March 31). That’s when the words and catchy tune of Fleetwood Mac’s “Don’t Stop Thinking About Tomorrow” hit me.

Here’s my point. Time and time again, we have been fooled by this virus. It will surprise nearly everyone (including me) to know that 28 states reported more new cases this week than last week - and 20 states even saw a double digit percentage increase in cases. Hospitalization trends usually follow new case trends by 2-3 weeks. It is therefore unsurprising that 17 states reported higher hospitalizations this week than last, while 5 states reported a double digit increase.

The United States has enjoyed a 4-6 week period of very low infections compared to the rest of the world. In part, that reprieve is the result of our high rate of Omicron infections in January and February. The predominant coronavirus strain throughout the world is now the Ba.2 subvariant of Omicron, and prior Omicron infection has proven to be highly protective against Ba.2.

Does that mean the pandemic is over? Hard to say. It likely means that the pandemic has evolved into endemicity, meaning it has become relatively static, not going away but generally controllable if current data are respected and available protective measures are followed.

The question I am frequently asked is what to do about the 4th dose. Subject to the critical caveat that I am not an infectious disease expert, this is what I think. If you are eligible (50 and older or immunocompromised) and were not infected by Omicron (i.e. no infection in the last 3+ months), then I recommend you immediately sign up to get the 4th shot. I don’t see any downside. However, if you are one of the 50% of Americans who were exposed to Omicron in the last 3+ months, then I recommend that you wait about 6 weeks or so before getting the 4th shot. As one friend described the effect of a prior Omicron infection, “It’s like a Get-Out-of-Jail-Free card.” You might as well take advantage of that privilege before it wanes.

As for the 3rd booster shot, allow me to repeat: if you are still waiting to get the booster, there is absolutely no excuse. Ba.2 is far more contagious than Omicron and, sooner or later, you will get sick.

Finally, on a personal note, I do not plan to write again for at least two weeks unless a sudden change in the data compels me to do so. I have a few family matters that must take priority. I assure you I will return with another edition of Frank’s Alabama Covid Newsletter (catchy title, don’t you think?) in a couple of weeks. The totals:

3/23 - 185

3/24 - 398

3/25 - 164

3/26 - Not reporting

3/27 - Not reporting

3/28 - 310 (net of 1,714 positive cases from tests conducted before 2/28)

3/29 - 284

3/30 - 253

3/31 - 258

4/1 - 141

4/2 - Not reporting

4/3 - Not reporting

4/4 - 579

4/5 - 237