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The Worst of the Omicron Wave Could Still Be Coming [推广有奖]






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Nicolle 学生认证  发表于 2022-1-15 03:41:14 |显示全部楼层

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  1. The Worst of the Omicron Wave Could Still Be Coming
  2. A long descent from a peak in cases could exact a larger toll than even Omicron’s blistering ascent.

  3. By Katherine J. Wu
  4. The Atlantic
  5. JANUARY 14, 2022, 12:02 PM ET
  6. SHARE
  7. Just weeks into its staggering ascent in the United States, Omicron appears to maybe, maybe, be taking its leave of a few big urban centers up and down the East Coast. Documented coronavirus infections seem to be leveling off, even falling, in cities such as Boston, New York, and Washington, D.C.—a possible preview of what the country’s been waiting on tenterhooks for: the beginning of the end of the Omicron wave.

  8. The pattern fits with what recent models predict. National case counts will hit a maximum this month, maybe a touch later. (Some think that the peak is already behind us.) It’s all a bit squishy still, but epidemiologists such as Justin Lessler of the University of North Carolina at Chapel Hill are “pretty confident” that the American apex is nigh. Peak could then give way to plunge, as it did in South Africa. It’s tempting, then, to imagine Omicron loosening its vice grip on the United States just as quickly as it latched on. February will be better; March, rosier still. Americans will get something like a Hot Post-Omi Spring.

  9. A symmetrical, V-shaped rise and fall is a very nice and neat story. It is also probably wrong.

  10. Before I stuff my foot completely inside my own mouth, let me be clear: This is not a Full-Blown Pandemic Prediction™. I personally do not know exactly what is on the other side of the Omicron peak. Neither do the experts. Actually, no one does. The back ends of curves can mirror the fronts, but they don’t have to—it depends on us and our immunity, on the virus and its hijinks, and on the frequency and intensity at which host and pathogen continue to collide. The decline could be sharp and fast, or sputtering and slow. It could start off steep, then lose steam. It could plateau—or even reverse course and tick back up.

  11. Read: We’re not at endemicity yet

  12. What we can say is that the higher a wave crests, the longer and more confusing the path to the bottom will be. We need to prepare for the possibility that this wave could have an uncomfortably long tail—or at least a crooked one. “I do think the decline is unlikely to be as steep as the rise,” Saad Omer, an epidemiologist at Yale, told me.

  13. During outbreaks, the only truly certain things are those “in hindsight,” Shweta Bansal, an infectious-disease modeler at Georgetown University, told me. And even the recent past is cloudy right now. We’ve lacked the test-and-trace infrastructure to fully track Omicron’s spread, which has seriously messed with our ability to forecast what the virus might do next. Most scientists are not even all that certain about where we stand in relation to the peak. And “the further into the future we want to project, the more uncertainty there is,” Lauren Ancel Meyers, the director of the University of Texas at Austin’s COVID-19 Modeling Consortium, told me.

  14. Even with the murkiness ahead, how we exit this wave will certainly be affected by how we entered it. On its record-shattering sprint upward, Omicron had certain advantages: The virus seems to thrive in the upper airway and become contagious fast; it’s ace at dodging a lot of the antibodies in vaccinated and previously infected people, giving it a larger pool of hosts to work with than Delta. In the United States, Omicron also arrived at an especially opportune time: Americans, many of them older, unvaccinated, or with a chronic health condition, were sick of masking, and were barreling into their holiday-heavy winter. The fleet-footed virus slammed into a susceptible population that, behaviorally, was quite amenable to slathering it around. That dangerous combination spurred our wave, then skyrocketed it.

  15. When this tide turns hinges on when Omicron starts to run out of new people to infect—either because it has burned through everyone it can or because we, through our behaviors, starve it of hosts. Cases crater; the curve, in turn, crashes. A version of this seems to have unfolded in South Africa, where recorded cases peaked around mid-December, then fell, and fell, and fell. (The United Kingdom, whose wave is a couple of weeks behind South Africa’s, seems poised to turn a corner too.)

  16. How those foreign free falls play out is instructive, “but we also need to recognize that the U.S. is not South Africa,” Maia Majumder, a computational epidemiologist at Harvard, told me. Even subtle differences in host populations can massage a wave into a different shape—a rounder pinnacle, a more leisurely wane. Yes, the United States’ population is more vaccinated than South Africa’s, but it’s also older. (And lots of Americans over 65 aren’t boosted.) The two countries’ health profiles, medical infrastructures, and approaches to controlling SARS-CoV-2 differ; so do the behaviors of their residents. Omicron also caught South Africa as it was heading into summer; the United States may have a tougher time unsticking itself from the virus during colder months. And Delta, which was already driving surges of its own before Omicron arrived, hasn’t yet disappeared here.

  17. Read: Calling Omicron “mild” is wishful thinking

  18. The United States is also an especially sprawling and diverse place, as Samuel Scarpino of the Rockefeller Foundation’s Pandemic Prevention Institute pointed out on Twitter. Viruses thrive on human interconnectedness, and an early surge in big cities can front-load cases so much that the national narrative booms, then starts to bust. After we pass the summit, “I think at least the initial downslope will be precipitous,” Yonatan Grad, an infectious-disease expert at Harvard, told me. But as the virus continues to trickle into more rural, sparsely populated parts of the country, that story gets more complicated: a smattering of regional peaks could slow and lengthen the overall decline. We tend to talk about “the peak” as if it’s one monolithic thing, but it’s an aggregate of asynchronous outbreaks; each community will experience its own, unique Omicron spike, Grad said. The national trajectory depends heavily on “how long it takes to percolate into different parts of the country,” Natalie Dean, a biostatistician at Emory University, told me. A cliff-like drop might give way to a series of rolling hills. (Scarpino thinks that South Africa’s decline, which has recently slowed, may now be exhibiting this geographical flattening effect.)

  19. How we react to the curve could also stretch it out, and that’s the biggest wild card of all. When people hear that we’ve skittered past the top of a peak, “psychologically, they loosen up,” UNC’s Lessler told me. (This is something that many epidemic models don’t account for.) Masks come off. Schools, workplaces, and leisure venues reopen. People rejoin social circles, or kick-start new ones. Smaller shifts such as these, multiplied by millions, can turn a waterfall decline into molasses. “So much of susceptibility is tied up in behavior,” Majumder said. And as people get further out from their most recent vaccination or infection, their risk of catching the virus goes back up.

  20. A lethargic decline is a costly one. Already, health-care systems around the country are being pummeled by record-breaking cases. In many states, hospitals are hitting capacity; people are struggling to access care for all sorts of sicknesses. Hospitalization and death waves are smaller in magnitude than infection waves, and lag behind them, but they’re “much more protracted,” UT’s Meyers said. The sheer height of our infection peak is already poised to haunt us. There have been so many infections that cases, hospitalizations, and deaths won’t return to November’s pre-Omicron levels—let alone the numbers of last year’s early-summer lull—for a long time. “It’s going to get much worse before it gets better,” Meyers said. Even if the United States’ curve turns out to be symmetrical, half of this wave’s infections, and more than half of its hospitalizations and deaths, are still ahead, past the peak of cases. Adding any more weight to the curve’s far side just makes that picture uglier.

  21. Read: Hospitals are in serious trouble

  22. On the more optimistic flip side, behavior can also curb transmission—enough to keep the overall number of infections lower than it might otherwise be. We heard this lesson early on in the pandemic, when cases were first rising at alarming rates: mask up, hunker down, flatten the curve. It’s still true now. The hope is that the lower the peak, the fewer unnecessary infections can occur after it, Lessler said.

  23. A horizontal squish does delay the peak and stretch out the wave. But it also buys us time to vaccinate more people and roll out treatments, and reduces the burden on the health-care system at any single point. We missed our chance for an early pancaking effect in many big cities, but smaller, rural parts of the country can still take heed, and it’s probably especially important that they do so. Those regions tend to have lower vaccination rates and lack “the capacity for a fast-running surge,” Anne Sosin, a public-health researcher at Dartmouth College, told me. If they’re not buffered from their own Omicron waves, the variant could concentrate in the parts of the country that can least afford to absorb it.

  24. What lies beyond the peak isn’t out of our control either. The decline can be sped up by the same mitigation behaviors that temper the rise, Majumder said. Curves can get flatter. They can also get shorter. And minimizing cases on the wave’s far side will still blunt the impact on the health-care system, and lessen the variant’s social toll. The key here, then, is to avoid seeing “past the peak” as a cue to relapse into riskier behavior. “The start of a decline is not sufficient to think we’re out of the woods,” Georgetown’s Bansal said. Every step we take now will determine how long we stay high up on this curve and, eventually, where we land—as well as what condition we’ll be in when we arrive at the bottom.

  25. The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.


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Nicolle 学生认证  发表于 2022-1-15 03:47:09 |显示全部楼层
就在其在美国的惊人发展仅仅几周后,Omicron 似乎可能会离开东海岸上下的几个大城市中心。在波士顿、纽约和华盛顿特区等城市,记录在案的冠状病毒感染似乎正在趋于平稳,甚至下降——这可能预示着该国一直在焦急等待:Omicron 浪潮结束的开始。

该模式符合最近的模型预测。本月全国病例数将达到最大值,也许稍晚一些。 (有些人认为高峰已经过去了。)一切都还有些模糊,但北卡罗来纳大学教堂山分校的贾斯汀·莱斯勒(Justin Lessler)等流行病学家“非常有信心”认为美国的高峰即将到来。届时,Peak 可能会像在南非那样暴跌。因此,很容易想象 Omicron 在锁定美国的同时迅速放松对美国的控制。二月会更好;三月,依旧红润。美国人将得到类似热后近江春天的东西。


Nicolle 学生认证  发表于 2022-1-15 03:48:13 |显示全部楼层
一个对称的V形上升和下降是一个非常漂亮和整洁的故事。 这也可能是错误的。

在我把脚完全塞进自己的嘴里之前,让我明确一点:这不是一个全面的大流行预测™。 我个人并不确切知道 Omicron 峰的另一边是什么。 专家也不行。 实际上,没有人这样做。 曲线的后端可以反映前端,但它们并非必须如此——这取决于我们和我们的免疫力,取决于病毒及其hijinks,以及宿主和病原体继续碰撞的频率和强度。 下降可能是急剧而快速的,也可能是缓慢而缓慢的。 它可能开始陡峭,然后失去蒸汽。 它可能会停滞不前,甚至会逆转并回升。


Nicolle 学生认证  发表于 2022-1-15 03:48:53 |显示全部楼层
我们可以说的是,波峰越高,到达底部的路径就越长,越混乱。 我们需要为这波可能有一条令人不舒服的长尾巴——或者至少是一条弯曲的尾巴的可能性做好准备。 耶鲁大学的流行病学家萨阿德·奥马尔告诉我:“我确实认为下降幅度不可能像上升那么大。”


Nicolle 学生认证  发表于 2022-1-15 03:50:12 |显示全部楼层
乔治城大学传染病建模师 Shweta Bansal 告诉我,在疫情爆发期间,唯一真正确定的事情是那些“事后看来”的事情。甚至最近的过去现在也是多云的。我们缺乏完全跟踪 Omicron 传播的测试和跟踪基础设施,这严重影响了我们预测病毒下一步可能发生的事情的能力。大多数科学家甚至都不确定我们相对于峰顶的位置。德克萨斯大学奥斯汀分校 COVID-19 建模联盟主任劳伦·安塞尔·迈耶斯 (Lauren Ancel Meyers) 告诉我,“我们想要预测的未来越远,不确定性就越大。”

即使前方充满了不确定性,我们如何退出这波浪潮肯定会受到我们进入它的方式的影响。在破纪录的向上冲刺中,Omicron 具有一定的优势:病毒似乎在上气道中茁壮成长并迅速传染;它在躲避接种疫苗和以前感染过的人体内的许多抗体方面表现出色,这使其拥有比 Delta 更大的宿主池。在美国,Omicron 也来到了一个特别合适的时机:美国人,其中许多人年纪较大、未接种疫苗或患有慢性健康问题,他们厌倦了戴口罩,并正在进入假期繁重的冬季。这种快速传播的病毒猛烈攻击了易感人群,从行为上讲,他们非常愿意将其涂抹在周围。这种危险的组合刺激了我们的浪潮,然后一飞冲天。


Nicolle 学生认证  发表于 2022-1-15 03:51:38 |显示全部楼层
当这种趋势转向时,取决于 Omicron 开始没有新的感染者来感染——要么是因为它已经烧毁了所有可能感染的人,要么是因为我们通过我们的行为使其缺乏宿主。案件陨石坑;曲线,反过来,崩溃。这种情况的一个版本似乎已经在南非展开,记录的病例在 12 月中旬左右达到顶峰,然后下降、下降、下降。 (英国,其浪潮比南非落后几周,似乎也准备好转机。)

这些外国的自由落体如何发挥是有启发性的,“但我们也需要认识到美国不是南非,”哈佛大学的计算流行病学家 Maia Majumder 告诉我。即使是宿主种群的细微差异也可以将波浪按摩成不同的形状——更圆的尖峰,更悠闲的衰减。是的,美国的人口比南非的人口接种疫苗更多,但也更老。 (而且很多 65 岁以上的美国人没有得到提升。)两国的健康状况、医疗基础设施和控制 SARS-CoV-2 的方法不同;他们的居民的行为也是如此。 Omicron 也赶上了即将进入夏季的南非。在较冷的月份,美国可能更难摆脱病毒的束缚。而在 Omicron 到来之前就已经带动了自己的浪潮的 Delta 还没有在这里消失。


Nicolle 学生认证  发表于 2022-1-15 03:55:17 |显示全部楼层
正如洛克菲勒基金会大流行预防研究所的塞缪尔·斯卡皮诺在推特上指出的那样,美国也是一个特别庞大和多样化的地方。病毒在人类相互联系的基础上茁壮成长,大城市的早期激增可以提前大量病例,以至于国家叙事繁荣,然后开始破裂。在我们通过峰会后,“我认为至少最初的下坡路会很陡峭,”哈佛大学传染病专家约纳坦·格拉德告诉我。但随着病毒继续蔓延到该国更多农村、人口稀少的地区,情况变得更加复杂:少数地区性高峰可能会减缓并延长整体下降速度。我们倾向于把“高峰”说成是一个单一的东西,但它是异步爆发的集合; Grad 说,每个社区都会体验到自己独特的 Omicron 尖峰。埃默里大学的生物统计学家娜塔莉·迪恩告诉我,国家轨迹在很大程度上取决于“渗透到该国不同地区需要多长时间”。悬崖般的水滴可能会让位于一系列连绵起伏的山丘。 (斯卡皮诺认为,最近放缓的南非衰退现在可能正在表现出这种地理扁平化效应。)

我们对曲线的反应也可能会将其拉长,这是最大的不确定因素。北卡罗来纳大学的莱斯勒告诉我,当人们听说我们已经飞过顶峰时,“从心理上来说,他们放松了”。 (这是许多流行病模型没有考虑到的。)口罩脱落。学校、工作场所和休闲场所重新开放。人们重新加入社交圈,或开始新的社交圈。像这些较小的变化,乘以数百万,可以将瀑布下降变成糖蜜。 “如此多的易感性与行为有关,”Majumder 说。随着人们远离最近的疫苗接种或感染,他们感染病毒的风险就会回升。


Nicolle 学生认证  发表于 2022-1-15 03:57:08 |显示全部楼层
昏昏欲睡的衰退是代价高昂的。全国各地的医疗保健系统已经受到破纪录病例的打击。在许多州,医院的容量正在达到极限。人们正在努力获得各种疾病的护理。 UT 的 Meyers 说,住院和死亡波的幅度比感染波要小,并且落后于它们,但它们“持续时间要长得多”。我们感染高峰的绝对高度已经准备好困扰我们。感染人数如此之多,以至于病例、住院人数和死亡人数在很长一段时间内都不会恢复到 11 月之前的 Omicron 水平——更不用说去年初夏平静期的数字了。 “在好转之前,情况会变得更糟,”迈耶斯说。即使美国的曲线证明是对称的,这一波的一半感染,超过一半的住院和死亡,仍然领先,超过了病例的高峰。在曲线的远端增加更多的权重只会让这张照片更难看。


Nicolle 学生认证  发表于 2022-1-15 03:59:01 |显示全部楼层
在更乐观的另一面,行为也可以抑制传播——足以使感染总数低于其他情况。 我们在大流行初期就听到了这个教训,当时病例最初以惊人的速度上升:戴上口罩,蹲下身子,拉平曲线。 现在仍然如此。 Lessler 说,希望峰值越低,之后发生的不必要感染就越少。


Nicolle 学生认证  发表于 2022-1-15 03:59:59 |显示全部楼层
水平挤压确实会延迟峰值并拉伸波浪。但它也为我们赢得了为更多人接种疫苗和推出治疗的时间,并在任何时候都减轻了医疗保健系统的负担。我们错过了在许多大城市中获得早期煎饼效应的机会,但该国较小的农村地区仍然可以注意,他们这样做可能尤其重要。达特茅斯学院公共卫生研究员安妮·索辛告诉我,这些地区的疫苗接种率往往较低,并且缺乏“快速激增的能力”。如果它们没有受到自己的 Omicron 波的缓冲,该变体可能会集中在该国最无力吸收它的地区。

超越高峰的事情也不是我们无法控制的。 Majumder 说,可以通过缓和上升的相同缓解行为来加速下降。曲线可以变得更平坦。它们也可以变短。最大限度地减少浪潮远端的病例仍将减弱对医疗保健系统的影响,并减少该变体的社会损失。因此,这里的关键是避免将“超过高峰”视为重新陷入风险更高行为的线索。 “下降的开始不足以认为我们已经走出困境,”乔治城大学的班萨尔说。我们现在采取的每一步都将决定我们在这条曲线的高处停留多长时间,并最终决定我们降落的位置——以及我们到达底部时的状况。


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