By Todd Neff and Katie Kerwin McCrimmon
Omicron cases in Colorado are surging with staggering infection rates and eye-popping positivity results — well over 25% for those seeking COVID-19 tests.
“There has been a huge surge in the number of cases. Everybody knows someone with omicron right now,” said Dr. Michelle Barron, senior medical director of infection prevention and control for UCHealth and a professor of medicine and infectious diseases at the University of Colorado School of Medicine.
While infections in Colorado and around the world have set records, hospitalizations also have been increasing, albeit at less dramatic rates. Even so, Barron and others are bracing for a possible flood of patients — mostly unvaccinated — who become so sick with omicron that they need care in already overcrowded hospitals.
“One in 10 people in Colorado have COVID-19 right now. That’s a big percentage. Who is going to get really sick with omicron? It’s those who are unvaccinated and those who are vulnerable,” Barron said.
One striking difference is emerging among patients who have COVID-19 and are hospitalized in UCHealth facilities now. Doctors are seeing more people who happen to have COVID-19 rather than those who need care because of a COVID-19 infection.
About one-third of hospitalized patients who tested positive for COVID-19 needed care because they are severely ill with COVID-19 while about two-thirds of hospitalized patients who tested positive actually sought care for a different reason and didn’t need treatment for the virus.
Barron cited the example of a person who breaks a leg while skiing and needs care related to the ski accident. When the patient comes to the hospital for help, they also get tested for COVID-19 and some might learn that they happen to have a COVID-19 infection. Nearly all COVID-19 infections in Colorado now stem from the omicron variant, which is out-competing the delta variant. Some patients may have minor symptoms of COVID-19, like the sniffles and congestion. Others are asymptomatic and have no idea that they’re positive for the virus. Thankfully, many of these patients do not need advanced treatments for COVID-19 ranging from monoclonal antibodies to oxygen to ventilation and life-saving care in intensive care units (ICUs).
It’s new for a high percentage of patients to happen to test positive for COVID-19 while seeking care for a different reason. Barron thinks this new trend relates to the incredibly infectious nature of the omicron variant and the decreased severity of illness tied to omicron.
“In the past, COVID-19 was driving hospital admissions,” Barron said.
Now, omicron has sparked a new chapter in the pandemic.
“Omicron is very different from delta,” Barron said.
Her team is seeing the following trends:
- Unvaccinated people still comprise the overwhelming majority of COVID-19 patients who need to be hospitalized and receive care in ICUs or be connected to ventilators due to breathing difficulties.
- More people who already recovered from COVID-19 are getting infected with the virus again.
- More vaccinated people are getting breakthrough infections.
- Fewer people who are sick with omicron infections of COVID-19 need hospital care.
- Vaccines are still highly effective and dramatically reduce the need for hospital admission, ICU care and ventilation.
- During the delta surge last fall and through December, about 90% of UCHealth’s hospitalized patients who tested positive for COVID-19 were being treated in the hospital for the infection, a stark difference from the roughly one-third of hospitalized COVID-19-positive patients who need treatment now.
- UCHealth gives COVID-19 tests to all patients who are being admitted to hospitals and has been doing so since the summer of 2020. Uniform testing keeps both health care workers and patients safer.
Omicron variant twice as contagious as delta
Barron and other public health experts expect omicron cases to continue skyrocketing over the next couple of weeks – although, as doctors will tell you, we can all do our part in blunting the tip of the spike by avoiding crowds, masking up, and getting booster shots.
Here’s what we know about omicron now: both the good and bad news.
The omicron variant is perhaps twice as contagious as a delta variant that was about twice as contagious as the “original” variant. As of Jan. 5, about 27% of tests statewide were coming back positive (public health officials would like to see this number below 5%). More than half of Colorado hospitals expect staffing shortages within the next week as caregivers themselves test positive. About one-third of hospitals expect ICU-bed shortages in the next week.
Mountain communities awash in visitors are getting slammed. Dr. Laura Sehnert, chief medical officer and emergency medical physician at UCHealth Yampa Valley Medical Center (YVMC) in Steamboat Springs, says that 32% of the samples collected came back positive during the week ending Jan. 2. How YVMC fares over the next month or so will depend, she said in an email, on “how willing our community is to buckle down and do all of the things we are tired of doing. We need everyone eligible to get vaccinated and boosted. We need everyone to wear a mask when indoors and in crowds. We need everyone to stay home if feeling ill, test appropriately, and seek medical care as needed.”
Prior experience with omicron
There is sunnier news. The spike and subsequent plunge in cases in South Africa, where omicron took root in late November, has been unaccompanied by the proportional leaps in hospitalizations that, in previous waves, followed with a roughly two-week lag.
But with respect to the coronavirus, South Africa differs from Colorado in one vital respect: Just 15% of South Africa’s population is age 50 and older. In Colorado, fully one-third of the population is over 50, and so far, 93% of the more than 10,500 coronavirus deaths in this state were among those 50 and up (nearly half of those being among the 80+ cohort). Age is a risk factor for serious coronavirus disease, and we’re older.
The United Kingdom’s demographics are a better fit. In late December, a UK Health Security Agency report found that, among hundreds of thousands of omicron cases (the UK omicron spike started in early December, about two weeks after South Africa’s and about two weeks before the U.S.’s), the risk of hospitalization was only about one-third of delta’s. In addition, the report said those having received booster shots enjoyed a 63% lower risk of symptomatic disease and an 88% lower risk of hospitalization than the unvaccinated. That said, people who had received a second vaccine dose more than six months earlier had essentially no protection from symptomatic disease with omicron – though still 52% less risk of hospitalization as compared to the unvaccinated.
The lab science is starting to catch up. Early petri-dish, animal, and human studies have found that omicron is less prone to settle deep into the lungs, where earlier variants caused the most damage. While these reports have yet to be peer-reviewed, they do hint at different infection mechanisms driving the often milder omicron disease.
As with this pandemic all along, the outcome will depend on math. If, for example, omicron is in fact just 33% as virulent as delta, then hospitals shouldn’t see admissions rise above those of the delta peak until a couple of weeks after omicron cases triple those of delta. As it happens, the seven-day average for coronavirus cases statewide as of Jan. 3 – probably 95% of them omicron – was about three times that of the mid-November delta peak. But it’s not a straightforward calculation, Barron said.
“It depends on who it’s hitting,” Barron said. “I think the healthy 20-year-olds are getting milder disease, but that’s not who we’re seeing.”
Challenges to care with omicron in Colorado
But even what look like straightforward numbers of coronavirus hospital admissions are more nuanced than they seem. On Jan. 4, about 130 of UCH’s 679 beds were occupied by those who had tested positive for the coronavirus – up from about 90 a week before, said Dr. Kelly Bookman, a UCH Emergency Department physician and professor and vice chair of operations for the CU School of Medicine’s Department of Emergency Medicine.
“We’re seeing an uptick in patients who are sick with covid and requiring admissions for that. But at the same time, we’re seeing an even more impressive uptick in those who are admitted for something else and also happen to be covid positive,” she said.
That makes for its own challenges, she says.
“Once you have covid, it’s harder to take care of you,” Bookman said. “There are all of the enhanced precautions, it’s harder on the care providers, and it’s a more difficult patient experience because you can’t have visitors.”
Dr. David Steinbruner, chief medical officer at UCHealth Memorial Hospital, said the four Colorado Springs-area hospitals have yet to see starkly rising admissions, but “we’re basically waiting for the shoe to drop.”
“Our concern is that we’ll see more hospitalizations just due to the sheer numbers. Even though it’s not as virulent, it affects more people,” he said.
Omicron hits staff at Colorado’s hospitals
Another pressing worry, he says, is the rising number of cases – however mild they tend to be – among Memorial Hospital staff. His concern echoed that of Bookman at UCH, who described increasing numbers of covid-positive colleagues “a staffing crisis,” and Sehnert in Steamboat Springs, who said breakthrough cases mean “other staff are picking up the shifts so their coworkers can rest and recover, but it pulls on everyone.”
In Colorado Springs, Steinbruner says, the rise in staff cases came as no surprise.
“There’s only so much we can do if it’s that infectious,” he said. “We just have to keep our workforce intact, because, when people do get sick, we need to have people at the bedside to take care of them.”
One benefit of having dealt with the peaks and valleys of a global pandemic for nearly two years is that UCHealth hospitals all have contingency plans in place, Bookman, Sehnert, and Steinbruner said. Steamboat Springs, being part of the larger system, has UCHealth’s major hospitals on the northern Front Range as a backstop, Sehnert added.
That doesn’t make the prospects for what may be coming any more pleasant.
“We are absolutely exhausted, both emotionally physically,” Sehnert said. “As health care workers, we have been facing this virus for the last 22 months.”
Bookman said, “It’s like an uphill marathon. It keeps getting a little bit steeper. Just when you think it can’t get any harder, it gets a little harder.”
And Barron: “I think everybody’s tired. I think there’s a sense of weariness,” she said.
But she added that January 2022 is not January 2021. “We have vaccines. We have medications. We know how to treat this now,” she said.
Barron worries about a creeping fatalism manifesting in people seeming resigned to contracting omicron and therefore not bothering to mask, distance, or to get a booster dose. Yet omicron is avoidable, she says, and taking steps to avoid it matters because, in aggregate, doing so can change the trajectory of the pandemic at a moment when that trajectory looks dire. Plus, she says, no one knows the implications of long covid.
“So if you can avoid it, why wouldn’t you?” Barron asked.