…is it mild enough that we’ll avoid having U.S. hospital capacity crash over the next three months?

Because there are going to be a lot of cases this winter. A lot. “Everything points to a large wave. A large wave is coming,” a senior Biden official told Axios. “It will be fast. It won’t be as severe, but regrettably, there will be plenty of hospitalizations.” It’s really, really, really transmissible, whether because it spreads faster or spreads among people with prior immunity or both:

BREAKING South Africa:

82% increase in cases, week over week.
34.9% positive rate.
Record 7-day average.

Not near plateau.

Even with milder disease (irrespective of cause), this will lead to more hospitalizations and deaths. https://t.co/7LSIcVNjjb

— (((Howard Forman))) (@thehowie) December 14, 2021

When we quantified the slopes of these infections, we found that Omicron was almost 4 times more infectious than the original strain. Even more than Delta!

12/16 pic.twitter.com/a18Ijzxupo

— Balazs Lab (@BalazsLab) December 14, 2021

I’m an Eeyore so I’ve been hammering the point lately in posts about Omicron that a “mild” virus that spreads like crazy can still kill thousands of people. Look no further than the flu. If one in a thousand infected people die but 50 million people get infected, well, do the math. South Africa’s largest health insurer pored through more than 75,000 cases attributed to Omicron to see whether the hospitalization rate really has been lower recently than it was during the first wave of the virus in 2020. The good news: It has. Omicron does look less severe. The bad news is that you’re “only” 29 percent less likely to be hospitalized if you catch Omicron than you were if you caught the original Wuhan virus. Scott Gottlieb expected the new variant to be milder than that, especially given how much more population immunity there is now in South Africa compared to 18 months ago.

This finding that risk of hospital admissions among adults with covid19 was 29% lower for Omicron than in March 2020 pandemic wave isn’t as large a reduction as I hoped for given high immunity in South Africa and continued suggestion Omicron is less severe https://t.co/GuZJjzFF3O

— Scott Gottlieb, MD (@ScottGottliebMD) December 14, 2021

If it’s wildly more transmissible than other variants but only somewhat less severe, that shakes out to a wave of hospitalizations.

It turns out the vaccines are less effective against Omicron too. The South African study found that two doses of Pfizer are 33 percent effective against infection and 70 percent against severe illness. That last number is good news, as it means even the unboosted will stand a solid chance of fighting off the variant without needing help from the ER, but two doses of Pfizer was 90 percent effective at preventing severe illness from Delta. Doesn’t that mean that the risk of severe illness for the average two-dose vaccinated person is greater from the “milder” variant?

That may also help explain why South Africa’s Omicron wave looks “milder.” Reportedly 72 percent in Gauteng province, the country’s hot spot, have been previously infected by the coronavirus. That natural immunity means that a great majority of South Africans may have strong protection from the new variant via T-cells they developed during their previous recovery, which can prevent future severe illness. That is, maybe Omicron appears “milder” in that country because the average South African has strong natural immunity. How strong will the T-cell immunity be in an American who’s had two doses of the vaccine but no previous infection?

Whatever the explanation, most cases tracked by the new study really did involve mild illness that passed fairly quickly, without as much trouble breathing as with previous variants. Although there’s evidence that kids may be at somewhat higher risk of symptoms this time:

Most infections are described as mild, with recoveries usually within three days, he said. The most common early symptom reported is a scratchy throat, followed by nasal congestion, a dry cough and myalgia, or aches, manifesting in lower back pain.

He said private hospitals reported that most patients were unvaccinated and many were initially admitted for non-covid-related illnesses. There was less evidence of respiratory infections in omicron-infected patients, compared to the other variants, with fewer patients requiring oxygen, Noach added…

Discovery Health’s data indicated that children under the age of 18 have a 20 percent higher risk of admissions for complications when infected with omicron compared to the other variants, she said.

There is some truly great news amid all of this, though. Evidence continues to accumulate that a third dose of the vaccines works extremely well against Omicron. Whether most vaccinated Americans are willing to get a booster is a separate question, but those who are should be well protected. Last week Pfizer found that two doses of its vaccine are substantially weaker against the variant but that three successfully neutralizes it. More data supporting that conclusion is coming out:

If you’re wondering what difference a booster makes, THIS is the key!

An mRNA booster on top of prior infection OR on top of two doses of vaccine confers 30X to 200X HIGHER neutralization titers versus Omicron.

Let’s talk about that! 🧵 pic.twitter.com/htkwDDe8Bc

— Chise 🧬🧫🦠💉 (@sailorrooscout) December 12, 2021

Another lab created a “pseudovirus” that mimics Omicron’s mutations and tested antibodies generated by three doses of the vaccine against it. With the original Wuhan virus, two doses versus three doses didn’t make much difference. With Omicron, it’s a big deal:

What was really surprising was that an mRNA booster made a huge difference in the ability of people to neutralize Omicron.

10/16 pic.twitter.com/jVOJIe1EoG

— Balazs Lab (@BalazsLab) December 14, 2021

The lab suspects that a third dose is doing more than just boosting the level of antibodies in your body. By giving your immune system a third look at the virus’s spike protein, it might be teaching you to produce more sophisticated antibodies that can cope with a wider array of new variants. That’s also the theory of why people with hybrid immunity do so well against so many variants: They’re initially infected by the virus, giving the body its first glimpse of SARS-CoV-2, and then that understanding deepens after the body is exposed to the spike protein again via vaccination.

Bottom line: Run, don’t walk, to get that booster. Fewer than 27 percent of vaccinated Americans have done so thus far, although that number is creeping up day by day as anxiety about Omicron spreads. The more people who are boosted, the better off hospitals will be. Which is important, because the trend lately isn’t great:

A little more than a month ago, hospitalizations nationally dipped below 47,000. Today they’re north of 67,000 with Omicron still gearing up.

In lieu of an exit question, read this op-ed by South Africa’s Dr. Angelique Coetzee. She was one of the first physicians there to treat Omicron patients and remains convinced that disease caused by the variant is much milder than previous versions were — to the point where she’s scolding the UK for reinstating COVID restrictions. Restrictions could backfire, says Coetzee, since catching such a mild virus and developing natural immunity from it is a blessing in disguise. The next variant that comes along might not be so mild, so that natural immunity might come in handy.