4 signs Omicron may soon peak in the U.S.

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Over the last six weeks, the hypertransmissive Omicron variant of the coronavirus has generated its fair share of bad news in the United States.

Daily COVID-19 case counts more than three times higher than ever before.

A record number of new hospitalizations, pushing thousands of hospital systems nationwide to the breaking point.

And now, tragically, another 2,000 COVID-19 deaths, on average, every single day.

At the current rate, America will likely top its summer Delta peak of about 2,100 deaths per day later this week — and could break its all-time record (about 3,300 deaths per day) by the end of the month.

In other words, while Omicron itself might be less likely to cause severe illness, especially in vaccinated or previously infected people, America’s Omicron surge — the sum total of all the havoc the variant has wreaked — hasn’t been as “mild” as many had hoped.

A man lies in a hospital bed while wearing a mask.
Kevin Barrett, in quarantine after a COVID-19 exposure, recovers from an injury at Harborview Medical Center in Seattle. (Elaine Thompson/AP)

But every coronavirus wave crests in due course, then starts to descend — and over the past few days, new signs have emerged from across the country that indicate the tide is starting to turn once again.

So here’s some good news about Omicron — namely, that the worst of its spread may be in the rearview mirror.

Case numbers are plummeting in New York City — and they’re falling even faster than they rose.

New York City was the first place in the U.S. to get slammed by Omicron: Between Christmas and New Year’s Day, reported cases there more than doubled, on average, from about 15,000 a day to about 33,000 a day.

Previously, America’s biggest city had never averaged more than about 6,200 cases in a single day. By Jan. 10, it was averaging more than 40,000.

But since then, transmission has fallen off a cliff.

According to data from the NYC Health Department — which is adjusted to reflect the date of diagnosis — the peak likely came on Jan. 3, when the average number of confirmed and probable cases hit 42,670.

A subway with open doors behind a sign that reads: Need a boost? Find one near you: ny.gov/vaccine
A COVID-19 vaccine booster advertisement on a New York City subway platform. (Michael Nagle/Xinhua via Getty Images)

As of Jan. 15, however, that number had plunged to 16,330 — a 62 percent drop in less than two weeks.

In the dozen days before the peak, the number of NYC cases was increasing at a rate of about 47 percent — meaning it's now going down faster than it went up.

This is encouraging because it suggests that once numbers in other parts of the country peak, those places too might see Omicron flame out even more swiftly and suddenly than it flared up in the first place.

In fact, if New York’s experience is any indication, the bulk of the current wave of transmission could effectively subside by the middle of February, about two months after it started.

By comparison, previous U.S. surges have taken about four months from start to finish.

Other cities are following NYC’s lead.

More good news: New York isn’t alone.

Right after Omicron exploded in New York, it started taking off in other dense, well-connected cities across the U.S.

Between Dec. 6 and Dec. 20, for instance, cases rose by 442 percent in Houston, 285 percent in Washington, D.C., 219 percent in Miami and 170 percent in Cleveland.

Over the last two weeks, however, cases have finally started to drop in most of these hard-hit cities: by 49 percent in Cleveland, by 20 percent in Washington, D.C., by 7 percent in Miami. In Houston, cases are down week over week.

A health care worker administers a COVID-19 test.
A health care worker administers a COVID test in North Miami on Jan. 13. (Joe Raedle/Getty Images)

Similar U-turns are also underway in Chicago, Boston, Philadelphia and Baltimore.

Meanwhile, even cities where cases have yet to officially turn are showing signs that they’re about to: a lower percentage of COVID tests coming back positive (Los Angeles); declining Omicron levels in sewage samples (the Bay Area).

Less vaccinated, more rural areas will take a little longer — but some may be starting to show improvement.

Because of how Omicron tends to spread — rapidly, through the densest places first — U.S. cities have been ahead of the curve; outlying areas have lagged. That largely explains why the states where the virus is now spreading the fastest are overwhelmingly rural: South Carolina, Oklahoma, Montana, North Dakota, Wisconsin, South Dakota, Alaska, Nebraska, Idaho, Wyoming. Such places tend to have below-average vaccination rates as well.

As Omicron spreads to less populated areas, the worry is that lower immunity levels and weaker health care infrastructure will lead to disproportionately high levels of hospitalization and death.

That dynamic certainly bears watching as the worst of today’s rising rural cases work their way through the system in the coming weeks.

A paramedic moves a cot into the home of a COVID patient in Shawnee, Okla.
A paramedic moves a cot into the home of a COVID patient in Shawnee, Okla., on Jan. 12. (Nick Oxford/Reuters)

Even so, at least three largely rural states with lower vaccination rates — Missouri, Georgia and Kentucky — may already be approaching plateaus of their own, with positivity rates that appear to be leveling off or even declining.

In fact, as researcher Conor Kelly has pointed out, positivity rates are now heading “in the right direction” across every region of the country.

A broader turnaround could be next, with other rural states not far behind.

The best news of all? Hospitalizations seem to be on the same downward trajectory.

As everyone knows by now, the most important metric isn’t how many people test positive for Omicron; the most important metric is how many of those people get sick enough to go to the hospital, or spread it to others who end up there.

By any measure, forcing U.S. hospitals to cope with 157,000 COVID-19 patients at once is an enormous burden — regardless of whether some percentage of those patients tested positive “incidentally” upon admission for another ailment. Patients with COVID must be kept separate from others, and health care workers who test positive must isolate no matter how mild their symptoms, leading to widespread staff shortages.

As the Atlantic’s Ed Yong recently explained, “In the short time since Omicron was discovered, the popular narrative about the variant has calcified around the idea that it is milder. That is true for individuals, and in comparison with Delta, but the variant certainly isn’t mild for unvaccinated people, for those who could develop long COVID from a supposedly 'mild' infection, and especially not for the health-care system as a whole.”

As hospitalization numbers typically lag cases by about two weeks, it will be some time before the extreme pressure on medical professionals lets up. And again, that process will take longer in most rural areas, which are closer to the beginning of their own surges than to the end — and where rates of hospitalization and death may be higher than in cities with higher vaccination rates.

A nurse leans over a hospital bed.
Nurse Estella Wilmarth tends to a patient at Harborview Medical Center in Seattle. (Elaine Thompson/AP)

U.S. Surgeon General Vivek Murthy outlined on Sunday how “the next few weeks will be tough” as Omicron continues to rise in different regions of the U.S.

“The good news is that there are parts of the country — New York in particular, and other parts of the Northeast, where we are starting to see a plateau and, in some cases, an early decline in cases,” Murthy told CNN. “The challenge is that … the entire country is not moving at the same pace. The Omicron wave started later in other parts of the country.”

But the light at the end of the proverbial tunnel is starting to flicker, even now.

In New York City, for instance, the average number of daily COVID hospital admissions fell from about 1,000 on Jan. 5 to about 500 ten days later — a rate roughly on par with the decline in cases. Overall hospitalizations have been falling for several days; they’re now at their lowest level since Christmas Eve. ICU and intubation numbers are down as well.

More broadly, regional hospitalizations are starting to level off across the Northeast and Midwest. And while it’s a tentative sign of progress that may reflect delays in reporting due to holidays, the number of COVID patients nationwide has now declined for three days in a row — for the first time in more than a month.

It may be too soon, in short, to say that Omicron has peaked in the U.S. But the peak is coming — and it appears to be coming sooner rather than later.


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