Paxlovid Availability vs the Omicron Wave

The Omicron wave is coming. Paxlovid is scarce. Which way will it go?

Omicron is coming to town… will paxlovid help?

As we demonstrated yesterday, paxlovid is in very short supply: only 58 courses yesterday afternoon, for the metro Boston population of about 4.87 million. That’s scarcity on a level that qualifies as “uselessly impossible” for most people to find.

Sure, it’ll get better. Maybe around April or May. By the usual standards of drug manufacturing, that’s lightning fast: I’m pretty sure nobody in Pfizer’s manufacturing arm or its suppliers is going to get much sleep or even a weekend for the next couple months. I say that sympathetically. Heaven bless their souls, for they work to save us all.

But… Omicron doesn’t care.

There’s a tsunami coming of Omicron infections, hospitalizations, ICU admissions, ventilator usage, and deaths. The timing is crucial: which comes first, the Omicron peak or rescue by paxlovid?

Alas, it appears the Omicron peak will happen first. Inspired by TheZvi, who looked at the IHME report for the entire United States, we consider the IHME projections for COVID-19 for the next month in our corner of the world, Massachusetts. ^[1]

• All the pictures below are linked to full-size images, so click to embiggen.
• In these graphs, the projections happen under various scenarios: no changes, Omicron much more severe, mask usage goes up to 80%, most people get a booster dose of vaccine, or vaccine hesitancy is reduced so the holdouts get vaccinated. Each scenario is indicated by the color of the dashed projection curve at the right-hand side.
• The color regions around the curve indicate uncertainty. While they didn’t document exactly what $\alpha$ level this was, I’m assuming it’s the traditional 95% confidence interval.
• There’s an important conclusion to draw from the way the scenario projections separate from each other in the Omicron wave. Can you guess what it is before I smack you in the face with it at the bottom?

Vaccine coverage:

• Massachusetts is one of the more vaccinated states. If you go to the IHME page in the references, you can see this in comparison to all 50 other states of the US and note that Massachusetts is near the top.
• I understand, sort of, why people won’t vaccinate at all. (It’s stupid, but I still – sort of – grasp the delusion.) I do not understand why anybody would stop with just 1 shot? Perhaps this is the J&J recipients, but I think it’s people who got the first mRNA dose but then never came back. What can they be thinking?
• Booters are apparently not included here. I really think boosters, for those eligible, should be the threshold to be considered “fully vaccinated”.
• I include this graph for a good reason: all the deaths and hospitalizations projected are occurring in just about the best case possible in the US for vaccinations. Less vaccinated states will have much worse outcomes than this. Take heed, and get vaccinated and boosted.

Mask use:

• This is the fraction of the population that wear a mask in public.
• Masking (presumably averaged over several kinds of masks of varying quality?) is estimated to reduce spread by 30%+.
• As you can see, we didn’t mask up until about May 2020, which was way too late.
• Then in summer 2021, we largely threw aside the masks.
• Since then, masking has only increased by about 1/3 the decrease. In other words, we started thinking “I’m done with COVID-19”, and dropped masks forever.
• This is a terrible tactical error!

Daily infections:

• This is an estimated infection rate. It includes those not reporting official test results.
• Either Omicron will be so nasty it just dwarfs the previous infection rates in the waves of the past, or testing for those past waves just wasn’t reported very well.
• Either of those can be true, but the “Omicron Tsunami” is the one for which the prudent prepare.

Hospital resource use:

• The 2 curves show hospital bed usage and ICU bed usage.
• The bottom line here is that although Omicron may be milder on average, since it infects so many more people the hospitals are about to be slammed worse than 2020 or 2021.
• Friends who have family working in Boston-area ERs confirm this: they’re already on overload, and it hasn’t peaked yet.

Daily deaths:

• This is a good indication of how bad the pandemic is at any moment. There’s a 17-21 day lag between higher infection rates and higher death rates.
• The projected death rates are comparable to the horrible rates seen last year in January. If you look at the upper end of the confidence limits, they may approach the even more horrible death rates of spring 2020 back in the pre-vaccine era.

Cumulative deaths:

• They’re showing about 21k - 25k cumulative deaths by the end of Omicron.
• Current deaths are about 20k, so this means Omicron will layer on top of that an additional 5% - 25% more of the current total.

The Scenarios: Remember those various scenarios above around mask use, vaccination, and so on? See how the projection lines don’t separate much from each other? Basically, the conclusion is that there’s not much we can do about this. We’re gonna get an Omicron wave and it will be pretty bad. Prepare for that.

Afterwards, it might be better. But the next month or month and a half will be other than we prefer.

The Weekend Conclusion

It’s going to be a rough 4-6 weeks ahead of us in the US. Now is a terrible time to show up at a hospital with a heart attack or a broken leg, so be careful for non-COVID reasons, too.

The peak will happen soon: late January or February.

Conclusion: Paxlovid available in April might as well be paxlovid available on Mars. Prepare to deal with Omicron by stocking up on food, medications, and living carefully enough to stay out of hospital for 4-6 weeks.

---

Notes & References

1: Institute for Health Metrics and Evaluation, “COVID-19 Projections” (Massachuseetts, USA), HealthData.org, retrieved 2022-Jan-12. ↩