‘I'm really feeling like this is going to be one of the most challenging periods’ of pandemic,’ MUSC scientist says

As Washington, D.C., New York, Florida, Puerto Rico and a growing list of other areas see COVID cases rise “like a space ship taking off,” in the words of the Medical University of South Carolina’s Michael Sweat, Ph.D., the likelihood that South Carolina will echo that troubling trajectory seems increasingly likely.

“I'm really feeling like this is going to be one of the most challenging periods, because people are exhausted,” Sweat said. “A lot of people who did all the right things are going to get infected. It's really disheartening and it's going to be a little scary. And I think it's going to have a lot of short term economic impacts, like businesses getting frozen up and supply chains being affected.”

Sweat, a public health expert who leads MUSC’s COVID-19 Epidemiology Intelligence Project, serves as a professor in MUSC’s College of Medicine and an adjunct professor with the Johns Hopkins Bloomberg School of Public Health. He’s also a former research scientist with the Centers for Disease Control and Prevention. Right now, he’s using the knowledge, gained over a career of monitoring and guiding public health, to inform his scientific calculations as he looks at where the Omicron variant will drive the pandemic next in his state.

“I've been running all these numbers, but it's very tricky. There's a lot of uncertainty. How high will infection levels go? They're just shooting right up. And how long would those high levels last? Also, how sick will Omicron make the people who do get it?”

How high will infection levels go?

The number of COVID cases began to rise recently in the four areas of South Carolina that Sweat’s team tracks: Charleston, Florence, Lancaster and the Midlands. He focuses on those locations because MUSC Health has hospitals there. Sweat recently predicted a new winter wave had begun, and other MUSC scientists reported on Christmas Eve that more than 60% of the cases they sequenced involved the Omicron variant.

The holidays have delayed new data reports from the South Carolina Department of Health and Environmental Control, but the agency plans to release several days’ worth on Dec. 29. Sweat predicts the new data will show the numbers continuing to rise. 

Will they shoot up like we’re seeing in other parts of this country, the U.K., Denmark and other hotspots? Probably, Sweat said. “In the U.K., it's up to 159 cases per day per 100,000 people and still climbing. In Denmark, it's up to 208 and still climbing.”

How long would high levels here last?

A lot of people felt encouraged when South Africa, where the Omicron variant was first reported, saw its steep surge appear to end and the numbers begin to plunge. And that’s great news for South Africa, Sweat said. “But there's a couple of fishy things in South Africa. They only went up to 39 cases per 100,000 people at their peak. And it was mostly in the Pretoria area, Johannesburg area. And then it kind of died down.”

He said the United States is much more like the U.K. than South Africa in terms of age, vaccination rates and health systems. “The South Africans are saying themselves that they think the drop they had was due to age. I think the median age there is about 28. Here it's about 38. They had 25% vaccination rates and their surveillance studies indicated that around 85% of people had been affected in recent waves. So their belief is that a lot of that natural immunity slowed their transmission, plus people were younger.”

Despite the differences between the U.S. and South Africa, Sweat said Omicron’s ability to spread at super speed may mean it peaks quickly in other places, too — including South Carolina. He encouraged people to be on guard for the next month or so. That means New Year’s Eve celebrations at home may be the safest bet.

“I think in a week or two, we’re going to know much more,” he said. In the meantime, Sweat is helping hospital leaders plan for multiple scenarios. “In one, it peaks at 25 days, in another it peaks at 35 days and another one involves a peak at about 45 days.” The longer Omicron takes to peak, the more powerful its impact could be on the health care system. 

How sick will Omicron make the people who do get it?

That’s the final factor that Sweat is scrutinizing. “We’re starting to get a better idea of a possible reduction in severity,” he said.

The Centers for Disease Control and Prevention says the verdict is still out on Omicron’s severity, but notes that vaccines are expected to protect against severe illness, hospitalization and death.

Sweat said other encouraging information is emerging, too. “There have been reports, they're fairly anecdotal, that when people go into the hospital, they're not staying very long. They're coming in really sick, but stay only about three days.”

But when a huge number of people get infected, even if only a small percentage go to the hospital, it can cause trouble. “It still puts a big burden on the hospital. This is what all the other models have been showing too. And you know, maybe it won't happen, but it's a little worrying that we could have some big numbers,” Sweat said.

Bottom line: Play it safe, Sweat said. “Here’s what I hope people walk away with. Don't freak out. We need to know a little more. It looks like the hospitals are going to be able to handle it. So far, that's the case in the U.K. And new, highly effective anti-viral drugs — especially Paxlovid by Pfizer — will be more available in the coming months. That’s another bright spot for the future."