“Omicron, with its extraordinary, unprecedented degree of efficiency of transmissibility, will, ultimately, find just about everybody.” Those were the words of America’s top infectious disease expert, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases to a Washington think tank on Tuesday.

First reported in the U.S. just six weeks ago, Omicron is now far and away the dominant COVID-19 variant in the U.S. The number of cases reported is exploding, with more than 1.4 million new cases reported in the U.S. on Monday.

However, evidence is starting to show that we may be close to the peak of the surge. In Great Britain, where the number of patients hospitalized with COVID has been shrinking, health officials announced on Wednesday the hospitalization rate fell below the 14-day average for the first time since November. And just up I-95 in New Jersey, where Gov. Phil Murphy had described what that state was experiencing as an “Omicron tsunami,” health officials reported a slight drop in hospitalizations.

Additionally, one highly regarded modeler, University of Washington’s Ali Mukdad, PhD, predicts infection rates will fall as fast as they rose, mostly, as seems to be the case after six weeks in South Africa, because there will be so many fewer people left who haven’t been infected.

But even if we are at or near the peak of infection, hospitalization rates tend to lag behind infection rates, prolonging the crisis. This weekend hospitalizations in the U.S. hit a record, more than 140,000 — although thankfully both hospitalizations and deaths have risen much more slowly than the total number of COVID cases.

One big reason for that is the effectiveness of vaccines at preventing serious illness. The data shows that fully vaccinated people, particularly those who have been boosted, are far less likely to become seriously ill or die. Although it’s too early to tell for sure, another reason this variant seems to generally cause less severe disease may be how and where Omicron infects the body. For instance, there’s some evidence it may replicate more slowly in the lungs than previous variants. 

But whatever you do, don’t call Omicron “mild,” the World Health Organization (WHO) warns, although lots of news outlets are doing that. "Just like previous variants, Omicron is hospitalizing people and it is killing people,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news conference last week. "In fact, the tsunami of cases is so huge and quick, that it is overwhelming health systems around the world." 

That’s certainly a concern right here in Maryland, where the University of Maryland Medical System (UMMS) now reports well over 800 patients hospitalized with COVID — twice the previous peak. And it’s not just taking up beds, it’s taking out increasing numbers of health care providers and support staff.

At a virtual town hall meeting Jan. 6, UMMS President and CEO Mohan Suntha, MD, MBA, said more than 1,100 UMMS team members had tested positive for COVID since the day after Christmas. As a result of patient loads and staff shortages, six of the system’s hospitals are now operating under a crisis standard of care. Suntha also addressed another important aspect of the Omicron surge: who is getting seriously ill with this strain of COVID. Among UMMS patients, about three-fourths are unvaccinated, fewer than a quarter are vaccinated, and only about 1 in 20 are people who were fully vaccinated and boosted.

For those of us lucky enough not to land in the hospital right now, perhaps the two most difficult challenges are how to make sense of changes in the rules about testing and isolating and just finding a test so you can make decisions about your health and maybe get back to work.

To that last point, the White House has promised to distribute 500 million rapid test kits to Americans, but it may be weeks before they arrive, possibly long after Omicron has peaked and subsided. In the meantime, the Maryland Department of Health is setting up 10 new testing sites adjacent to hospitals, including one across from the University of Maryland Medical Center that is planned to open next week.

Joining University of Maryland, Baltimore President Bruce E. Jarrell, MD, FACS, to discuss issues surrounding the state of COVID-19 on his regular program, Virtual Face to Face with President Bruce Jarrell, on Jan. 13 was Kathleen M. Neuzil, MD, MPH, FIDSA, professor of medicine at the University of Maryland School of Medicine (UMSOM) and director of UMSOM’s Center for Vaccine Development and Global Health.

Watch the entire discussion, including questions from the audience, by accessing the link at the top of the page.