On Tuesday, Johns Hopkins reported 1,082,549 new cases of COVID-19 in the United States in a single day, annihilating all past records in the U.S. or in any other nation. This record was assisted by belated recording of cases logged over the New Year’s holiday weekend. Looking at the Centers for Disease Control and Prevention (CDC) or WorldOMeters results brings up numbers about half those logged by the Johns Hopkins data. However, even these relatively smaller numbers are still massively higher than the 260,000 cases logged in a single day of January 2020, which had represented the previous record high.

No matter what the source, the U.S. is flattening the curve—but only in the sense that it has become a near-vertical line.

At the same time, the idea omicron is “mild” may be one of the most dangerous impressions to emerge since the beginning of the pandemic. How “mild” omicron may be in relation to other variants is still in dispute. Early studies indicated that omicron is actually little different from delta when it comes to causing severe illness, but real-world data from some regions indicated that there were signs of reduced severity. However, even if omicron is many times less likely to cause severe illness, the sheer number of cases represents an enormous potential to overload health care systems, resulting in untold harm. And that’s exactly what seems to be happening.

To this point, the daily deaths logged by the CDC have no matching spike. This follows reassuring data from South Africa and the U.K., where high levels of cases due to the fantastically communicable omicron variant have resulted in relatively modest increases in the rate of deaths. However, “relatively modest” does not mean “none.” Both nations experienced an increase in deaths over the last month, and other countries, such as Germany, have experienced definitive increases in deaths even as omicron became the dominant variant.

Hospitalizations are already hitting record highs, especially among children

Whether omicron is 90%, 50%, or just 20% as likely to result in hospitalization as delta, that difference can be swamped by the massive flood of new cases coming in. As The Washington Post reports, New York surpassed all previous records on Monday, not just for new cases, but for the number of patients hospitalized with coronavirus infection. The St. Louis Post-Dispatch notes that the same thing is true in Missouri. KXAN reported on Monday that Texas Children’s Hospital was seeing record levels of hospitalization resulting from COVID-19. Similar reports have been seen elsewhere across the country. 

It’s not actually clear that omicron is more serious for younger patients than previous variants. However, as with older patients, the rapidly rising number of cases is enough to overrun available beds in several locations. New admissions of pediatric patients are up by two-thirds over the last week, exceeding the highest counts of either the delta peak over the summer or the earlier peak that occurred in January 2020.

The official CDC numbers nationwide are compiled at week’s end and show a 17.5% increase between the weeks of Christmas and New Year’s. While this has the nationwide hospitalization rate still significantly below the worst of the 2021 peaks, expect this number to rise steeply over the next two weeks.

CDC numbers show a 17% week over week increase going into the end of the year. Expect a bigger jump this week.

Differentiating variants is a big problem, but that one may be going away quickly

As The Washington Post reported on Monday, most doctors and hospitals lack an easy way to differentiate between patients infected with omicron and those infected with delta or other variants—and not knowing the variant has consequences. Both lab studies and real-world data suggest delta is much more likely to infect the lungs than omicron, meaning that patients infected by the two variants may benefit from very different treatment.

In addition, omicron has proven to be highly evasive of the benefits provided by monoclonal antibody treatments. These treatments, from Regeneron and Eli Lilly, remain expensive, and there is a far from adequate supply to address all patients. So being able to identify patients in the first day or two after symptoms appear, when these treatments provide the most benefit, is essential to using monoclonal antibodies efficiently. 

Giving these antibodies to omicron patients is essentially wasting a costly, limited treatment that has much more value to patients with delta or other variants. But the difficulty in determining which patients have omicron (especially after omicron subvariants emerged that don’t display the more easily detectable S-gene dropout) is making it hard to properly target the monoclonal antibody supply.

But this problem may not be a problem much longer. That’s because the latest CDC numbers show omicron all but eliminating other players from the variant pool. One month after it first appeared in the U.S., omicron now accounts for approximately 95% of all new cases. Earlier estimates showing omicron rising even more sharply were revised, but these numbers are likely to remain close to the current projections.

What’s one way to solve the “we can’t tell the variant” issue? Get rid of all the variants except one.

In a single month, omicron has gone from 0% to roughly 95% of all new COVID-19 cases in the United States.

Omicron protects against Delta, but the reverse is not true

Reinfection has been a concern since the beginning of the pandemic. While earlier variants showed only a very small number of repeat cases of COVID-19, that wasn’t true when delta rolled around. Those who had been through an infection with beta, or one of the early variants, proved to have a level of protection against delta that was much lower than that provided by vaccines, and reinfections were relatively common. 

This is even more true with omicron. Multiple studies, as well as real world evidence, have demonstrated that cases of COVID-19 from delta or earlier variants of the SARS-CoV-2 virus do little to protect against infection by omicron. Research from Imperial College of London in early December showed that protection provided by past infection, including delta, provided as little as 19% protection against omicron. Reinfection rates with omicron were estimated to be over five times higher than with previous variants.

However, a study from Africa Health Research Institute indicates that being infected with omicron could provide much higher levels of protection against delta. The levels of neutralizing antibodies against delta increased sharply in patients infected by omicron. Enough so that “the increase in Delta variant neutralization in individuals infected with Omicron may result in decreased ability of Delta to re-infect those individuals,” according to the authors of the study.

This could help to explain how omicron isn’t just outpacing, but rapidly replacing delta. It’s not just infecting patients more rapidly, it’s blocking delta’s spread to the chunk of population that both variants are fighting to infect.

Despite increased evasion by omicron, the latest data shows that the unvaccinated are still six times more likely to become infected by the new variants. With 62% of Americans overall being vaccinated, including 72.8% of adults, it’s the unvaccinated group that represents the primary source of potential new infections. Omicron is claiming those people first, and its ability to defend against rival variants is allowing it to sweep the field more quickly than previous variants.

62% of Americans are fully vaccinated, including 72.8% of those 18 and over.

Schools remain an enormous issue, and forcing them open simply isn’t possible

As America sets new records for COVID-19 infections, schools across the nation are reopening following the holidays. Or at least, they’re trying to reopen. 

Schools in some areas are closed at the moment from winter storms that moved swiftly across the eastern U.S. But, as USA Today reports, even more regions are seeing schools closed from COVID-19. Some schools have already announced they are moving to virtual classes for a matter of days or weeks.

This is coming in spite of states like Florida sanctioning schools that attempted to restrict classes or enforce mask mandates. And executive orders requiring schools to be open without requiring masks. It’s in spite of orders requiring schools to conduct in-person classes, and in spite of rampaging attorney generals suing schools for any action to protect students. 

It’s coming not so much from politics as something even more fundamental: logistics.

Schools have been struggling with a substitute teacher shortage throughout the pandemic. That shortage grew worse during the delta surge, with more than 75% of school districts reporting difficulty finding sufficient substitute teachers by November.

A classroom is not an office. When a teacher is absent, it means 30 or more kids, aged somewhere between 5 and 18, left in a room unsupervised. Schools have been forced to join classrooms together, sometimes across grade levels. The resulting classrooms have very little value for providing instruction … but they’re very good at spreading COVID-19. 

With the increase in the number of cases with omicron, schools are simply missing too many teachers to hold classes. The number of substitutes is limited. Being a substitute teacher is a thankless, dangerous, low-paying job even without the pandemic, and schools simply cannot locate enough people to hold classes in many areas. The same thing applies with other staff, such as bus drivers.

Teachers are almost universally underpaid. They’re told their jobs are essential, and that in-person instruction is vital to the nation’s future. They’re simultaneously being told that their health is not worth preserving, and that increased wages are impossible. All of this is much worse when it comes to substitute teachers, bus drivers, and other school staff. Whether it’s in New York City; or Beloit, Wisconsin; or Columbus, Ohio; school districts are closing because they have to.

Republicans may  scream death threats at school board meetings. Florida Gov. Ron DeSantis may threaten to rob schools of their payroll. Eric Schmitt may encourage parents to snitch on anyone who dares try to enforce a public health order. None of that matters. Schools are closed because teachers are sick. They’re also hampered by a lack of tests that means every cold-like symptom has to be treated as omicron, even for those who have been vaccinated.

That’s not going to change until the current wave of cases is past.

Line shows seven-day moving average of new cases by state. The redder the color, the stepper the increase.