Which was worse?

This is a reader requested topic!

Let’s talk about Delta and Omicron. Specifically, which one was worse?  

This is actually a very good example of the difference between thinking medically and thinking about public health. It unpacks very neatly.  It was more dangerous for any individual person to be infected with Delta than to be infected with Omicron. Delta infections are more likely to cause severe complications. They were more likely to hospitalize you and they were more likely to kill you. So as an individual person, if you had to choose between the two, the infection you wanted was omicron. That's the individual medical perspective.

The public health perspective is not the same. Things are different if you consider infection from a community or population level. Let's say you lived in a midsize Midwestern city like Madison, or Dayton. If you knew that your city was going to get one of those two variants of COVID and only one, what would you hope for? It’s going to sweep through the city. It's going to infect as much as it can.

You’d want Delta to come to your city, because it would infect fewer people. Those individual people would be more likely to have severe consequences. But fewer people would get infected, so smaller number of people in total would suffer those severe consequences. If Omicron came to your city, many more people would be infected. Even though a smaller percentage of people would have the severe form, in absolute numbers, you'd end up with more people that have severe COVID. Omicron would be worse for the city as a whole, even if it went easier on each individual person.

Or, putting it differently, let’s talk about kids. Any individual child is safer having Omicron than having Delta. But for a school as a whole, it’s better to have a delta outbreak because fewer kids would get sick. Those individual kids would be more likely to be hospitalized, but the school’s total number of hospitalizations would be lower. A large percentage of a small number is less than a small percentage of a huge number. (I’m not using actual numbers here because the science is still settling.)

Both of these perspectives are completely valid. Sometimes you're thinking about one person and sometimes you're thinking about populations, and you need to think both ways. You need to be aware of both views. I believe that we tend to mix it up. We forget that these are different views. If we say “better,” or “worse,” we don't stop specify whether we mean for one infected person or whether we mean an entire population. More clarity on perspective and in language would take us a long way in thinking sensibly about COVID.

So, which is worse – Delta or Omicron? It depends.