January 14, 2022 1:08 pm
When the highly transmissible and deadliest delta variant began to rage in the United States in 2021, it threw us into pandemic limbo. The virus remained a danger especially for unvaccinated people, but they wanted to move on. The majority of vaccinated people also wanted to move on. It was the virus that didn’t want to do it. And so we got stuck in a lethal routine, and the number of Americans who died from covid-19 in 2021 was higher than in 2020.
Now the omicron variant is spreading to every state – even among those who have been vaccinated several times – and new cases are ramping up. The virus continues to kill mostly the unvaccinated, but the very high number of infections, mostly mild, among the vaccinated is shaking us from our post-delta routine.
In dealing with this extremely contagious but now lighter variant, we need to review our position towards the pandemic.
Fast but unsafe route
The Centers for Disease Prevention and Control (CDC) have already reduced the isolation period for vaccinated people. Infections of the vaccinated are becoming commonplace. And Anthony Fauci refers to hospitalizations, rather than cases, to measure the true impact of omicron, as many infections affect vaccinated people, and they are mild.
By infecting numbers so high and so fast, omicron is also accelerating our race towards an endemic future in which everyone will have some form of immunity, making the novel coronavirus less lethal. But in the short term omicron, as an accelerator, is dangerous. The quickest route to endemicity is not the safest.
There may be no preventive confinement, but there will be unpredictable cancellations
There are still many unvaccinated or undervaccinated people in the United States, and today the number of cases that in the past would have occurred over several months is concentrated in a few weeks. Even if a lower percentage of patients end up in hospital than in the past, that low percentage multiplied by a very high number of cases will overload hospitals that have already been strained. The next few weeks will be a bad time to get sick with covid, appendicitis, or break a leg.
Compressing all those mild cases in a few weeks comes at a price: too many healthcare workers fall ill at the same time, exacerbating the hospital staff shortage. Schools, airlines, subways and businesses also find workers affected by omicron. There may be no preventive confinement, but there will be unpredictable cancellations. “It will be messed up weeks. I don’t think there’s a way around it, ”says Joseph Allen, a professor of public health at Harvard University.
The fact that sooner or later we will find ourselves with an endemic covid-19 has not changed. Nor has it changed the fact that people cannot hope to avoid the virus forever in an endemic scenario. Omicron forces us today to face the fact that people can catch and transmit covid-19 even when they are vaccinated. The problem is that we are doing it in a crisis mode.
With so many people taking covid-19, our mindset towards the virus is changing. Vaccinated infections are the new norm. For some time, at least in certain highly vaccinated blisters, people who became infected despite being vaccinated have been scrambling to figure out what they did “wrong”. But now – sorry for the hyperbole – everyone has the covid. And if you don’t have it, you probably know someone who does. Even the most careful people are getting sick. “I think the positive aspect, if there is one, is that the shame [di essere positivi] it is rapidly dissolving. And luckily, ”says Lindsey Leininger, a public health policy expert at Dartmouth college. Infections among vaccinates will be the norm when the virus eventually becomes endemic.
While covid-19 cannot be avoided forever, there are good reasons to try to avoid catching it or passing it on to others.
Vaccinated people also realize, and with good reason, that the risk of individually contracting a bad case of covid-19 is much, much lower than it was in March 2020 (the omicron variant also appears to be inherently a little less virulent than the delta, but since the delta was more virulent than the original coronavirus, omicron has a viral load similar to the original). The transition to endemicity has always had a partly psychological dimension, with people slowly abandoning the idea that covid-19 should or can be avoided forever. The omicron variant simply clarified the concept very quickly.
While covid-19 cannot be avoided forever, there are good reasons to try to avoid catching it or passing it on to others. Better treatments for the omicron variant are on the horizon, says Syra Madad, an infectious disease epidemiologist at Harvard. Pfizer’s highly effective pill has just been cleared by the US Food and Medicines Agency (FDA), but supplies are scarce. Only one monoclonal antibody, sotrovimab, currently works against omicron, and again supplies are scarce. “It’s a terrible time, unfortunately, to be hospitalized and not have these kinds of therapies available,” says Madad. In a few months, the outlook will improve for individuals at severe risk of covid-19.
Even for society at large, a huge number of cases right now are a risk to our hospitals and essential services. Just think of everything a person vulnerable to the virus needs, says Leininger. “We need water in his tap, and we need food in his refrigerator. And we need external nurses to be able to arrive by plane, because our hospitals are under siege ”. This means that water plants, grocery stores and airlines need employees to stay healthy and keep working.
This is where things get more complicated. Even our omicron strategy is weakened at this point by the less will of a more tired population. Now that the virus is circulating so much, we need to flatten the curve again. But in March 2020, we conceived social distancing to “flatten the curve” as a temporary measure that would keep us going through the next few weeks or months unscathed. “Well, it’s been two years now. Do we have to do this for five years? It’s just not sustainable, ”says Julie Downs, who studies risk perception at Carnegie Mellon University. If the more drastic restrictions linked to the virus – confinement and preventive closures – remain out of the question, we cannot avoid a staggering number of omicron cases.
The CDC which reduces the periods of isolation from ten to five days for sick people makes an attempt to balance these realities. The agency managed to launch the new recommendations in the most confusing way possible: first by not requiring a test for people without symptoms and by downplaying the usefulness of tampons, and then by adding an optional test. But the CDC essentially has to deal with a difficult set of compromises: we don’t have enough quick tests for every sick person right now, and isolating people for too long or too short has consequences. Keeping teachers and students in isolation for too long prevents schools from staying open; getting them back too soon makes it easier for the virus to spread and, again, schools can’t stay open.
Omicron forces us to reconsider how we treat mild cases of covid-19 that will never completely go away. Unfortunately, it does so in a chaotic and dangerous moment. In view of the next variant and next winter, we will have to plan ahead. The challenges that await us are already clear. Hospitals, which are under pressure even in the toughest flu seasons, will have to contend with both covid-19 and flu every winter.
The coronavirus will also continue to evolve, and new variants will emerge that will continue to erode our immunity. In a series of three papers published Jan.6, a group of Biden’s former advisers outlined a long-term strategy to monitor all respiratory infections – including covid-19, influenza, and respiratory syncytial virus – and maintain their joint weight. below that of a bad flu season. This is through increased use of testing, surveillance, mitigation, and the development of vaccines and therapies. We spent 2021 skidding in the face of new variants. But what the US needs now is a far-reaching target for covid-19. Even if the coronavirus were to surprise us again.
(Translation by Federico Ferrone)
This article was posted on the Atlantic website.