We are entering the third year of the pandemic with a confusing state of affairs. The United States has far surpassed the number of daily covid-19 infections compared with the previous peak last winter, yet many businesses remain open, stadiums are packed and children are headed back to school. News headlines announce that “omicron infections seem to be milder” than earlier variants, yet this could be the “worst public health challenge of our lifetimes.”
Here’s how to reconcile the seeming contradictions of where we are: The risk to individuals is low, while the risk to society is high. Policy solutions that demand substantial individual sacrifice will not work; instead, we need to acknowledge the public’s very real weariness and come up with practical strategies that keep society functioning.
Research is increasingly pointing to omicron causing less severe disease compared with previous variants. In addition, vaccination — especially with a booster — appears highly protective against hospitalization and death. The tsunami of viral transmission means that many vaccinated people will have breakthrough infections, but the vast majority will have symptoms somewhere between a mild cold and the flu.
As a result, it’s unreasonable to ask vaccinated people to refrain from pre-pandemic activities. After all, the individual risk to them is low, and there is a steep price to keeping students out of school, shuttering restaurants and retail shops, and stopping travel and commerce.
At the same time, out of control virus dynamics pose existential threats to society. So many firefighters and emergency medical personnel are out because of covid-19 that Cincinnati declared a state of emergency. One in 6 police officers in New York City had symptoms or were diagnosed with covid-19 last week. Thousands of flights have been canceled, in part because of inadequate staffing from quarantined workers.
The situation facing hospitals is particularly dire. At least six Maryland hospitals have shifted to crisis standards of care, citing depletion of existing resources. New York state has asked 32 hospitals to postpone nonurgent elective scheduled surgeries. Leaders from nine Minnesota hospitals took out an ad that began, “We’re heartbroken. We’re overwhelmed.”
The United States has three options for dealing with this surge. First, we could reimpose lockdowns. While some European and Asian countries have chosen this path, I believe it’s a nonstarter here. Even if lockdowns could more quickly bring omicron under control, there is no political appetite or public backing for this level of collective sacrifice.
Second, we could let omicron run its course. There’s a school of thought that omicron is so contagious it will infect nearly everyone anyway, and it’s better to get this variant and develop additional immunity. Instead of trying to stop it, we could treat omicron as we do a common cold: We don’t isolate people with colds, and getting rid of isolation and quarantine would alleviate staffing shortages and keep the economy going. However, this path of uncontrolled spread would almost assuredly push many hospitals over the edge, and patients could die because they can’t access timely care.
There is a third path that aims to save our hospitals while also minimizing disruption. We don’t need to ask people to stay home, but we should require that they wear high-quality masks in all indoor public spaces. We don’t need to cancel gatherings, but we should mandate proof of vaccination — and boosters — for all indoor dining, gyms, movie theaters, and sporting events.
Last week, the Centers for Disease Control and Prevention announced that it is shortening the isolation period for those infected with covid-19 from 10 days to five. It can go even further — not to get rid of isolation requirements for everyone but to reduce or even forgo isolation and quarantine (while mandating high-quality masks) for those working in public safety, transportation, education and other critical jobs.
In the meantime, we must do much more to protect the most vulnerable, including ensuring boosters for all nursing home residents and staff, ramping up production of preventive monoclonal antibodies for the immunocompromised and expediting vaccine approval for children under 5.
The Biden administration should be up front and say that it is taking these actions out of necessity. These are not the scientifically most sound or the most efficient ways to curb covid-19, but they are the practical middle path that balances what Americans can tolerate with what we need to do to avert the collapse of our health-care system.
This is our new reality going forward. There could well be surges of new variants every year — or even every few months. As long as vaccines continue to protect against severe illness and the risk to most individuals remains low, our paradigm has to shift from preventing infection to stopping societal devastation.