As the omicron blizzard recedes, and as more Americans itch for pandemic restrictions to be lifted, a vocal segment of the country is pleading for caution. As with omicron, they argue, the possibility of an unforeseen variant remains a serious threat.
Many areas are already seeing a steep decline in infections. New York City’s case numbers are about seven times lower than just three weeks ago, and hospitalizations are down. Others in the throes of the omicron wave are expected to emerge by the end of February. A new sub-variant — the so-called stealth omicron — could complicate recovery due its heightened contagiousness, but vaccinated and boosted people still appear to be protected. Between the vaccinated and those with at least temporary immunity due to recent infection, we should have enough population immunity to experience a lull in the coming months.
So while the much-hyped “hot vax summer” of 2021 famously did not materialize, thanks to the delta variant, maybe this time we can enjoy a "hot vax spring.”
That would mean, in areas where hospitalizations are declining, the rapid removal of restrictions with the understanding that they may need to come back if new threats emerge. Doing so could give weary Americans much-needed respite while also preserving public health authority for when it’s needed again.
The most important step is to have a quick off-ramp for masking. While many people do not see masking as a major inconvenience, plenty see it as a symbol of the pandemic. Mandatory masking, especially in schools, has engendered major opposition, and a reasoned conversation about when to lift mask requirements is overdue.
There are two approaches here. One is gradual and based on case numbers and test positivity. Communities can identify two thresholds for transmission. At the higher level, there should be two out of three protective measures: vaccines, testing or masking. Workplaces and schools that require vaccines and that have regular testing can already do away with masks. At the lower level, one out of three is enough, such that vaccines or testing alone can replace the need for masks.
Another approach, which I am beginning to favor, is to state that every person 5 and older can be vaccinated, and high-quality masks can protect individuals well. Therefore, masks can be optional, not required, even at high rates of community transmission. The threshold for re-implementing indoor masking would shift from case numbers to hospital capacity. (Of course, masking could also return if a deadlier variant arises that evades prior immunity.)
Along with mandatory masking, other precautions should also go, including venue capacity limits and pre-departure testing for international travel. The one pandemic restriction I wouldn’t change is the vaccine requirement. In fact, I’d encourage municipalities, businesses and the federal government to embrace it even more.
That’s because the single biggest threat to resuming pre-pandemic normal is the strain on our health-care system. New data from the Centers for Disease Control and Prevention show that unvaccinated people ages 65 and up are 52 times more likely to be hospitalized from covid-19 than those who are vaccinated and boosted. For those between ages 50 and 64, the difference is 46 times. Another analysis found that nearly half of coronavirus hospitalizations this winter could have been prevented if the United States had comparable vaccination rates to leading European countries.
So keep vaccine requirements and drop everything else. The vaccinated, who have done everything right, should not have any restrictions placed on them; it’s not fair to them and it disincentivizes vaccination.
Since last May, I’ve argued that reopening should be tied to vaccination. We lost that opportunity then but have a new one. Provide proof of vaccination, and you don’t need to mask, quarantine when exposed or test before traveling. There would be little preventing you from returning to pre-pandemic life. You could still contract covid-19 — there’s no such thing as zero risk, including from long covid. But your symptoms will likely be mild and similar to a bad cold.
To be sure, I am not advising that we throw all caution out the window. There will be many who cannot let their guard down, including the immunocompromised and parents of young children. Officials will still choose to be careful and voluntarily limit their activities. The Biden administration needs to speed up anti-viral treatments and expedite authorization of pediatric vaccines. They should closely monitor when additional boosters are needed and provide free testing and high-quality masks to those who want them.
But it’s time to allow — even encourage — most Americans to enjoy their “hot vax spring.” An effective public health response depends on knowing when to end a state of emergency. Vaccinated people should enjoy the months ahead and appreciate this period of relative calm while we can, before another variant threatens to upend our lives again.