The US has experienced a brutal winter wave of COVID-19, powered by the highly transmissible Omicron variant. Daily deaths are higher today than at the peak of the Delta wave last fall, and have stabilized at about 2,500 per day. Many hospitals are still under great pressure, postponing elective surgeries to make beds for patients with COVID-19. The daily number of cases was higher than during the Delta wave, despite multiple enthusiastic predictions in the past that we had achieved herd immunity and that the pandemic was over.
Nevertheless, there are promising signs that we are turning the corner. New diurnal cases are declining rapidly – they are down more than 75% from the peak of the Omicron wave. The number of hospital admissions is also falling. While we’re not completely clear yet, especially in poorly vaccinated regions of the US, the sharp drop in cases is cause for optimism.
The fall in the number of cases is also an opportunity for fundamental preparation, given the high probability of a future wave. To avoid being overwhelmed again, we must now be proactive in setting up a preparedness system.
Instead, given these declining cases, some experts are calling for an end to pandemic control measures, such as indoor masking and testing people without symptoms. And several states have rolled back mask mandates, though inner mask mandates remain popular in public polls (the Biden administration is more cautious about easing masks). We fully understand the frustration and impatience behind these calls. Pandemic fatigue is real. Yet this longing for “normal” overlooks the reality that before COVID-19 our society was anything but normal. If it had, we might not have had such a devastating pandemic as we are now. Instead, it was the very conditions that created terrible inequalities and disproportionate consequences for America’s poor that continue today.
We are concerned that the Biden administration is not taking preparations seriously enough. It was a welcome step to see the government making 400 million N95 masks available for free in pharmacies and health centers, and we’re excited that Americans can now go online and order four free rapid tests per household. But four quick tests and a mask won’t be enough to end the pandemic. These measures are disproportionate to the magnitude of the problem and must be linked to effective public health strategies for effective deployment and sustainable application.
Perhaps the biggest problem is that there is still a huge amount of viral transmission, with about 175,000 new cases every day. Less than two-thirds of Americans are fully vaccinated — defined as two doses of Pfizer or Moderna or one dose of Johnson & Johnson — which doesn’t offer as much protection as it did before Omicron. Only a quarter of Americans have received a booster dose, which provides the highest level of protection against infection, hospitalization and death. There are persistent inequalities in vaccination, including racial disparities, with black and Hispanic populations being vaccinated at a slower rate compared to white populations. Only 24% of children aged 5 to 11 and 57% of children aged 12 to 17 have been fully vaccinated. Hospital admissions under 5 reached record levels during the Omicron wave, but vaccines are not yet approved for this age group.
Read more: Nasal vaccines could help stop COVID-19
There’s also what the New York Times calls a “pandemic of the forgotten.” About 7 million Americans have immune systems weakened by transplants, cancer treatments, rheumatoid arthritis medications or other medical conditions, and they can become very sick if they get COVID-19. Yet this urge to return to normal seems to ignore them business-wise. And there is a growing number of people suffering from long-term morbidity after surviving an infection – the condition now known as Lung Covid – that we are just beginning to understand.
A recurring problem when it comes to pandemics is that we suffer from short-term memory. We cross our fingers and hope this wave is the last. Many of us were surprised when Vice President Kamala Harris said the Biden administration “didn’t see Delta coming… Omicron didn’t see it coming.” That’s absurd. Viral mutations were fully expected. There is a serious risk of further variants emerging, especially with uneven and low vaccination coverage across much of the world due to supply hoarding. Spreading a few quick tests and masks and hoping this wave will dissipate and end the US pandemic is not a good approach.
Even with the current variants in circulation, we could see further waves, such as in the south in recent summers, especially in poorly vaccinated states, and as people move indoors to escape the heat and humidity. We might see future winter waves in the same way as we have seen in the northeast. With Omicron’s cases declining, now is the time to put in place a proper infrastructure, resilient enough to handle further spikes. Instead of declaring “mission accomplished,” we must declare a significant effort for true preparedness.
What would real preparedness look like, besides boosting vaccination rates?
Rather than a one-off distribution of N95 masks, the government should replenish supplies enough to redeploy them in the face of future outbreaks. These should be available everywhere, and in a variety of shapes and sizes, outside of all high-risk locations, including public transportation or crowded indoor congregation locations (supermarkets, malls, shops, movie theaters, gyms, offices) during peak times.
Serial rapid tests are needed, and they need to reach those who can’t order them online. A single test is a snapshot – so after a known exposure it is necessary to have enough tests for daily tests for 5 to 7 days before you leave the house. Rapid tests identify contagious people before they develop symptoms, helping people prevent the infection from spreading, breaking the cycles of transmission. One of us has made similar arguments for both Ebola and Zika in the past. Such rapid tests for SARS-CoV-2 can help keep schools and workplaces open, and they can protect vulnerable people in nursing homes, prisons, prisons and other high-risk gathering environments. High-quality masks and rapid testing are especially critical for protecting frontline workers.
With the advent of new antiviral drugs, such as Paxlovid, and data showing that early-stage antiviral use is more effective, universal access to free tests has become even more urgent. These drugs can reduce your chances of hospitalization or death if taken soon enough after symptoms start, but they require access to tests for an early enough diagnosis. Better access to testing must be combined with fair and equitable access to these drugs, especially for communities that traditionally have limited access to care.
A joint preparation plan also includes paid sick leave. During the 2009 swine flu pandemic, an estimated 3 in 10 people with symptoms in the US went to work, infecting up to 7 million others. The US is the only high-income country without mandatory federal health insurance, and this will continue to be a huge barrier to managing COVID-19.
Another way to combat the transmission of SARS-CoV-2 is to improve ventilation and air filtration in all buildings, including schools. Congress has allocated up to $170 billion for improvements to school infrastructure, including improving air quality. Unfortunately, too much of this money has been left on the table. In some cases, as Joseph Allen and Celine Gounder note, some schools are “already under attack from parents who oppose other pandemic-related public health measures, such as masking.” Other school districts don’t have the know-how to make the upgrades – they need better guidance and standards. Some schools say they are struggling to afford improved ventilation systems even with federal aid.
Rather than being caught flat-footed by the next wave or variant, we need more comprehensive data and monitoring systems, including wastewater sampling, as well as genomic monitoring to identify and track new variants. With better data, we can know when to titrate public health protections up and down. As Megan Ranney, professor of emergency medicine and academic dean of public health at Brown University says, we now need “investments in better data systems to signal when a wave is coming and to provide clear statistics on when to increase protection.” (such as masks) – and clear rules about when these protections can be relaxed.”
With so many people worldwide still unvaccinated and many Americans without boosters, we need to prepare for future pandemic ebbs and flows. To end the pandemic, the US needs to do much more to increase global access to vaccines, including donating multiple doses, sharing vaccine technology more urgently, and funding massive global production. Domestically, an important guiding principle is that our policies should be based on data, not dates – for example, we believe it is better to base the end of mask mandates on metrics such as vaccination coverage, hospitalization rates and ICU capacity rather than to choose any end date. Unlike the start of the pandemic, we now have a remarkable set of science-based tools that can turn COVID-19 into something akin to a cold or flu, but to get there we need higher vaccination rates, better data and surveillance systems. data-driven policies on masks and rapid tests, improved ventilation in shared public areas, and a more resilient preparedness system.
This post The Omicron wave is receding, but the pandemic is far from over
was original published at “https://time.com/6148270/covid-19-pandemic-far-from-over/”