The recent Chicago public school crisis, the collapse of the Broadway theater in New York City, the ongoing changes in NBA and NFL player screening protocols, and the extreme scarcity of rapid tests across the country are all a deafening call for an urgent review of our national COVID-19 response plan. These and similar scenes of chaos and conflict over the reopening of American institutions and commerce reflect the lack of a coherent national plan that addresses the infectiousness of the Omicron variant. Central to this current failure is the need for a clear national definition of “public security” that the American people can understand and accept. Vague and impressionistic calls for “security” are torn apart by partisan divisions over real-world policy and implementation.
First, we need to establish this definition of security as the necessary foundation for building a robust national plan. Second, our COVID-19 policy must not abruptly move from scientific inquiry to inquiry, alter the availability of critical resources, and move from federal agency to agency. Rather, policy should respond pragmatically to the drivers of human behavior and to a coherent picture of where the pandemic is headed.
The new plan must take into account the current political reality. The best single predictor of Americans’ response to the pandemic is their political ideology and partisanship. Polls during the pandemic have consistently revealed deep Red State/Blue State polarization in COVID-related attitudes, behaviors and policies. Significant differences in immunization and death rates are also noted across party lines, both at the state and provincial levels. This becomes especially relevant when you consider that over the past year there has been a 17 to 20-fold increase in hospitalizations and death rates in unimmunized versus immunized populations.
The portability and rapid spread of the Omicron variant have further exacerbated these divisions. Most states are currently experiencing their highest-to-date pandemic caseload, although they are beginning to decline in some places. Healthcare systems and caregivers are overwhelmed and burned out. At the same time, schools, colleges, employers and most sections of society are struggling to “return to normal” as they face backlash from key voters over the definitions and markings of safety. As a nation, we are stagnating because we simply have not understood what to do.
dr. Anthony Fauci, the president’s chief medical adviser, recently argued, “We need to get the American people to work together.” But patriotic calls for dual harmony are woefully insufficient to unite us. To restore our dynamism and prosperity, we must forge a new national COVID-19 plan based on a pragmatic application of public health principles that encompasses both of our well-known political counter-narratives.
The liberal narrative calls for the avoidance of infection at all costs and is more willing to accept socioeconomic consequences of personal and societal security measures. Conservatives generally have a higher risk tolerance for infection and are more willing to accept the health consequences for themselves and the public.
Read more: Omicron could be the beginning of the end of the pandemic
Bipartisan policy making should be evidence-driven and responsive to both political narratives. Neither counter-narrative has a monopoly on “following science.” Omicron is politically agnostic. Although the virus is blind to religion, ethnicity, race and gender, it makes the economically disadvantaged and those with underlying health conditions highly vulnerable. It also has a fierce geriatric agenda. This leads to an ambitious but achievable framework for a new national policy with four pillars that respond to the now fairly well-defined characteristics of Omicron:
1) Change the national policy target for the non-vulnerable
Our current goal is to prevent cases or infections – defined as test positives – in everyone. With Omicron’s unprecedented portability and relatively mild health outcomes, this is unsustainable and unnecessary. The new foundation and pivot of our national goal must be serious health outcomes (ER visits, hospitalizations, and deaths) in the 260 million non-vulnerable Americans. A review of recent studies and modeling by the University of Washington concludes that Omicron is 90-99% less severe than Delta. This is due to a large increase in asymptomatic infections (about 80-90 percent of the total), a 50 percent reduction in those hospitalized and a 5-10 fold reduction in those hospitalized. reduction in death. These numbers put the relative risk of severe Omicron disease in the non-frail individuals in the same range as the flu, a virus we have learned to live with.
Many non-vulnerable individuals equate infection with fear of dying, debilitating long-term effects, and endangering the safety of loved ones. These emotions are deeply ingrained after two years of anxiety. This is often reinforced by the emphasis on alarming uncertainties by our public health officials, scientists, mainstream and social media. This does not reflect a balanced data-driven risk assessment. Key concerns need to be addressed by focusing on protecting the vulnerable. A robust nationwide education campaign to build confidence in this strategy and address fears, misconceptions and relative risks should involve moving the goalpost to focus on serious results.
The longer we wait to make this inevitable political and cultural transition in resetting our goals from avoiding infection to avoiding serious illness, the longer this political split and conflict will continue to hinder us.
2) Focus public health and social protection on the most vulnerable
Eighty percent of U.S. COVID-19 deaths and 46 percent of hospitalizations are concentrated in the elderly and immunocompromised people. People over 65 have a full 95% vaccination coverage and more than half have been boosted, but they are still at risk for breakthrough infections and serious consequences. This population continues to absorb the brunt of the wrath of the pandemic and every effort must be made to reduce their risk. With Omicron’s risk profile, avoiding infection is a mandatory sanity reduction strategy, only among the vulnerable population. In communal facilities, this means avoiding exposure through mandatory vaccination and prompt screening of staff and guests. We also need to ensure that they have easy access to the remarkably effective new oral antiviral therapies. It is more difficult to ensure this protection in multi-generational households and public indoor environments, and this deserves further consideration of housing and other best practices for indoor containment.
3) Maximize voluntary vaccine uptake and minimize mandates.
Vaccination is a strong protection against serious consequences caused by Omicron. Yet about 39 million Americans remain highly resistant to vaccination. Almost everyone will become at least partially immune in the current wave through vaccine or natural infection-generated immunity. When the unvaccinated individuals become infected, they passively provide further general benefit by delaying transmission, although the amount can vary significantly from person to person. Immunization policy should take into account the marginal cost-benefit ratio of general mandates under these circumstances.
The public health risk that unvaccinated individuals pose to the vulnerable should be the main driver for vaccine mandates. Policy mandates should be applied in a more targeted way, emphasizing the impact of high priority on public health (eg nursing homes and health professionals). We must avoid mandates in environments where the political friction outweighs the public health benefits.
4) Rearranging the role of preventive interventions
The policies regarding masking, physical distancing, quarantine, self-isolation and screening and surveillance testing should be re-examined to align with the new goalposts. Public policy should only mandate these interventions when interruption of transmission provides clear public health benefits in high-risk environments – defined as situations that directly affect vulnerable people – such as public transportation, community facilities and multigenerational households. The role and indications for routine rapid testing and surveillance of asymptomatic populations should be carefully evaluated. Personal and institutional choices should determine the use of these preventive interventions in non-high-risk settings.
Omicron’s ubiquity and much lower virulence have given us the biological signal to move on to the inevitable endemic “living with the virus” endgame. The country must now challenge itself in both public policy and private spheres to heed its implications. Omicron has presented us with clear new dual goal posts: preventing serious consequences in 260 million non-vulnerable Americans and infections in the remaining 70 million. Our job now is to get the ball into the end zone.
This post We urgently need a new national COVID-19 response plan
was original published at “https://time.com/6142718/we-need-new-national-covid-19-response-plan/”