When the Omicron wave peaks come, there is bad news and good news. The bad news is that the key strategies to slow the spread – repeated tests, masks and vaccine boosters – are largely in vain for that purpose. The good news is that while protecting the vulnerable remains crucial, curbing the spread of the virus does not have to be a priority. The biggest danger from Omicron is probably the acute shortage of hospital staff, partly due to asymptomatic employees staying home from work after being tested positive.
While Covid testing can be helpful, it also has important limitations. The “Goldstandard” PCR tests are often too sensitive; research has shown that in many cases, people who test positive are no longer contagious. The increasingly used rapid antigen tests have the opposite problem, as they often cannot detect infections in the earlier part of the five-day isolation period with suspected infectivity.
This coronavirus, especially the Omicron variant, is moving so fast that mass testing and contact tracking, and probably even isolation and quarantine, cannot slow it down significantly. Britain and other countries, unlike the United States, had already spread rapid test capacity during their recent hikes, but they experienced the same meteoric rise in cases. As with other interventions, such as booster shots, testing is most helpful for those at high risk for serious complications that may benefit from early treatment.
In terms of masking, the Centers for Disease Control and Prevention has recently recognized that drug masks do relatively little to prevent spread. Some experts on coronavirus, including epidemiologist Michael Osterholm, have been questioning the effectiveness of the masks for almost two years. A recent thorough review of his research team from the University of Minnesota concludes: “We are well past the emergency phase of this pandemic, and it should be well known by now that wearing face masks or surgical masks, universal or otherwise, has a very less role to play … It’s time to stop overselling their effectiveness and unrealistic expectations about their ability to end the pandemic. “
The first large, community-level randomized study, published last month in Science, showed that while generic surgical masks provided a modest (approximately 10%) reduction in the risk of Delta infection, drug masks did not significantly reduce the risk. Masks can be even less protective against an extremely contagious variant like Omicron.
This has led to calls for mandatory N95-type masks, which are more effective but harder to use. Some schools even have mandates for children. Still, two years is a long time for someone’s face to be covered for many hours a day, and it’s infinitely long for young children, possibly leading to lasting psychosocial and other injuries. Like Delta and earlier variants, Omicron does not seriously threaten the vast majority of children; Preliminary evidence suggests much less risk to young people than from Delta. An increasing number of public health experts, including infectious disease specialist Monica Gandhi, have called for the end of school mask mandates soon.
And while vaccines and boosters continue to offer strong protection against serious illness and death – and are therefore crucial for those at high risk – they are less effective in preventing infection, especially with the Omicron variant. While a new CDC study finds that boosters significantly reduce the risk of infection as well as hospitalization from Omicron, countries such as the UK and Israel, which had widespread booster coverage before Omicron struck, have also seen unprecedented increases in cases.
In any case, even if you get a booster now, the current increase is likely to subside when immunity sets in. It is possible that future variants will arise against which currently administered boosters would still be useful, although immunity at that time may have diminished significantly. The European Medicines Agency recently warned that repeated boosters could weaken the immune system over time.
Which brings us to the good news: Because the new variant is relatively mild, and so many people already have some immunity to vaccines, previous infection, or both, Omicron’s explosive spread is much less threatening than previous waves. A recent study in Southern California examined more than 50,000 patients infected with the new variant. Not one required mechanical ventilation, and only one died, compared with 14 deaths and 11 ventilations out of about 17,000 infected with the Delta variant in the same period. Consistent with evidence from other countries, hospital admissions were significantly lower and mean admissions were much shorter among Omicron and Delta patients.
Although the reported number of “Covid admissions” has increased nationally, these numbers include patients admitted for other reasons who randomly test positive. Based on data from several states and the UK, it appears that about half of these admissions are probably not caused by the virus. Data from the Health and Human Services Department indicate Total The number of patients in U.S. hospitals has hardly increased over the past six months.
Because the new variant is primarily aimed at the upper airways instead of the lungs, doctors report that few patients need ventilation or even supplemental oxygen. Christopher Murray of the Institute for Health Metrics and Evaluation estimates in the Lancet that the number of Omicron deaths “seems to correspond to the level of a bad flu season in countries in the northern hemisphere in most countries.” In 2017-18, the flu caused about 52,000 deaths in the United States, which probably peaked at more than 1,500 a day.
The public health authorities have begun to come to terms with the fact that the Covid emergency is over. Six experts who advised the Biden transition, including Mr Osterholm, earlier this month called for a turning point in accepting Covid as an endemic disease, following the example of several European countries. As Anthony Fauci has acknowledged, “almost everyone” will eventually become infected. Some scientists have even suggested that Omicron may end up giving a kind of global “superimmunity” to serious disease from future variants.
It is time to shift the focus from trying to eradicate all new infections to protecting the most vulnerable from serious illness directly through vaccination and other evidence-based measures and remedying shortages of hospital staff. Ending mask mandates, toning down isolation and encouraging vaccination should be a compromise most of us can live with.
Mr. Halperin is an adjunct professor at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill and author of “Facing Covid Without Panic.”
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