A brutal winter wave in COVID-19 has hit the United States, driven by the transmissible Omicron variant. Daily deaths are higher today than they were during the peak of last fall’s Delta wave, and have plateaued at about 2,500 per day. Hospitals are under great strain. Many are delaying elective procedures to allow more beds for COVID-19-infected patients. The daily cases are higher than ever since the Delta surge, in spite of many optimistic predictions that we would have reached herd immunity by now and the end of the pandemic.
However, we do have some signs of improvement. New daily cases are falling rapidly—they are down by over 75% from the peak of the Omicron wave. Hospitalizations also are falling. Although we’re not yet out of trouble, especially in areas where there are few vaccines, this sharp decline is reason to be optimistic.
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Given the possibility of another wave, the fall in cases can also be an opportunity to prepare. We should take action now to create a system of preparedness in order not to be overwhelmed again.
In the face these declining cases, pundits call for an end pandemic-control measures like indoor masking and screening people who have no symptoms. While indoor mask mandates continue to be popular in polling, several states have reversed their decision. The Biden Administration however is more prudent about easement of masking. This is understandable. Pandemic fatigue can be real. Yet this yearning for ‘normal’ ignores the reality that our society before COVID-19 was anything but normal. We may have not suffered such a devastating pandemic if it hadn’t been. Instead it was those very conditions that allowed for terrible inequities and outsized impacts on America’s poor, which still continue today.
It is concerning that the Biden administration does not seem to take preparation seriously enough. We were pleased to see 400 million N95 Masks made available free of charge at community health centers and pharmacies. It is also a positive step that Americans are now able to order 4 free quick tests online. However, four quick tests and one mask won’t be sufficient to stop the epidemic. For effective implementation and sustainable uptake, these measures must not be used in proportion to the scale of the problem.
The greatest problem, however is that viral transmission continues to be a major issue with approximately 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 does not provide as much protection as it did before Omicron. A booster dose provides greater protection from infection, hospitalization and death. Only 25% of Americans have had it. Inequalities in vaccination continue to exist, such as racial disparities. Black and Hispanic people are vaccinated less frequently than whites. Fully vaccinated children are only 24% and 57% for those between 5-11 years. The Omicron surge saw record numbers of children under five admitted to hospitals, but vaccines for that age group are still not licensed.
There is also what the New York Times calls a “pandemic of the forgotten.” Around 7 million Americans have weakened immune systems from transplants, cancer treatment, rheumatoid arthritis medications, or other medical conditions, and they could get very ill if they get COVID-19. These issues are being ignored in the rush to get back to normal. And, there is the growing number of people who are suffering from long-term morbidity after surviving infection—the condition now known as Long Covid—which we are only just beginning to understand.
When it comes to pandemics, one problem is our short term memory. Crossing our fingers, we hope. ThisWave is the final. Many of us were surprised when Vice President Kamala Harris said that the Biden Administration “didn’t see Delta coming….didn’t see Omicron coming.” That’s absurd. It was entirely normal for viral mutations to occur. Due to the supply hoarding and inequitable vaccination coverage, there is an increased risk that more variants will emerge. It is not wise to distribute a few quick masks or tests in the hope that the wave will disappear and the U.S. pandemic will end.
We could still see more waves, even with current variations in circulation. This is especially true in South summers past, when people moved indoors to avoid the heat and humidity. Similar winter waves could be seen in future as what we saw in the northeast. Omicron cases receding means that now is the right time to build a resilient infrastructure capable of handling future surges. Instead of declaring “mission accomplished,” we must declare a considerable effort toward true preparedness.
What would real preparedness look and feel like, besides increasing vaccination coverage?
Instead of just distributing N95 masks once, the government should keep enough stockpile to be ready for future outbreaks. They should be readily available and of different sizes and placed in high-risk areas such as public transport and crowded indoor congregations (groceries, malls and retail, cinemas, gyms and offices) when there is a surge.
They are required in serial rapid testing and must be available to those who cannot order online. A single test is a snapshot in time—so after a known exposure, having enough tests for daily testing prior to leaving the home is what would actually be needed for 5 to 7 days. It is possible to quickly identify those who have the symptoms and prevent them from spreading it. In the past, one of us had presented similar arguments regarding Zika and Ebola. Rapid tests for SARS CoV-2 are a great way to protect schools, workplaces, and vulnerable individuals in prisons, nursing homes, or other high-risk settings. Protecting front-line workers is especially important with high quality masks.
Access to universal free testing has never been more essential with the new antiviral drugs like Paxlovid. Data also shows that early Remdesivir use is better. The use of these medications can lower your risk of death or hospitalization if taken promptly after symptoms appear. But, this is only possible if you have access to the testing necessary for early diagnosis. Greater access to testing needs to be combined with fair and equitable access to these medications—especially for communities that traditionally have low access to care.
Payed sick time would also be part of a joint-up preparedness program. The 2009 Swine Flu Pandemic saw an estimated 3 of 10 U.S. citizens with the symptoms go to work. Infecting as many as 7 million people, it was a devastating event. It is the only nation with high income that does not have mandatory federal sick pay. This will be an obstacle to COVID-19 control.
SARS-CoV-2 can be prevented by increasing ventilation and air quality in schools, as well as other buildings. Congress has approved $170 billion in funding for improvements to school infrastructure, as well as improving air quality. Unfortunately, this amount has not been used. In some cases, as Joseph Allen and Celine Gounder note, some schools are “already under attack by parents who are opposed to other pandemic-related public health measures, like masking.” Other school districts lack the know-how to make the upgrades—they need better guidance and standards. Some schools claim they are unable to afford new ventilation systems, even with federal assistance.
To avoid getting caught by surprise when a new wave of variants emerges, more detailed data is needed and surveillance systems are required. These include wastewater sampling as well as genomic surveillance. We can use better data to determine when public health protections should be adjusted. As Megan Ranney, professor of emergency medicine and academic dean of public health at Brown University says, we need “investments in better data systems, now, to signal when a surge is on its way and to provide clear metrics of when to increase protections (like masks)—and clear lines about when these protections can be relaxed.”
We should be prepared for any future pandemics as there are still so many unvaccinated people in the world and too many Americans who don’t have boosters. For the end of the pandemic, America should make more efforts to improve global vaccine access. They must also provide several times more vaccines, share vaccine technology faster, and fund large-scale global production. Domestically, an important guiding principle is that our policies should be driven by data and 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 picking an arbitrary end date. Unlike the start of the pandemic, we now have a remarkable array of science-based tools that can turn COVID-19 into something akin to a cold or flu, but to get there we’ll need higher vaccination rates, better data and surveillance systems, data-driven policies on masks and rapid tests, improved ventilation in shared public spaces, and a more resilient preparedness system.
