The arrival of Omicron, the latest and most transmissible COVID-19 variant to date, underscores the tremendous need for updated COVID-19 policy in the U.S. We always knew it would be difficult to contain a highly transmissible respiratory virus before Omicron. The arrival of the Delta variant forced us to abandon our goal of “herd immunity.” With the arrival of Omicron, a more appropriate goal of protecting those at risk of severe breakthrough infections is now in order. Omicron has provided a new framework that will enable us to end the endless cycle of recommencing and removing COVID restrictions on the basis of metrics no longer clinically relevant.
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Highly transmissible variants, such as Delta and Omicron, will lead to high numbers of asymptomatic or mild infections among the vaccinated. These breakthrough infections should not be considered “vaccine failures”. Instead, they should be recognized as the hallmark of highly effective vaccines that are operating precisely as intended—to prevent serious illness or death.
Americans must understand that this is not March 2020. This is especially true for highly vaccinated communities. These same areas are closing schools again. We can make this crucial transition by developing a strategy to identify those at greatest risk for severe breakthroughs, and then protecting these people at all costs.
At this stage, what strategies work?
Neue Metrics
The new COVID-19 restriction strategy will use different metrics. Uncoupled data has shown that hospitalizations are not related to case count in vaccinated populations. The number of COVID-19-positive individuals in a given community is not able to predict the amount of hospitalizations and deaths. This uncoupling means that we should no longer focus on the number of COVID-19 infections as predictive of the need for lockdowns, physical distancing, or mask use. Instead, we could follow the path of Singapore which changed their metrics from cases to hospitalizations in September for both protecting the country’s population and to avoid unnecessary harm to the economy, which in turn, has a direct impact on health. Marin County in California recently adopted a similar approach. If public health officials tie policies to hospitalizations, not cases, the media’s obsession with case counting will likely abate and help refocus attention on serious illness alone, as spelled out here. With this sharper focus, our time can be better spent on vaccinating the unvaccinated and boosting as soon as possible the most vulnerable, such as residents of nursing homes, persons over age 65, and those with chronic health issues. The new strategy however highlights the importance of the CDC’s increased tracking and reporting on severe, breakthrough infections by individuals to ensure that those who are most at risk can quickly be identified for treatment.
Blanket mask Mandates retired
To protect those most at-risk of serious breakthroughs, blanket mask mandates should be abolished. Since almost one year ago, our adult population has been able to access highly effective vaccines. More recently, every child aged 5 or older was eligible for vaccination. While N95, KN95 and KF94 should be used to mask high-risk individuals, it isn’t sustainable. Perpetual masking of whole populations is also not feasible. Children, who are the lowest-risk group for serious COVID-19 disease, endure longer periods of continuous masking than adults at higher risk. This strategy would mean making child masking optional at 12 weeks after the last school-age child became eligible for vaccination.
Rational Testing Policies
We need to retire the policy of school closures and the cancellation of school sporting events based on asymptomatic testing. While quarantines and testing were considered reasonable options prior to vaccine availability, the disruptions cannot be justified because they have any direct effect on lowering the likelihood of serious illness in the lives of the people affected, which includes athletes, students, spectators, or anyone else.
While schools have reopened since 2021 many parents and students still suffer educational losses and disruptions from school testing and quarantines. Recent endorsement by the CDC of test to remain has been made. This policy is safe for children and reduces disruption. This policy must be quickly adopted until school-based testing ceases to exist. Similarly, testing protocols should be updated for all places of work, shortening the period of isolation following infection. It is better to return to school or work as soon as the rapid test shows that COVID-19 has been eliminated. This is in contrast with the old 7-day period of isolation (with a positive test).
Nuanced Booster PolicySpacing
The revised roadmap contains modifications of vaccination policies that better reflect the nuanced understanding we have of vaccine efficacy as well as population risk. Booster vaccination should be promoted for everyone over 16 years. This will ensure that we reach those who are most at risk for serious breakthrough infections, including those living in hospitals and those with chronic conditions. Without worrying about decreasing vaccine intake, it is important to practice the spacing of vaccinations for young men as well as paying attention to adverse reactions that may result from booster vaccinations given to men younger than 30.
In addition to acknowledging natural immunity, the new roadmap also recognizes prior infection. This will be reflected in vaccine mandates that recommend 1 dose for natural infections. This policy would increase public trust, particularly among more vaccine hesitant communities, as a more accurate reflection of the evidence to date.
Continue reading: Why COVID-19 Case Counts Don’t Mean What They Used To
The new road map reframes policy to reduce harm and shift away from zero COVID policies. Travel bans do not reduce transmission. They are also inequitable and punish other countries who engage in laudable activities like data sharing. Paxlovid is a way to show our non-vaccinated people that we care about them. Finally, it is counterproductive to suppress the growth of variants by promoting booster vaccines for healthy young adults. It also runs in direct contradiction to the belief that all people are equal.
We urge the Biden administration to adopt a rational approach towards the COVID-19 Pandemic, which is approaching 2022. In his December 21 speech, President Biden stated that the Administration will continue to expand access to quick testing and increase the capacity of hospitals to handle low-vaccination cases. These are important and welcomed commitments. In addition to meeting these immediate practical needs of the pandemic, we hope that the administration will recognize that it is time to reframe our approach, moving beyond case counts and community-based restrictions and revising policies specifically aimed at protecting vulnerable populations and assuring that our nation’s children will stay in school. We believe this will provide a scientific-based and sensible approach for the next stage of our response.
