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COMMENTARY | The next wave of the pandemic requires charting a middle course between dismay and dismissal.
The omicron wave is upon us, and the national conversation is vacillating between panic and indifference. Those who are near panic point to rapidly rising case counts and lockdowns in several European nations. Those who are indifferent lean into reports of Omicron being a milder coronavirus variant; after nearly two years of COVID, that can feel like reason enough to put the pandemic in the rear-view mirror and get on with their life.
Both perspectives are understandable, but neither is helpful. Successfully navigating the next wave of the coronavirus pandemic requires charting a middle course—one designed with clear goals in mind: preventing deaths, protecting our hospitals from crushing caseloads, and keeping schools and businesses open. We can do this with the proven, effective tools we already have, while giving in to neither dismay nor dismissal.
Much remains unknown about the dynamics of Omicron, and new evidence is emerging as rapidly, it seems, as the variant is spreading. But we know enough to anticipate some key features, particularly the variant’s unprecedented transmissibility. We should now expect a very large wave of infections—one that is gathering steam already in New York City, and will spread quickly throughout the country. We will see cases rise rapidly in the next few weeks, likely peaking sometime in mid-January. With any luck, cases will then fall as quickly as they rose, getting to very low numbers by the end of February. All of this suggests that the work ahead is to manage the next six to eight weeks.
Given the transmissibility of this virus, nothing short of a hard lockdown will prevent a large spike in cases. That is the path the Netherlands has taken. But at this point in the pandemic, in our country, a lockdown would fail because too many Americans would refuse to comply. Thankfully, we can take a very different approach.
First, we need more vaccinations. Vaccines remain the most powerful and effective tool in our arsenal. Back in the spring, these game-changing shots heralded what seemed like the end of the pandemic. The virus’s evolution and the vaccinated population’s waning immunity has quashed those hopes. At this point, it’s clear that protection against both Delta and Omicron requires three vaccine doses. This is not novel; lots of vaccines require three or even four doses. Unfortunately, this idea has not yet settled into the minds of most Americans.
Every American adult needs three doses of mRNA vaccines (or at least two doses of Johnson & Johnson’s vaccine) to be fully protected. This is particularly important for older Americans and those with significant chronic illnesses, for whom inadequate protection means breakthrough infections with serious risk of complications and death. The uptake of the third “booster” shot is still far too low. Only 20 percent of adults, including only half of elderly Americans, have received their third shot. To avoid high-risk Americans flooding hospitals and dying, we need to get as many people as possible boosted as quickly as possible, particularly nursing-home residents and others in high-risk settings.
Beyond vaccines, we need a massive increase in the availability and use of rapid tests. Omicron or no, Americans are traveling and seeing family and friends this holiday season, and rapid tests can make these get-togethers much safer. These tests are starting to become more available; a growing number of states and localities are making them accessible at low or no cost to vulnerable communities. This is progress. As demand increases and supply does too, we will see more competition and economies of scale bringing down the price of these tests. The government must use all of its powers to get more tests into the marketplace and into homes. The Biden administration is making important strides here. It needs to keep going. Booster uptake and widespread availability of testing will help reduce the strain on hospitals.
We also need a clear strategy for schools, where our experience this fall has been uneven at best. Most kids have returned to in-person learning, but one infection in a classroom can send an entire class of kids home for two weeks of quarantine with repercussions for whole families. This will be unsustainable amid the wave of infections that will follow the school holidays. And it is also unnecessary. We can keep kids in school safely using the so-called test-to-stay strategy in which students exposed to infected classmates continue to attend school so long as they test negative with regular rapid tests. The evidence behind test-to-stay is clear and strong. It is a strategy that could be modified for workplaces as well. But test-to-stay can be deployed only with adequate supplies of rapid tests.
Finally, we can make some modest sacrifices in the upcoming weeks to prevent the unnecessary spread of infections, such as avoiding large holiday parties and other unmasked indoor gatherings. Cultural events, such as concerts and theater shows, are far more doable if everyone remains masked to make these gatherings safer. Encouraging mask wearing has wrongly become political, as if during a respiratory-virus pandemic (and we’re in one, folks), a simple mask were a partisan bumper sticker. It shouldn’t be. Masks work because they apply lifesaving drag to runaway infection rates. As a local, interim measure, tying mask use to local hospital capacity makes sense. In this model, when hospitals start filling, local authorities would act quickly to encourage residents to wear masks in indoor public spaces. When pressure on hospitals eases, mask recommendations can be pulled back.
We have choices to make. During this Omicron wave, we can’t do everything we’d want to do if the pandemic were over. But we can do so much, and far more safely than at the beginning of the pandemic. Large indoor holiday parties with eating and drinking? As fun as they are, we should probably be canceling those. But seeing friends and family? That is essential, and we should feel comfortable celebrating with our nearest and dearest these holidays—as long as everyone eligible is vaccinated and boosted, and uses rapid testing as an additional layer of protection.
This isn’t the holiday season we had wished for, but it needn’t be anything like the fearful and isolated winter a year ago. Omicron’s spread makes a surge of infections inevitable, but the impact of those infections depends on the steps we take over the next few weeks. Boosted folks will largely do fine; partially vaccinated people will get infected at very high rates. Unvaccinated and high-risk folks with breakthroughs will be at risk for hospitalizations.
But with the tools and strategies described above, we can meet the challenges of this latest variant—protecting our hospitals, allowing schools to remain open safely, and keeping open the businesses, theaters, and more that enrich our lives and sustain our communities.
Ashish K. Jha, is the dean of Brown University’s School of Public Health.