Omicron is forcing us to rethink mild COVID

When Delta swept across the United States last year, the highly transmissible virus and more deadly variant threw us in pandemic limbo. The virus remained a danger primarily to unvaccinated people, but largely they wanted to move on. People who were vaccinated largely wanted to move on as well. The virus did not want to pass. So we got stuck in a deadly rut, and more Americans died of COVID-19 in 2021 than in 2020. Today, Omicron is spreading from state to state, even the most vaccinated, and new cases are increasing more and more. The virus is still the deadliest for the unvaccinated, but the sheer number of mostly mild infections among the vaccinated shocks us out of this post-Delta stasis. To deal with this extremely transmissible but now softer variant, we are in the middle of a COVID reset.

Already, the CDC has shortened the isolation period for those vaccinated. Revolutionary infections become routine. And Anthony Fauci is indicating hospitalizations, rather than cases, as a measure of Omicron’s true impact, as many infections are now mild breakthroughs.

By infecting so many people so quickly, Omicron is also accelerating us towards an endemic future where everyone has some immunity, so the coronavirus is ultimately less deadly. But in the short term, the Omicron as an accelerator is dangerous. The quickest route to endemicity is not the best route. The United States still has too many unvaccinated and under-vaccinated people, and cases that could have spanned months are now compressed into weeks. Although a smaller percentage of patients end up in hospital than before, this small percentage multiplied by a simply huge number of cases will overwhelm hospitals who are already too stretched. The coming weeks will be a bad time to have COVID, or appendicitis, or a broken leg.

Compressing all these mild cases into weeks has its own toll: Too many healthcare workers fall ill at the same time, making it worse continuing shortage of staff in hospitals. Schools, airlines, subways and businesses also find their workers sick with Omicron. There may not be preventative stops, but there will be unforeseeable cancellations. “It’s going to be a few complicated weeks. I don’t think there is a way around it, ”says Joseph Allen, professor of public health at Harvard.

The fact that we will eventually end up with rampant COVID has not changed. And the fact that people cannot be expected to avoid the virus forever in an endemic scenario has not changed. Omicron is now forcing us to look directly at the reality that people can contract and spread COVID even when they are vaccinated. The problem is, we’re doing it in crisis mode.

With so many people infected with COVID, our mindset towards the virus is changing. Revolutionary infections are the new normal. For a while, in some very vaccinated bubbles at least, people who have had breakthrough infections racked their brains over what they did “wrong”. But now excuse the hyperbole, everyone has COVID. And if you don’t, you probably know someone who does. Even the most careful of people get sick. “I think the silver lining, as far as there is a silver lining, is that shame [of getting COVID] melts quickly. And thank goodness, ”Lindsey Leininger, public health policy expert at Dartmouth College, told me. Revolutionary infections will be the norm when COVID eventually becomes rampant too.

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Vaccinated people also see, and rightly so, that their individual risk of a bad case of COVID is much, much lower than it was in March 2020. (Omicron also appears to be inherently a little less virulent than Delta, but because Delta was more virulent than the original coronavirus, Omicron is in the same stage as the original.) transition to endemicity was always going to be partly psychological, in which people slowly let go of the idea that COVID must or can be avoided forever. Omicron just made it clear very quickly.

Even though COVID cannot be avoided forever, there are good reasons to try to avoid contracting or spreading it over the next few weeks. Better treatments for Omicron are on the horizon, Syra Madad, infectious disease epidemiologist at Harvard told me. The highly effective pill from Pfizer has just been cleared by the FDA, but supplies are short. Only one monoclonal antibody, sotrovimab, currently works against Omicron, and supplies are also short. “It’s a terrible time to be unfortunately hospitalized and not having access to these types of therapies,” Madad said. In a few months, the outlook will improve for those at serious risk of COVID.

For society as a whole, too, a large number of cases right now pose a risk to our hospitals and essential services. Consider everything a person vulnerable to COVID needs, Leininger said. “We need water in his tap and we need food in his refrigerator. And we need the visiting nurse to be able to arrive because our hospitals are under siege, ”she told me. This means that water treatment plants, grocery stores, and airlines need employees to stay healthy and keep working.

This is where things get more complicated. Our Omicron strategy is also constrained, at this stage, by the will of a more tired public. With so many viruses, we have to flatten the curve once again. But in March 2020, we realized that social distancing “flattens the curve” as a temporary measure to get us through the weeks or months to come. “Well, it’s been two years now. Do we have to do this for five years? It’s just not sustainable, ”says Julie Downs, who studies risk perception at Carnegie Mellon University. If the most drastic COVID restrictions – stay-at-home orders and preventative shutdowns – are ruled out, we cannot avoid a staggering number of Omicron cases.

The CDC reducing isolation periods from 10 to five days for sick people is an attempt to balance these realities. The agency succeeded in rolling out the new recommendations in the as confusing as possible– by not requiring testing for people without symptoms first and by minimizing the usefulness of testing before adding an optional test. But the CDC basically faces a difficult set of tradeoffs: We don’t have enough rapid tests for every sick person right now, and isolating people for too long or too little time has consequences. Keep teachers and students isolated for too long and schools cannot stay open; getting them in too early, they spread the virus and schools cannot stay open either.

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Omicron is forcing us to reconsider how we deal with mild cases of COVID, which will never go away completely. He does so, unfortunately, in a chaotic and dangerous time. For the next variant and for next winter, you have to plan in advance. The challenges ahead are already clear. Hospitals, stressed even in bad flu seasons, will have to deal with COVID and flu combined every winter. The coronavirus will also continue to evolve, and new variants that continue to erode our immunity will emerge. In one series of three papers Last week, a group of former Biden advisers crafted a long-term strategy to monitor all respiratory infections – including COVID, influenza, and respiratory syncytial virus – and keep their collective burden below that of bad influenza season through more robust testing, surveillance, mitigation and development of vaccines and therapies. We’ve spent the last year shaking in reaction to new variants, but what the United States needs now is a global target for COVID, even if the coronavirus surprises us again.