Even as daily new COVID cases set all-time records and hospitals fill up, epidemiologists have arrived at a perhaps surprising consensus. Yes, the latest Omicron variant of the novel coronavirus is bad. But it could have been a lot worse.
Even as cases have surged, deaths haven’t—at least not to the same degree. Omicron is highly transmissible but generally not as severe as some older variants—“lineages” is the scientific term.
We got lucky. But that luck might not hold. Many of the same epidemiologists who have breathed a sigh of relief over Omicron’s relatively low death rate are anticipating that the next lineage might be much worse.
Fretting over a possible future lineage that combines Omicron’s extreme transmissibility with the severity of, say, the previous Delta lineage, experts are beginning to embrace a new public health strategy that’s getting an early test run in Israel: a four-shot regimen of messenger-RNA vaccine.
“I think this will be the strategy going forward,” Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast.
Omicron raised alarms in health agencies all over the world in late November after officials in South Africa reported the first cases. Compared to older lineages, Omicron features around 50 key mutations, some 30 of which are on the spike protein that helps the virus to grab onto our cells.
Some of the mutations are associated with a virus’s ability to dodge antibodies and thus partially evade vaccines. Others are associated with higher transmissibility. The lineage’s genetic makeup pointed to a huge spike in infections in the unvaccinated as well as an increase in milder “breakthrough” infections in the vaccinated.
That’s exactly what happened. Health officials registered more than 10 million new COVID cases the first week of January. That’s nearly double the previous worst week for new infections, back in May. Around 3 million of those infections were in the United States, where Omicron coincided with the Thanksgiving, Christmas, and New Year holidays and associated traveling and family gatherings.
But mercifully, deaths haven’t increased as much as cases have. Worldwide, there were 43,000 COVID deaths the first week of January—fewer than 10,000 of them in the U.S. While deaths tend to lag infections by a couple weeks, Omicron has been dominant long enough that it’s increasingly evident there’s been what statisticians call a “decoupling” of cases and fatalities.
“We can say we dodged a bullet in that Omicron does not appear to cause as serious of a disease,” Stephanie James, the head of a COVID testing lab at Regis University in Colorado, told The Daily Beast. She stressed that data is still being gathered, so we can’t be certain yet that the apparent decoupling is real.
Assuming the decoupling is happening, experts attribute it to two factors. First, Omicron tends to infect the throat without necessarily descending to the lungs, where the potential for lasting or fatal damage is much, much higher. Second, by now, countries have administered nearly 9.3 billion doses of vaccine—enough for a majority of the world’s population to have received at least one dose.
In the United States, 73 percent of people have gotten at least one dose. Sixty-two percent have gotten two doses of the best mRNA vaccines. A third have received a booster dose.
Yes, Omicron has some ability to evade antibodies, meaning the vaccines are somewhat less effective against this lineage than they are against Delta and other older lineages. But even when a vaccine doesn’t prevent an infection, it usually greatly reduces its severity.
For many vaccinated people who’ve caught Omicron, the resulting COVID infection is mild. “A common cold or some sniffles in a fully vaxxed and boosted healthy individual,” is how Eric Bortz, a University of Alaska-Anchorage virologist and public health expert, described it to The Daily Beast.
All that is to say, Omicron could have been a lot worse. Viruses evolve to survive. That can mean greater transmissibility, antibody-evasion or more serious infection. Omicron mutated for the former two. There’s a chance some future Sigma or Upsilon lineage could do all three.
When it comes to viral mutations, “extreme events can occur at a non-negligible rate, or probability, and can lead to large consequences,” Michael said. Imagine a lineage that’s as transmissible as Omicron but also attacks the lungs like Delta tends to do. Now imagine that this hypothetical lineage is even more adept than Omicron at evading the vaccines.
That would be the nightmare lineage. And it’s entirely conceivable it’s in our future. There are enough vaccine holdouts, such as the roughly 50 million Americans who say they’ll never get jabbed, that the SARS-CoV-2 pathogen should have ample opportunities for mutation.
“As long as we have unvaccinated people in this country—and across the globe—there is the potential for new and possibly more concerning viral variants to arise,” Aimee Bernard, a University of Colorado immunologist, told The Daily Beast.
Worse, this ongoing viral evolution is happening against a backdrop of waning immunity. Antibodies, whether vaccine-induced or naturally occurring from past infection, fade over time. It’s not for no reason that health agencies in many countries urge booster doses just three months after initial vaccination. The U.S. Centers for Disease Control and Prevention is an outlier, and recommends people get boosted after five months.
A lineage much worse than Omicron could evolve at the same time that antibodies wane in billions of people all over the world. That’s why many experts believe the COVID vaccines will end up being annual or even semi-annual jabs. You’ll need a fourth jab, a fifth jab, a sixth jab, et cetera, forever.
Israel, a world leader in global health, is already turning that expectation into policy. Citing multiple studies that showed a big boost in antibodies with an additional dose of mRNA and no safety concerns, the country’s health ministry this week began offering a fourth dose to anyone over the age of 60, who tend to be more vulnerable to COVID than younger people.
That should be the standard everywhere, Ali Mokdad, a professor of health metrics sciences at the University of Washington Institute for Health, told The Daily Beast. “Scientifically, they’re right,” he said of the Israeli health officials.
If there’s a downside, it’s that there are still a few poorer countries—in Africa, mostly—where many people still struggle to get access to any vaccine, let alone boosters and fourth doses. If and when other richer countries follow Israel’s lead and begin offering additional jabs, there’s some risk of even greater inequity in global vaccine distribution.
“The downside is for the rest of the world,” Mokdad said. “I’m waiting to get my first dose and you guys are getting a fourth?”
The solution isn’t to deprive people of the doses they need to maintain their protection against future—and potentially more dangerous—lineages. The solution, for vaccine-producing countries, is to further boost production and double down on efforts to push vaccines out to the least privileged communities.
A sense of urgency is key. For all its rapid spread, Omicron has actually gone fairly easy on us. Sigma or Upsilon might not.
Over the past two years, historians and analysts have compared the coronavirus to the 1918 flu pandemic. Many of the mitigation practices used to combat the spread of the coronavirus, especially before the development of the vaccines, have been the same as those used in 1918 and 1919 — masks and hygiene, social distancing, ventilation, limits on gatherings (particularly indoors), quarantines, mandates, closure policies and more.
Yet, it may be that only now, in the winter of 2022, when Americans are exhausted with these mitigation methods, that a comparison to the 1918 pandemic is most apt.
The highly contagious omicron variant has rendered vaccines much less effective at preventing infections, thus producing skyrocketing caseloads. And that creates a direct parallel with the fall of 1918, which provides lessons for making January as painless as possible.
In February and March 1918, an infectious flu emerged. It spread from Kansas, through World War I troop and material transports, filling military post hospitals and traveling across the Atlantic and around the world within six months. Cramped quarters and wartime transport and industry generated optimal conditions for the flu to spread, and so, too, did the worldwide nature of commerce and connection. But there was a silver lining: Mortality rates were very low.
In part because of press censorship of anything that might undermine the war effort, many dismissed the flu as a “three-day fever,” perhaps merely a heavy cold, or simply another case of the grippe (an old-fashioned word for the flu).
Downplaying the flu led to high infection rates, which increased the odds of mutations. And in the summer of 1918, a more infectious variant emerged. In August and September, U.S. and British intelligence officers observed outbreaks in Switzerland and northern Europe, writing home with warnings that went largely unheeded.
Unsurprisingly then, this seemingly more infectious, much more deadly variant of H1N1 traveled west across the Atlantic, producing the worst period of the pandemic in October 1918. Nearly 200,000 Americans died that month. After a superspreading Liberty Loan parade at the end of September, Philadelphia became an epicenter of the outbreak. At its peak, nearly 700 Philadelphians died per day.
Once spread had begun, mitigation methods such as closures, distancing, mask-wearing and isolating those infected couldn’t stop it, but they did save many lives and limited suffering by slowing infections and spread. The places that fared best implemented proactive restrictions early; they kept them in place until infections and hospitalizations were way down, then opened up gradually, with preparations to reimpose measures if spread returned or rates elevated, often ignoring the pleas of special interests lobbying hard for a complete reopening.
In places in the United States where officials gave in to public fatigue and lobbying to remove mitigation methods, winter surges struck. Although down from October’s highs, these surges were still usually far worse than those in the cities and regions that held steady.
In Denver, in late November 1918, an “amusement” lobby — businesses and leaders invested in keeping theaters, movie houses, pool halls and other public venues open — successfully pressured the mayor and public health officials to rescind and then revise a closure order. This, in turn, generated what the Rocky Mountain News called “almost indescribable confusion,” followed by widespread public defiance of mask and other public health prescriptions.
In San Francisco, where resistance was generally less successful than in Denver, there was significant buy-in for a second round of masking and public health mandates in early 1919 during a new surge. But opposition created an issue. An Anti-Mask League formed, and public defiance became more pronounced. Eventually anti-maskers and an improving epidemic situation combined to end the “masked” city’s second round of mask and public health mandates.
The takeaway: Fatigue and removing mitigation methods made things worse. Public officials needed to safeguard the public good, even if that meant unpopular moves.
The flu burned through vulnerable populations, but by late winter and early spring 1919, deaths and infections dropped rapidly, shifting toward an endemic moment — the flu would remain present, but less deadly and dangerous.
Overall, nearly 675,000 Americans died during the 1918-19 flu pandemic, the majority during the second wave in the autumn of 1918. That was 1 in roughly 152 Americans (with a case fatality rate of about 2.5 percent). Worldwide estimates differ, but on the order of 50 million probably died in the flu pandemic.
In 2022, we have far greater biomedical and technological capacity enabling us to sequence mutations, understand the physics of aerosolization and develop vaccines at a rapid pace. We also have a far greater public health infrastructure than existed in 1918 and 1919. Even so, it remains incredibly hard to stop infectious diseases, particularly those transmitted by air. This is complicated further because many of those infected with the coronavirus are asymptomatic. And our world is even more interconnected than in 1918.
That is why, given the contagiousness of omicron, the lessons of the past are even more important today than they were a year ago. The new surge threatens to overwhelm our public health infrastructure, which is struggling after almost two years of fighting the pandemic. Hospitals are experiencing staff shortages (like in fall 1918). Testing remains problematic.
And ominously, as in the fall of 1918, Americans fatigued by restrictions and a seemingly endless pandemic are increasingly balking at following the guidance of public health professionals or questioning why their edicts have changed from earlier in the pandemic. They are taking actions that, at the very least, put more vulnerable people and the system as a whole at risk — often egged on by politicians and media figures downplaying the severity of the moment.
Public health officials also may be repeating the mistakes of the past. Conjuring echoes of Denver in late 1918, under pressure to prioritize keeping society open rather than focusing on limiting spread, the Centers for Disease Control and Prevention changed its isolation recommendations in late December. The new guidelines halved isolation time and do not require a negative test to reenter work or social gatherings.
Thankfully, we have an enormous advantage over 1918 that offers hope. Whereas efforts to develop a flu vaccine a century ago failed, the coronavirus vaccines developed in 2020 largely prevent severe illness or death from omicron, and the companies and researchers that produced them expect a booster shot tailored to omicron sometime in the winter or spring. So, too, we have antivirals and new treatments that are just becoming available, though in insufficient quantities for now.
Those lifesaving advantages, however, can only help as much as Americans embrace them. Only by getting vaccinated, including with booster shots, can Americans prevent the health-care system from being overwhelmed. But the vaccination rate in the country remains a relatively paltry 62 percent, and only a scant 1 in 5 have received a booster shot. And as in 1918, some of the choice rests with public officials. Though restrictions may not be popular, officials can reimpose them — offering public support where necessary to those for whom compliance would create hardship — and incentivize and mandate vaccines, taking advantage of our greater medical technology.
As the flu waned in 1919, one Portland, Ore., health official reflected that “the biggest thing we have had to fight in the influenza epidemic has been apathy, or perhaps the careless selfishness of the public.”
The same remains true today.
Vaccines, new treatments and century-old mitigation strategies such as masks, distancing and limits on gatherings give us a pathway to prevent the first six weeks of 2022 from being like the fall of 1918. And encouraging news about the severity of omicron provides real optimism that an endemic future — in which the coronavirus remains but poses far less of a threat — is near. The question is whether we get there with a maximum of pain or a minimum. The choice is ours.
Why are so many vaccinated people getting COVID-19 lately?
A couple of factors are at play, starting with the emergence of the highly contagious omicron variant. Omicron is more likely to infect people, even if it doesn’t make them very sick, and its surge coincided with the holiday travel season in many places.
People might mistakenly think the COVID-19 vaccines will completely block infection, but the shots are mainly designed to prevent severe illness, says Louis Mansky, a virus researcher at the University of Minnesota.
And the vaccines are still doing their job on that front, particularly for people who’ve gotten boosters.
Two doses of the Pfizer-BioNTech or Moderna vaccines or one dose of the Johnson & Johnson vaccine still offer strong protection against serious illness from omicron. While those initial doses aren’t very good at blocking omicron infection, boosters — particularly with the Pfizer and Moderna vaccines — rev up levels of the antibodies to help fend off infection.
Omicron appears to replicate much more efficiently than previous variants. And if infected people have high virus loads, there’s a greater likelihood they’ll pass it on to others, especially the unvaccinated. Vaccinated people who get the virus are more likely to have mild symptoms, if any, since the shots trigger multiple defenses in your immune system, making it much more difficult for omicron to slip past them all.
Advice for staying safe hasn’t changed. Doctors say to wear masks indoors, avoid crowds and get vaccinated and boosted. Even though the shots won’t always keep you from catching the virus, they’ll make it much more likely you stay alive and out of the hospital.
Healthy individuals who have been vaccinated, and especially those who have been boosted, appear unlikely to develop severe infections from the omicron variant that would land them in the hospital, say medical experts who have monitored the effects of the newest coronavirus variant since it was identified over four weeks ago.
While omicron has sent U.S. infections soaring to levels not seen since last winter’s wave, it appears to have less severe effects than the delta variant, according to a handful of international studies and early data from several U.S. hospitals.
Those infected by the omicron variant are 15 to 20 percent less likely to go to an emergency room, and 40 percent less likely to be hospitalized overnight, compared with those infected with delta, according to English data analyzed by scientists from Imperial College London. That aligns with early U.S. data from some hospitals.
At the Houston Methodist hospital system, about 15 percent of symptomatic individuals have ended up hospitalized — around a 70 percent reduction compared with those infected by the delta variant, said James Musser, chair of pathology and genomic medicine.
A separate study from Britain, which is not yet peer reviewed, found that people infected with omicron were almost 60 percent less likely to enter the hospital than those infected with delta.
“What is absolutely clear is there is lower rate of hospitalization with our omicron patients in our hospital system,” Musser said. “That does not necessarily mean that this variant is quote-unquote ‘less virulent.’ The jury’s still out on that. What we know now is that … if you are immunized and, more importantly, if you are boosted, you’re going to stay out of substantial trouble.”
He and other experts warn against complacency, however, cautioning that millions of Americans, particularly the unvaccinated, remain vulnerable to more serious disease from the most transmissible coronavirus variant to date.
Other factors that might lead to greater risk include an individual’s age, the type of vaccine or booster they received, and whether they have underlying health problems, such as heart disease or obesity, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of President Biden’s covid-19 transition task force.
“Have you previously had infection? Were you vaccinated? How many doses of vaccine, and was it more than six months ago? So in some ways this is almost like a calculus problem. It’s got a lot of moving parts to it and we’re trying to figure it out,” Osterholm said.
Doctors also caution that far more people will become infected with omicron simply because of its transmissibility. If even a small fraction of those land in the hospital, they worry that health care systems that are already short-staffed because of delta infections could be overwhelmed — with potentially dire results for those needing critical care as a result of car accidents, heart attacks, strokes, or any number of things that bring people to emergency rooms.
“We need to be respectful of the fact that our hospital system has been under this kind of duress for such a long time,” said Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center in Seattle. “We need to do everything we can to not allow the situation, where there’s such crowding and such intensity that we can’t optimally take care of the people who get severe disease.”
Anthony S. Fauci, Biden’s chief medical adviser, said the rapid increase in the numbers of people getting infected with the omicron variant will invariably put additional strain on the system.
“We’re going to have a real challenge to the health-care delivery system — namely the number of beds, the number of ICU beds and even the number of health care providers,” Fauci said in an interview. “Even vaccinated people are getting breakthrough infections. So if you get enough nurses and doctors infected, they are going to temporarily be out of action. And if you get enough of them out of action, you could have a double stress on the health care system.”
The welcome news for most people who are vaccinated and boosted is that omicron infections often mimic the symptoms of the common cold. Those with two shots of vaccine, but no booster, also appear to fare relatively well, though they may develop more intense symptoms that may last longer, experts said.
In a series of Twitter posts, Craig Spencer, who teaches emergency medicine at Columbia University Medical Center, said every boosted patient he has seen in the emergency room has had no difficulty breathing or shortness of breath. Those who have had two doses of either the Pfizer or Moderna vaccines also have had mild symptoms, he said, “but more than those who had received a third dose.”
But almost every patient who had to be hospitalized was unvaccinated, he said.
“No matter your political affiliation, or thoughts on masks, or where you live in this country, as an ER doctor you’d trust with your life if you rolled into my emergency room at 3am, I promise you that you’d rather face the oncoming Omicron wave vaccinated,” Spencer wrote.
Experts cautioned that those at higher risk of severe infection to previous variants probably remain vulnerable to this one.
It’s not yet clear whether older, boosted individuals and those with underlying conditions, such as diabetes and heart disease, face the same lowered risk with omicron. Answering such questions is key to assessing the likely trajectory of the variant in the U.S. since it is older and less healthy than many of its global peers.
So far, though, early U.S. data echoes what has been seen in South Africa and Britain, where omicron waves are slightly ahead of this country’s.
A group of Scottish scientists said recently that vaccinated people appear to have some protection against symptomatic infection from omicron, although less than they did against delta. A third dose or booster of an mRNA vaccine was associated with a 57 percent reduction in the odds of developing a symptomatic omicron case.
In the Johns Hopkins Hospital emergency department, physicians are seeing more infections than atany other point in the pandemic, but most of the cases are not severe, said Stuart Ray, a professor of medicine in the division of infectious diseases. But he warned that there is not yet “reassuring evidence” the United States will be spared from a disruptive wave of infections and complications.
The country faces other challenges with omicron in terms of its medicine cabinet. Two of the three existing intravenous treatments called monoclonal antibodies — those from Regeneron and Eli Lilly — do not work against the variant. Some Republican governors had touted the ability of those with covid-19 to receive monoclonal antibodies, spurring some Americans to see those treatments as an alternative to getting vaccinated.
The only monoclonal antibody that does work, sotrovimab from Vir Biotechnology and GlaxoSmithKline, is in short supply and will not be available to many of those who become infected. The Food and Drug Administration authorized two easy-to-take antiviral pills last week and one has high efficacy against omicron, but it will be in initial short supply. Distribution of the pills is expected to begin shortly.
It is also unclear whether the surge in the United States will follow the same pattern as South Africa’s, which rapidly passed the peak of omicron cases last week.
South Africa’s population is significantly younger and has far lower vaccination rates, with about 35 percent of the population immunized, and virtually no oneboosted.The country also grappled with a delta variant wave that infected a far greater portion of the population than it did in the United States.
The significant number of South African residents infected with delta compared with the United States could prove to be an important distinction that might make more Americans vulnerable to omicron, said Chris Beyrer, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
Beyrer also noted that infections in the United States, Britain and Germany seemed to be increasing at a significantly faster rate than they were in South Africa.
“This is an incredibly infectious virus and it is moving right along,” Beyrer said. He added that the United States has numerous tools — including ready access to vaccines and booster shots, the new antiviral medicines, testing and masking — that could help curb its effects.
But referring to those who have refused to follow public health guidelines, Beyrer said, “We have a lot of resistance so that makes us vulnerable to infection.”
For nearly two years, Americans have looked carefully at coronavirus case numbers in the country and in their local states and towns to judge the risk of the disease.
Surging case numbers signaled growing dangers, while falling case numbers were a relief and a signal to let one’s guard down in terms of gathering with friends and families and taking part in all kinds of events.
But with much of the nation’s population vaccinated and boosted and the country dealing with a new COVID-19 surge from omicron — a highly contagious variant that some studies suggest may not be as severe as previous variants — public health officials are debating whether the nation needs to shift its thinking.
Many people are going to get omicron — but those that are vaccinated and boosted are unlikely to suffer dire symptoms.
As a result, hospitalizations and deaths are the markers that government officials need to monitor carefully to ensure the safety of communities as the nation learns to live with COVID-19.
“This is the new normal,” said Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner. “This is what we will have to accept as we transition from the emergency of COVID-19 to living with it as part of the new normal.”
David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said that Americans all need to shift to focus on hospitalizations over cases as we enter into another year of the pandemic.
“I think that we need to start training ourselves to look, first of all, at hospitalizations. I think hospitalizations are a real-time indicator of how serious things are,” he said.
Rising case numbers still say something about the disease, and the spikes from omicron are leading to real concerns.
Anthony Fauci, the government’s top infectious disease expert, noted on Sunday that even if omicron leads to less severe cases of COVID-19, if it infects tens of millions it will have the potential of straining resources in hospitals.
“If you have many, many, many more people with a less level of severity, that might kind of neutralize the positive effect of having less severity when you have so many more people,” he said during an appearance on ABC’s “This Week.”
At the same time, the nation must get used to dealing with the coronavirus as it would deal with an annual flu season. It’s a challenge for most parts of American life, from schools and businesses that have to consider worker and student safety, to professional sports leagues that must decide how long someone sits out after a positive test — even if the person is vaccinated and not symptomatic.
“Omicron in a way is the first test of what it means to live with COVID-19,” said Wen. “And by that I mean we are going to see many people getting infected but as long as our hospital systems are not overwhelmed and as long as vaccinated people are generally protected against severe outcomes, that is how we end the pandemic phase and switch into the endemic phase.”
The omicron strain is so infectious that once the current surge has faded in the United States, it’s likely a large majority of the population will either have been vaccinated against COVID-19 or have been infected, experts say. At that point, the focus should shift away from preventing infection to preventing serious illness, multiple experts said, a message already being echoed in some corners of the White House.
Many states have been seeing staggering numbers of positive tests and lines for COVID-19 testing that stretch for several blocks. Washington, D.C., and New York state have set records in recent days for the number of new cases reported as omicron barrels through the population.
But even with case totals surpassing last year’s numbers, President Biden and White House officials have been quick to point out that hospitalizations haven’t been as high as the numbers seen in the winter of 2020.
“Because we have so many vaccinated and boosted, we’re not seeing hospitalizations drive as sharply as we did in March of 2020 or even this past fall. America has made progress; things are better,” Biden said on Monday on a White House COVID-19 response team call with the National Governors Association to discuss the administration’s response to the omicron variant.
“But we do know that with rising cases, we still have tens of millions of unvaccinated people and we’re seeing hospitalizations rise,” he added, saying that some hospitals are going to get overrun both in terms of equipment and staff.
The White House pointed to Biden’s remarks last week when asked about whether the president wants Americans and health experts to take the emphasis off of case numbers and put it on hospitalizations.
“Because omicron spreads so easily, we’ll see some fully vaccinated people get COVID, potentially in large numbers. There will be positive cases in every office, even here in the White House, among the vaccinated … from omicron. But these cases are highly unlikely to lead to serious illness,” Biden said on Dec. 21.
Chief of staff Ron Klain on Monday retweeted a CNN report about how hospitalizations are about 70 percent less than what they were around the last peak in September, but that COVID-19 cases in unvaccinated Americans could end up overwhelming health systems.
Health experts have suggested the White House’s shift in messaging away from a focus on the number of cases is a sign of what’s to come as the pandemic eventually becomes endemic.
“For two years, infections always preceded hospitalizations which preceded deaths, so you could look at infections and know what was coming,” Ashish Jha, dean of the Brown University School of Public Health, said Sunday on ABC. “Omicron changes that. This is the shift we’ve been waiting for in many ways.”
Dowdy said positive tests are also up because people are getting tested before visiting relatives.
“If a lot of people are testing positive because they are asymptomatic and wanting to make sure that they can travel etc., having a lot of those kinds of cases is not a big problem,” he said.
“In fact, that’s a good thing. It means that we’re doing the right thing as a country to define those cases,” Dowdy added.
Lawrence Gostin, a professor of global health at Georgetown University, said the shift away from tracking case numbers as a way to measure the pandemic means devoting more resources toward treatment options like the Pfizer antiviral pill.
Gostin also said testing should increasingly be used to self-diagnose so individuals can get proper treatment, rather than testing for the purpose of stopping the spread of the virus.
“The White House has got a very difficult balancing act. Certainly for now it’s going to have to emphasize the idea of masking and distancing for the purpose of protecting the health system,” Gostin said.
“We can’t live our lives in a bubble to prevent us from getting a pathogen that’s so contagious that you can’t avoid it if you’re going to be circulating and living a life in this world,” he continued. “What it means to transition to a normal life or more normal life is you have to focus not so much on preventing cases, but on preventing hospitalizations and deaths.”
COVID-19 cases are surging across the U.S. ahead of Christmas, sparking the cancellation of sporting events and a growing list of hospitals postponing nonessential surgeries — both a reminder of last year’s holiday surge and a sign that the next several weeks will determine the pandemic’s trajectory for the rest of the winter months.
Nationwide, the daily average for new cases was more than 133,000 on Dec. 18, a 21 percent jump over the last two weeks, according to data compiled byThe New York Times.
Health officials have warned the omicron variant — which appears to cause less severe illness, though is more transmissible — could exacerbate the ongoing delta-fueled surge and overwhelm the healthcare system.
“I think we’re really just about to experience a viral blizzard,” Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN during a Dec. 17 interview. “I think in the next three to eight weeks, we’re going to see millions of Americans are going to be infected with this virus, and that will be overlaid on top of delta, and we’re not yet sure exactly how that’s going to work out.”
New York — where omicron accounts for at least 13 percent of new cases — for two consecutive days set a record for the daily number of new cases reported. Health officials reported more than 21,000 new cases on Dec.17 and 21,908 on Dec. 18. Three Midwestern states and Vermont also set COVID-19 records last week, including Ohio, which reported nearly 12,000 new cases Dec. 16.
While early data suggests omicron is tied to less severe illness than the original strain, health officials have warned against underestimating the virus. The outgoing National Institutes of Health director, Francis Collins, MD, PhD, offered a grim projection during a Dec. 19 interview with NPR.
“Even if it has somewhat lower risk of severity, we could be having a million cases a day if we’re not really attentive to all of those mitigation strategies,” Dr. Collins said.
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said areas with low vaccination coverage will likely be especially hard hit across the coming weeks.
“We are going to see significant stress in some regions of the country on the hospital system, particularly in those areas where you have a low level of vaccination, which is one of the reasons why we continue to stress the importance of getting those unvaccinated people vaccinated,” he told CNNDec. 19, adding that in some regions of the U.S., omicron accounts for 50 percent of new infections, “which means it’s going to take over.”
“This virus is extraordinary. It has a doubling time of anywhere from two to three days,” Dr. Fauci said.
The daily average for U.S. COVID-19 hospitalizations was more than 69,000 as of Dec. 19, marking a 16 percent rise across the last two weeks; and while omicron may be associated with lower disease severity, a significant surge would inevitably lead to more hospitalizations and deaths, health officials say. Connecticut, Washington, D.C., and Rhode Island have seen the highest percent increase in hospitalization rates over the last two weeks.
As the holidays and planned celebrations near, Dr. Fauci emphasized the importance of booster doses in combating the surge. He urged against holiday gatherings and travel among people who have not been fully vaccinated or received their boosters. Given a rise in breakthrough cases, he also suggested people take a rapid test before attending a gathering.
“If you do these things … I do believe that you can feel quite comfortable with a family setting, the dinners and the gatherings that you have around the holiday season,” Dr. Fauci told ABC NewsDec. 19. “Nothing is 100 percent risk-free, but I think if you do the things that I just mentioned, you’d actually mitigate that risk enough to feel comfortable about being able to enjoy the holiday.”
Moderna said Dec. 20 that a booster dose of its vaccine increased antibody levels against omicron 37-fold. Laboratory findings from Pfizer also indicate its booster offers significant protection against the strain.
CDC data showed 61.4 percent of the nation’s population had been fully vaccinated as of Dec. 19. Nearly 30 percent of the fully vaccinated population had received their booster dose.
On the spectrum from active outbreak to eradication, control is the most likely path forward for COVID-19 in the U.S., NIAID Director Anthony Fauci, MD, said during a National Press Club briefing today.
Fauci’s words served as a reality check for those holding out hope that COVID-19 one day might be as rare as measles or polio in America.
“We’re never going to eradicate this,” he said. “We’ve only eradicated one virus, and that’s smallpox. Elimination may be too aspirational, because we’ve only done that with infections for which we’ve had a massive vaccination campaign like polio and measles. Even though we haven’t eradicated [those viruses] from the planet, we have no cases, with few exceptions, in the U.S.”
Fauci said the country should focus on control — a level of infection “that isn’t zero, but that with the combination of the vast majority of the population vaccinated and boosted, together with those who recovered from infection and also are hopefully boosted, that we will get a level of control that will be non-interfering with our lives, our economy, and the kinds of things we would do, namely to get back to some degree of normality.”
“It’s not going to be eradication, and it’s likely not going to be elimination,” he said again later in the briefing. “It’s going to be a low, low, low level of infection that really doesn’t interfere with our way of life, our economy, our ability to move around in society, our ability to do things in closed indoor spaces.”
Fauci said the only way to achieve this will be with vaccinations, boosters, and mitigation strategies such as wearing masks in congregate settings.
“Over time, we feel confident we will get this under control,” he said. While he said he “hopes” this comes in the “next several months,” he cautioned that he “never predict[s], because you never get it right. Sure enough, someone will come back and say, ‘You said this in December and you were wrong.'”
In terms of boosters, Fauci said it’s possible that a third shot — “and maybe an additional one” — will be enough to provide durable immunity, but that “we’ll just have to wait and see. We don’t know yet.”
Kids under age 5 who have yet to be vaccinated will have to wait a few more months to get their shots, he added. While the lower, 3 μg dose of the Pfizer vaccine looked sufficient for children ages 6 months up to 2 years, that dose was not sufficient for those ages 2 to 5, he said.
“The company decided that they believe this is really a three-dose vaccine, and there’s no doubt if you give three doses you’re going to get an effective and safe vaccine,” he said. “But they haven’t proven it yet, so that’s the delay.”
“I can guarantee you it’s going to be effective,” Fauci added.
Data aren’t expected until the end of the first quarter of 2022, he said, meaning vaccines for this pediatric population likely won’t be available until “a few months into 2022.”
Top government health officials on Sunday warned that the United States will probably see record numbers of coronavirus cases and hospitalizations as the omicron variant spreads rapidly and forces Americans to again grapple with the dangers of a pandemic that has upended life around the globe.
“Unfortunately, I think that that is going to happen. We are going to see a significant stress in some regions of the country on the hospital system, particularly in those areas where you have a low level of vaccination,” Anthony S. Fauci, the nation’s leading infectious-disease specialist, said on CNN’s “State of the Union” when asked whether the United States could see record numbers of cases, hospitalizations and deaths.
Fauci described the variant as “extraordinary” in its transmissibility, with a doubling time of two to three days. It accounts for 50 percent of coronavirus cases in parts of the country, which meant it would almost certainly take over as the dominant variant in the United States, he added.
“It is going to be a tough few weeks, months, as we get deeper into the winter,” Fauci said.
On CBS News’s “Face the Nation,” Francis Collins, director of the National Institutes of Health, said that cases will rise steeply over the next couple of weeks and that the country could soon see 1 million new cases a day tied to the omicron variant, dramatically exceeding the record of about 250,000 new cases per day set in January.
“The big question is, are those million cases going to be sick enough to need health care and especially hospitalization?” Collins said. “We’re just holding our breath to see how severe this will be.”
Health officials have continued to urge the unvaccinated to get their shots and those who have received only two doses of either the Pfizer or Moderna mRNA vaccines to get booster doses. Vaccines cannot be the only layer of protection against the omicron variant, Fauci said, but defeating the pandemic would not be possible without them.
There are still safe ways for vaccinated people to get together for the holidays, including wearing a mask while traveling, testing beforehand and knowing the vaccination status of everyone present at indoor celebrations, Fauci said on “Face the Nation.”
“If you do these things, I do believe that you can feel quite comfortable with a family setting,” he said. “Nothing is 100 percent risk-free, but I think if you do the things that I just mentioned, you’d actually mitigate that risk enough to feel comfortable about being able to enjoy the holiday.”
Collins stopped short of urging people to cancel holiday plans but said travel will be risky even for vaccinated people.
“This virus is going to be all around us,” he said. “I’m not going to say you shouldn’t travel, but you should do so very carefully. … People are going, ‘I’m so sick of hearing this,’ and I am, too. But the virus is not sick of us, and it is still out there looking for us, and we’ve got to double down on these things if we’re going to get through the next few months.”
Doctors, nurses and others are warning that the nation’s health system continues to be strained by an unending stream of coronavirus cases. Confirmed U.S. coronavirus infections have surpassed more than 128,000 per day and confirmed virus deaths are near 1,300 per day, according to The Washington Post’s rolling seven-day average.
“For people trained to save lives, this moment is frustrating, exhausting and heartbreaking,” the American Hospital Association, the American Medical Association and the American Nurses Association said in a joint statement on Friday, urging more Americans to get booster shots.
Public health experts are bracing for a winter surge of cases driven by the omicron variant, which can evade some protection conferred by vaccinations and prior infections, as well as cases linked to the delta variant. Officials caution that they are still relying on preliminary data about the omicron variant’s severity compared with earlier forms of the virus.
President Biden plans to address the nation Tuesday on the status of the country’s fight against the virus, the White House said Saturday.
“We are prepared for the rising case levels,” White House press secretary Jen Psaki wrote on Twitter, adding that Biden “will detail how we will respond to this challenge. He will remind Americans that they can protect themselves from severe illness from COVID-19 by getting vaccinated and getting their booster shot when they are eligible.”
The speech, coming just before Christmas and New Year’s Day, underlines Biden’s struggle to contain the pandemic nearly a year into office. On top of the emergence of new variants and attendant challenges, the administration has at times faced criticism for what some have described as mixed signals.
Biden won high marks from the public during the first half of the year as cases declined, the country opened up from shutdowns and vaccines became widely available. But the past few months have been more difficult. After he gave a speech on July 4 saying the country was “closer than ever to declaring our independence from a deadly virus,” the situation started changing. Case rates increased as the delta variant gained a foothold and many Americans refused to get vaccinated.
Fauci conceded Sunday that the administration needed to do better on increasing the availability of at-home coronavirus rapid tests, though he emphasized that the country was in a much better place than it was a year ago, with 200 million to 500 million tests available per month, many of them free.
“We’re going in the right direction,” he said on CNN. “We really need to flood the system with testing. We need to have tests available for anyone who wants them, particularly when we’re in a situation right now where people are going to be gathering.”
The omicron variant also has challenged the nation’s coronavirus medicine cabinet, with evidence that mutations will wipe out or weaken the effectiveness of treatments that can reduce the virus’s severity and keep people out of hospitals. As a result, the Biden administration around Thanksgiving paused distribution of sotrovimab, the one monoclonal antibody that remains effective against the omicron variant, with senior officials such as David Kessler calculating that the drug should be maximally deployed when the variant becomes more prevalent.
By Thursday, administration officials decided to resume shipments of the drug, amid indicators that the omicron variant was spreading faster in states such as New York and Washington than data published by the Centers for Disease Control and Preventionearlier in the week indicated, said two officials with knowledge of the deliberations.
“Shipment of product will begin soon, and jurisdictions will see product arrive as early as Tuesday, December 21, 2021,” the federal health agency said in a statement on Friday, announcing that about 55,000 doses of sotrovimab would soon go out.
Doctors said they were desperate for treatments like sotrovimab as emergency rooms begin to crowd and case numbers soar.
“Too slow! We are already seeing widespread omicron,” texted one infectious-disease doctor at a large New York City hospital, who estimated that at least 50 percent of patients had contracted the variant and requested confidentiality to discuss patient care. “It’s a lot of hospitalizations that could have potentially [been] averted because of slow response.”
Fauci said Sunday that he expected it to be months before antiviral drugs can be mass-produced and available to anyone who needs them. While he did not foresee the kind of shutdowns that were put in place in the early days of the pandemic, Fauci also noted that it would be difficult to keep the virus under control when there remained “about 50 million people in the country who are eligible to be vaccinated who are not vaccinated.”
Similarly, several governors on Sunday shied away from the possibility of implementing more shutdowns to fight the spread of the new variant. Maryland Gov. Larry Hogan (R) said on “Fox News Sunday” that his state, which has seen a 150 percent increase in hospitalizations over the past two weeks, was not considering shutdowns and instead was putting more resources into testing and encouraging vaccinations and boosters. New Jersey Gov. Phil Murphy (D) said on the same show that shutdowns remained “on the table” but that he didn’t think such a move was likely because a high percentage of the state’s population was vaccinated.
What they’re saying: “These numbers are stark, but they’re not surprising,” said Rochelle Walensky, the CDC’s director, adding that the growing infections reflect what has been seen in other countries.
While the Delta variant still drives up a lot of new infections, Walensky told AP she anticipates “that over time that Delta will be crowded out by Omicron.”
What’s next: President Biden on Tuesday will deliver a speech outlining new steps the administration will take to address the rapid spread of the new variant.