The main lesson of the Covid pandemic is that change is the only constant. Variants spread, cases increase and decrease, treatments change and knowledge expands. This means that we – the public, elected officials and public health leaders – must constantly learn and adapt quickly, acting on the understanding that no policy response is likely to be effective for long.
Now is the time to put that flexibility into practice. Rising Covid cases in Europe, the toll Omicron is taking especially on unvaccinated seniors in Hong Kong, and the slowing down of vaccinations are warnings that a new wave of infections is likely approaching the United States. But we are certainly not powerless. We can prepare better, save lives and reduce nuisance.
While the exact reasons for the rapid increase in cases in Europe are unknown, it is almost certainly due to a combination of the highly contagious BA.2 Omicron subvariant, changing public behavior and declining immunity.
BA.2 makes up an increasing proportion of new cases and prolongs the Omicron peak. At the same time, countries in Europe are lifting Covid-19 restrictions, including mask mandates and indoor capacity limits, and immunity to infection from vaccines and possibly from previous infections is declining. Fortunately, while protection against infection through vaccination is something of a flash-in-the-pan phenomenon, the protection vaccines provide against serious infection and death is more durable.
We also learned more about the nature of the threat. It was an open question whether Omicron is a much less severe variant of the Covid virus than previous strains, or whether it caused a much less severe disease because it had run into a wall of immunity to vaccination and previous infection in the United States. , Europe and parts of Asia with high vaccination coverage. The deadly outbreak in Hong Kong answers that question: Covid remains raging and Omicron is deadly in an immunologically naive population, especially among unvaccinated elderly people. This has caused the devastating increase in deaths there and helps explain why the United States still reports about 1,000 deaths a day, the vast majority among people unaware of vaccination.
Unfortunately, in the United States and many other high-income countries, vaccination has slowed to a trickle: It has fallen more than 95 percent in the United States from its peak of 4 million vaccinations per day. In some African countries, where competing health risks are significant and healthcare infrastructure is sparse, vaccination rates are very low and likely to remain so for many months to come.
The risks to the United States are clear. BA.2 is on the rise and will probably soon be responsible for most of the new cases in the country. Masks have gone off and about 60 percent of Americans, including more than a third of people over 65 — more than 15 million seniors — are unaware of vaccination. This does not mean that BA.2 will inevitably cause a deadly wave. But it does mean that the number of cases could increase rapidly and that unvaccinated and under-vaccinated elderly and medically vulnerable people could pose a deadly threat.
Leaders must redouble their efforts to get more Americans, especially older adults, vaccinated and stimulated. Also, people who are older or immunocompromised and their environment should consider masking with a more protective N95 or equivalent mask. Increasing access to rapid testing could mitigate the case increase by isolating people more quickly and linking those who test positive to prompt treatment with drugs that dramatically reduce the risk of serious illness.
Improving vaccination coverage may be more difficult with the rollback of vaccine mandates, which have increased vaccine uptake and saved lives. With vaccine mandates politically or legally unfeasible in some places, other strategies are becoming increasingly important. These include ensuring that every doctor offers Covid-19 vaccination to every patient at every clinical visit. Outreach programs and media campaigns can involve people without a regular doctor or who are otherwise not receiving care. Providers and health systems should contact any Medicare patient who may not be up to date to schedule the vaccination.
Repeated Covid spikes have ameliorated the underlying weaknesses and chronic underfunding of our public health and primary care systems. Infectious diseases arise where society fails. Lack of trust limits the ability of governments to protect their people. Weak public health systems mean that new threats are discovered when it is too late to take action. Sustained funding can help protect Americans from future pandemic threats by allowing permanent exemptions from the budget cap for critical health defense functions rather than relying on temporary additional funding for every health emergency. Until US primary health care is much more robust, diagnosis, treatment and vaccination against Covid and other threats will continue to fail, allowing Covid to spread among populations that are much less resilient than they would be if people were given proper preventive measures. concern.
“Follow the science” is a mantra, but science can be painfully slow and decisions inevitably have to be made before perfect information is available. We don’t yet know what is driving the emergence of variants or what future variants will bring. We also do not know what the optimal vaccination schedule is for different groups, whether a fourth dose will be needed, and if so, for whom and when. And we don’t know if the highly effective treatments that have been discovered, on which the Biden administration is betting heavily, can reach enough people to greatly reduce hospitalizations and deaths. The battle to get even half of eligible Americans up to date on vaccinations doesn’t bode well for widespread treatment; treatment is generally much more difficult to scale up than vaccination.
Yet we must try. Public health, like politics, is the art of the possible. Rigorous epidemiology, rigorous response management, and well-communicated science should form the basis of public health action. Increasing vaccination, including boosters, among older and frail people is a life-or-death challenge. Scaling up the link between testing and treatment can significantly reduce hospitalizations and deaths and protect health care systems. The United States must also support national and global faster detection and response systems. In addition to strengthening other tracking systems, monitoring for Covid in wastewater, as is done for polio and other diseases, can identify the spread of disease before many people get sick. As public health professionals Finding outbreaks as soon as they start helps leaders limit the spread.
For now, most of us can enjoy the warm spring sun on our unmasked faces. But we can also do a lot more to get Covid under control. If we learn quickly and act quickly, we can outsmart the virus. As Covid continues to adapt, our response must also adapt. We can enter the endgame for Covid. How we play it will determine what happens next.
Tom Frieden served as director of the Centers for Disease Control and Prevention from 2009 to 2017, overseeing the U.S. response to the H1N1 flu, Ebola, and Zika epidemics. He is the president of Resolve to Save Lives.
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