Holiday season

It’s the holiday season. Time for another COVID-19 pandemic panic?

The New York Times warns of increasing hospitalizations due to the delta variant, and The Atlantic believes that the emergence of the omicron variant augurs well for “the vaccine pandemic.”

Hours after this variant was discovered, President Joe Biden banned travel from several South African countries and New York Governor Kathy Hochul declared a “disaster emergency.” She then revived a statewide mask tenure, as did the Governor of California.

The outgoing New York City mayor has upped the ante with mandatory vaccinations for private company employees and banned unvaccinated children from restaurants and theaters.

Before succumbing to a repeat of last year’s holiday season panic – a time before vaccines, unlike today, when nearly 203 million Americans, or over 61% of the population, are fully vaccinated – let’s try to sort through what we know and don’t know about the increase in COVID-19 cases, the emergence of a new variant, the effectiveness of vaccines and the prospect of new treatments.

  • COVID-19 cases are on the rise again. This year began with the hope that vaccines would end the pandemic; 2021 ends with another outbreak of infections. Although scientists have not declared COVID-19 endemic – a disease that, like the flu, will always be present – it will still be with us in 2022 and possibly beyond. This would mean adjusting our expectations of COVID-19 eradication to coexistence with it.
  • COVID-related hospitalizations and deaths are also increasing, but hospital capacity remains robust. Hospitalizations increased by 50% between November 6 and December 9, from nearly 40,000 to nearly 60,000. This number, while worrying, must be put in context. As of December 11, the Department of Health and Human Services reported that only 79% of hospital beds were occupied and patients with COVID-19 occupied only 9%. Intensive care unit occupancy rates were also 79%, with 19% of beds occupied by COVID-19 patients. Critical care capacity is still strong, even in states tested by increases in hospitalizations linked to COVID-19. Michigan’s intensive care units were operating at 88% of their capacity (39% with COVID-19); Maine at 68% of its capacity (38% with COVID-19); and Missouri at 89% of capacity (27% with COVID-19). Peak cases can create episodic crises for hospitals faced with the dual challenge of supply (fewer workers) and demand (more patients). But the United States is not facing a generalized hospital crisis.
  • Vaccines may be less effective against infection and transmission of COVID-19 than initially advertised. In July 2020, an FDA official, Dr Peter Marks, said that if 70% of the population were vaccinated against COVID-19, it would “help eliminate this infectious disease.” As cases continue to rise in the UK, which is rapidly approaching the 70% threshold, public health officials rarely talk about eliminating SARS-CoV-2. The Centers for Disease Control and Prevention recognizes that vaccinated people can contract and transmit the disease, although their risk of infection with the delta variant is lower than that of the unvaccinated.
  • Vaccines significantly reduce the risk of hospitalization and death from COVID. If vaccinated people can still be infected and spread the disease, why get bitten? Because scientists continue to believe that vaccines dramatically reduce the risk of serious illness and death. There is great value in a product that makes COVID-19 less likely to land you in a hospital bed, on a ventilator, or in a mortuary.
  • The Food and Drug Administration may soon approve drugs that reduce the risk of death from COVID. Last December, the FDA cleared two vaccines against the virus that causes COVID-19. In December, it could erase two new COVID-19 treatments. An interim analysis found that Pfizer’s COVID-19 oral drug (paxlovid) reduced hospitalizations and deaths by 89%. Merck reported that its oral antiviral (molnupiravir) reduced hospitalizations and deaths from COVID-19 by 30%. An FDA advisory group recommended merck’s drug authorization, and Pfizer has asked the FDA to review its product. If soon after becoming infected, patients can take pills that ward off serious illnesses, COVID-related hospitalizations and deaths could drop in 2022, even as infections increase.
  • Scientists don’t know much about the omicron variant yet. The South African government reported it on November 24. Since then, scientists have produced very preliminary information about the variant, leaving three questions unanswered:

1) Is omicron more contagious than the previous variants?

New cases of COVID-19 in South Africa, where omicron is likely responsible for most new infections, have risen from less than 300 a day in mid-November to more than 19,000 on December 12.

Scientists report that two vaccinated people quarantined in separate hotel rooms in Hong Kong both tested positive for the omicron strain, although they had no contact with each other, suggesting that even quarantine could do not prevent its spread. This doesn’t prove that omicron is more contagious than previous variants or that it will supplant delta as the dominant strain, but it does provide plausible evidence that it could be.

2) Is the omicron as deadly as the previous variants?

The preliminary information on serious illnesses is more encouraging. One study found that most patients at a South African hospital diagnosed with the omicron strain of the pathogen were not oxygen dependent. This is the opposite of the pattern seen by the hospital during previous COVID-19 outbreaks. Hospitalizations in South Africa remain very low despite an upsurge in COVID-19 infections.

There have been no deaths and only one hospitalization among the first 43 U.S. cases reported to the CDC. This patient, who had been vaccinated, was released after two days. While this is not enough evidence to conclude that the omicron variant is less likely than earlier strains to cause serious disease, early data suggests that it could infect many people, but produce milder disease.

3) Do natural immunity and vaccines protect against infection with the omicron variant?

Several early studies suggest not.

A study in South Africa looked at reinfection rates among 2.8 million patients who had recovered from COVID-19 throughout the pandemic. While reinfection rates were low for the beta and delta variants, the study found that the omicron variant had “a substantial ability to evade immunity from a previous infection.”

A study of laboratory samples from 12 patients who had received the Pfizer vaccine found that the omicron variant had “a huge loophole in vaccine-induced immunity.”

An unpublished study in Israel found that a full cycle of Pfizer vaccine did not protect against omicron, but a third dose offered some protection, albeit four times less than against delta. The CDC’s study of the first 43 U.S. cases found 34 were fully vaccinated, of which 14 had received boosters.

Although vaccines may be less effective against omicron infection than with previous strains, there is some evidence that they protect against serious disease. Discovery Health, a company that helps administer South Africa’s healthcare system, found that the Pfizer vaccine reduced hospital admissions by 70% among people infected with the omicron variant.

These results are still preliminary and barely definitive, but they suggest that although omicron is more likely than previous strains to infect people who have been vaccinated and previously infected, vaccines still significantly reduce the risk of hospitalization and death.

People react to uncertainty and risk differently. For some government officials, the increase in cases and the specter of a new variant are prompting a return to the usual restrictions and mandates.

The alternative to the government’s heavy hand? Frankness, honesty and trust. Provide Americans with truthful information, recognize that much remains unknown, and remind them that the disease continues to pose serious risks to the elderly and those with certain underlying medical conditions.

Government officials should note that vaccines offer the best protection against the worst outcomes. They should enable Americans to learn their COVID-19 status by creating ubiquitous and affordable rapid self-test kits. And, pending FDA clearance, they are expected to enable large-scale production and distribution of drugs to treat COVID-19 patients.

In short, communicate clearly and honestly, treat people like adults, and facilitate informed decision-making.

This approach is less dramatic than retaining five-year-olds outside of restaurants, but it is evidence-based, reasonable and consistent with democratic values.

This piece originally appeared in The Daily Signal


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