If you want to know what the Omicron variant means for protecting you and your community in the next few months, look at New York City. The variant is causing a dramatic surge of cases in the unvaccinated and vaccinated alike and will almost certainly become the dominant strain in weeks — a process that took the Delta variant months. This will soon happen across the country, adding to the wintertime surge many places are already experiencing because of Delta infections.
The great unknown is whether a record number of infections will translate into a record number of hospitalizations and deaths. If the country rapidly adjusts its public health strategy, this potential toll can be avoided.
Public acceptance of Covid disruptions, like business and school closings, has waned. Combine that with a highly infectious variant, and policymakers are left with a limited number of options. But they are not helpless. President Biden’s Covid-19 address planned for Tuesday must lay out how the federal government will support states in reducing severe illness and death, while maintaining the public’s resolve to follow basic Covid-19 control measures. These two goals work together: If severe illness and death can be limited, the public is more likely to patiently continue going along with basic control measures; yet if those measures intensify and end up exhausting both the vaccinated and unvaccinated, they will be ineffective.
While Omicron means that a large number of coronavirus infections is now inevitable, vaccines mean a correspondingly large number of hospitalizations and deaths is optional. Adjusting Covid-19 policies and intensifying support for hospitals, nursing homes and schools can help reduce severe illness and promote public acceptance.
Policy change begins with the Centers for Disease Control and Prevention redefining people as “up-to-date” or “fully vaccinated” if they have received their initial shots plus a booster, because the additional dose increases protection against Omicron. The message must be crystal clear: In the time of Omicron, being “up-to-date” may only delay, not prevent, you from being infected, but it will protect you from becoming severely ill and help your community avoid running out of hospital beds. (In places that mandate vaccinations for all health care workers, staffing shortages may be exacerbated in the short term, as some people will resist an additional injection. It will, however, prevent work force disruptions over the long term, as it will avert some infections and protect many from severe illness.)
Isolation periods for vaccinated people who test positive and no longer have symptoms need to be shortened from the currently recommended 10 days to around five days. Since levels of the coronavirus decline rapidly in vaccinated people who are infected, people with breakthrough infections will be able to return to their daily lives faster, even though a small percentage may still be infectious.
So-called “test-to-stay” policies should apply to all people who learn that a close contact has tested positive for Covid. Instead of requiring people to both stay home and be monitored, public health agencies can allow people to return to school or work if they do not have symptoms and test negative for the virus initially and periodically over the next seven days. This is being embraced by schools, but, in places where rapid test kits are widely available, it should also be used by workplaces as well to minimize the disruptions to personal lives and work.
All public health agencies must focus messaging on vaccinations as the single best way to save lives and keep the health care system from collapsing. In New York City, responders like myself learned that the single best method to achieve high vaccination levels in adults — who are at the highest risk of severe illness — is through workplace mandates and vaccine verification programs, especially for higher-risk indoor activities, like visiting bars, restaurants and gyms.
New York City embraced a vaccine-first policy to prepare for seasonal and variant-related surges. During such surges, we reasoned that people will no longer accept a prolonged citywide “stay at home” order and complete closings of schools and businesses two years into the pandemic. Through laws that motivate almost all adults to become vaccinated, leaders can immediately reduce demand on their hospitals. Cities and states should try to adopt similar vaccine requirements for workplaces and higher-risk indoor activities, and people must organize to demand these as basic public safety measures.
While high levels of community vaccination are necessary, public health leaders must recognize they are not sufficient to protect hospitals, nursing homes and schools.
The greatest challenge of this Covid-19 wave will be staffing. Across the country, health care workers and teachers are exhausted and demoralized. Many hospitals, nursing homes and schools were understaffed even before Omicron. The problem will only worsen as vaccinated health care workers and teachers become too ill to work and their colleagues stay home to avoid getting sick. In hospitals and nursing homes, staffing shortages can greatly worsen quality of care, causing patients to die from Covid-19 or other illnesses they might normally survive.
Unlike in 2020, all jurisdictions need to recognize that in-person school is as essential to society as hospitals. Keeping children in class requires a redoubling of efforts in all school systems on vaccinations (particularly for all adults), masks, ventilation and testing to keep students and staff members healthy to learn and work.
States must activate emergency management systems now, even before Omicron surges in their area, to ensure sufficient staffing, testing, protective equipment, ventilation and public communication for hospitals, nursing homes and schools. For example, where rapid test kits are limited, the government should reallocate them away from community testing sites and toward schools and nursing homes. I also hope to hear Tuesday how the Biden administration will finally make rapid tests abundant and affordable.
Of course, public health leaders like myself need to recognize that many elected officials concluded well before Omicron that both Covid infections and deaths are inevitable and that even the most rudimentary measures, such as adding Covid vaccination to the long list of vaccines already mandated for health care workers, infringe on people’s liberties or cost too much. If you live in one of those areas, your protection from Covid-19 is now, unfortunately, mostly an individual responsibility.
Thankfully there are many actions people can take to protect themselves. Everyone should get three doses of an mRNA vaccine or an mRNA booster if they received a different kind of vaccine initially. You should acknowledge that certain gatherings and time with grandparents are essential to mental health, but be judicious about how you approach them. In the Omicron era, don’t assume that an indoor event is safe from infection risk just because only vaccinated people are present. Add layers of protection, such as using rapid tests no more than a few hours before entry, wearing high-quality masks and opening windows and doors.
Most importantly, prepare yourself and your loved ones for massive disruptions again. Unlike in 2020, when local governments ordered businesses to close, expect to see what’s happening now in New York City, where many restaurants, bars and offices are now closing because they lack a healthy staff to run them, not because of a government lockdown.
If we as individuals do our part by getting vaccinated and being smarter about social gatherings, and the government does its part to protect schools, hospitals and nursing homes, we can make this pandemic moment safer for as many people as possible.
Dr. Jay K. Varma (@DrJayVarma) is a physician and epidemiologist focused on prevention and control of emerging infectious diseases, such as Covid-19, Ebola and more. He was recently the Covid-19 adviser to Mayor Bill DeBlasio of New York, and organized its Covid testing, tracing and vaccination campaigns. He is a professor at Weill Cornell Medicine.
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