Opinion | What Does Living With Omicron, and the Next Covid Variants, Truly Mean?


Americans, by contrast, “have accepted more harm to children in exchange for less harm to adults, often without acknowledging the dilemma or assessing which decisions lead to less overall harm,” The Times’s David Leonhardt writes. “Given the choices that the country has made, it should not be surprising that children are suffering so much.”

Beyond January, the virus’s trajectory is uncertain. “The future burden of Covid depends in large part on whether highly transmissible variants able to evade pre-existing immunity, such as Omicron, continue to emerge,” Jeffrey Shaman writes. “If new variants arise roughly twice per year, for example, then we should expect multiple outbreaks each year, even in the summer.”

The Biden administration’s response to Omicron does not bode well for that eventuality, the Times columnist Zeynep Tufekci argues. It was, after all, just a matter of luck that Omicron seems to cause less severe illness. “If it had been more deadly — as Delta has been — the U.S. government’s haphazard and disorganized response would have put the whole country much more at risk,” she writes. “Even with this more moderate threat, the highest-ranking public health officials are making statements that seem more aimed at covering up or making excuses for ongoing failures, rather than leveling with the public.”

So what would a more future-proof public health approach look like? Last week, six former advisers to the Biden administration who were frustrated with its coronavirus response took the unusual step of publicly calling for a new domestic pandemic strategy. In three Journal of the American Medical Association articles, the authors write that the country must shift to a “new normal” in which the coronavirus does not disappear but instead circulates alongside other respiratory viruses like the flu.

Getting to the “new normal” they envision would require not concession but aggressive adaptation:

  • First, because interventions to reduce coronavirus transmission, like ventilation, work across respiratory pathogens, the authors argue that public health decisions should from now on be based on the aggregate risk of all respiratory viruses. Policymakers then need to establish an aggregate risk threshold beyond which emergency measures would be triggered. In their view, the appropriate threshold would reflect the peak weekly deaths, hospitalizations and transmission of viral respiratory illnesses during prepandemic, high-severity years. (In the worst week of 2017-18, for example, about 3,000 Americans died of respiratory viruses.)

  • Second, to ensure that total respiratory viral infections, hospitalizations and deaths do not exceed severe prepandemic levels, the authors call for a vaccine coverage rate of at least 90 percent (which will require vaccine mandates); development of mucosal, variant-specific and universal coronavirus vaccines; and rapid production of therapeutics, along with a mechanism to make them immediately and freely available to anyone who tests positive.

  • Third, to reduce Covid transmission and sustain the “new normal,” the authors argue the nation would need a greatly improved public health infrastructure that includes a new, permanently funded system for testing, surveillance and mitigation measures.

“Without a strategic plan for the ‘new normal’ with endemic Covid-19, more people in the United States will unnecessarily experience morbidity and mortality, health inequities will widen, and trillions will be lost from the U.S. economy,” they write. “This time, the nation must learn and prepare effectively for the future.”

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