Defend against omicron without lockdowns
WASHINGTON — Americans sat down to their Thanksgiving tables on Thursday with deep gratitude that two years of pandemic finally seemed to be winding down. On Friday, they woke to news that the World Health Organization would identify a new “variant of concern,” called “omicron.”
The strain appears to be bad news, though it’s not yet clear how bad. It may be responsible for an “exponential rise” in new cases in South Africa, and it appears to have a lot of mutations in the spike protein that could affect transmissibility, or allow the virus to evade the immunity we’ve already acquired from vaccination or prior infection.
Stock markets cratered, and a number of countries slapped bans on travel from southern Africa.
Israel, which has already identified a case in a traveler from Malawi, is on the brink of declaring a state of emergency.
It’s now time for us to shake off our collective food coma and figure out what we’re going to do — not just about omicron but also other variants that may eventually follow. We’re living in the era of persistent pandemic. We need policies that let us live through it, while still actually living.
That strategy can’t be “everyone go back home again and stay there.” The costs of further lockdowns would be heavy, from eating disorders and opioid overdoses to small business failures and school kids falling behind. Besides, pandemic fatigue is setting in even in blue states. We must be more selective in our policies, opting for anti-covid measures that disrupt daily life as little as possible. And we should look for ones that sidestep contentious political battles, such as mask mandates.
Fortunately (or rather, unfortunately), there are a lot of effective strategies the United States still hasn’t exploited effectively, such as better ventilation and updating building codes to require it.
We can also re-implement policies we have used to good effect. Travel bans such as the one the Biden administration imposed Friday can’t stop variants from penetrating our borders, but they can slow new strains down and give us time to ramp up other mitigations, such as variant-tailored booster shots. Germany’s BioNTech says it takes about two weeks to determine whether a variant is evading the company’s vaccines — and that, if so, BioNTech could ship an updated vaccine within 100 days. A travel ban can buy us some time to protect our populations before the new variant really hits.
Of course, that’s assuming our regulators can operate at the speed of virus. Historically, the Food and Drug Administration’s preferred pace has been closer to a stately crawl. After the testing debacle early in the pandemic, it’s admittedly become a mite more spritely, but things are still moving slower than they should.
Antiviral treatments that seem to massively cut the risk of severe complications are now available. But though Britain has already approved molnupiravir, Merck’s antiviral treatment, the FDA won’t rule until at least Nov. 30. Paxlovid, Pfizer’s candidate, works so well that its trials were halted early because it was deemed unethical to keep giving the control group patients placebos. Why, then, is it ethical for the FDA to make others wait until they get around to approving it?
The FDA’s caution has still left us behind other countries in key respects, notably rapid testing. With a new variant about, we should be able to break out rapid home test kits to keep our social gatherings from turning into superspreader events. But backlogs at the FDA, combined with an insistence on precision over speed, have left the United States unable to do so on the necessary scale. Tests are too expensive to use frequently, if you can find them at all.
We need home testing kits so cheap and plentiful that everyone has piles of them everywhere. Heck, give them away in boxes of cereal. That means the FDA should approve tests even if they’re a little less accurate. If that’s not enough to make test kits ubiquitous, the U.S. government should stand up something like an Operation Warp Speed for testing.
Too, the government should improve its own tracking game. The United States ranks 28th in the world in terms of its capacity to track variants through genomic sequencing; we ought to be first. We also need to clean up our vaccination data, which is a mess. After we’ve fixed our own problems, we should spread the wealth around, helping poorer countries do more testing and tracking. While we’re at it, let’s further subsidize production of more vaccines for the rest of the world, because the fewer infections, the fewer chances the virus has to mutate.
None of this is beyond our capacities. And none of it requires everyone to self-exile for another two years. What it takes is an administration, and a public health establishment, that are willing to demand as much change from themselves as they have from everyone else over the past 18 months.