Dr. Anand Parekh, chief medical advisor for the Bipartisan Policy Center, discusses how the U.S. can bolster its response to the spread of the omicron variant.
According to the Centers for Disease Control and Prevention (CDC), approximately 700,000 Americans are testing positive for Covid-19 each day. That number is sure to be a significant undercount given high positivity rates across the U.S., unreported positive home tests, and the mildness of omicron, especially in those who are vaccinated and boosted such that many infected Americans are either asymptomatic or so mildly symptomatic that they forgo testing. More than likely, millions of Americans are contracting the omicron variant each day.
While long Covid is certainly a concern for individuals testing positive, hospitalizations and deaths are even a bigger concern in the short-term. On that front, we are seeing more hospitalizations of Covid-19 patients than at any time during this pandemic. However, hospitals are reporting that not all admitted patients have acute Covid-19 illness; rather a sizable minority of patients are testing positive incidentally while being admitted for different causes (in some of these cases Covid-19 may in fact be responsible for the exacerbation of an underlying condition). Nevertheless, total inpatient capacity is at 78% occupancy—the highest of any time during this pandemic, underscoring the stress on our current health care system and workforce. Further, people with Covid-19 occupy over 25% of these hospital beds necessitating strict infection control protocols.
Arguably the most important metric is deaths, a metric that is rising with nearly 1,500 Americans with Covid-19 dying daily. Yet there are data questions here as well: While the vast majority of previously reported Covid-19 deaths during this pandemic are verifiable (many experts believe we have in fact underestimated deaths), given the omicron variant’s incidental finding in many hospitalized patients, it will be important to track whether future deaths in these patients are due to Covid-19 versus an unrelated cause of admission.
These data issues need to be probed and compound pre-existing data challenges impeding our ability to better understand the full impacts of this virus through daily stratification of Covid-19 cases, hospitalizations, and deaths by vaccination status (including number of doses, timing, and type), age, and comorbidities.
In spite of the data challenges, we know much more today and have a variety of tools two years into the pandemic to help us get through this current wave. In addition to strengthening existing medical surge capacity and advocating for universal public indoor mask wearing, focusing on three areas would bolster the U.S. response.
Getting More People Vaccinated And Boosted
Facility level data give us a clear picture of who is most sick from Covid-19 in our nation’s intensive care units. Far and away, this includes unvaccinated individuals and, to a smaller degree, vaccinated individuals who are elderly, those with co-morbidities, and individuals who have not received a booster dose.
We are currently averaging 1-1.5 million vaccinations daily in the U.S, with booster shots accounting for the majority. There are 30 million adults still unvaccinated, and new vaccinations are averaging over 300,000 daily. We should aim to double the uptake rate through a rejuvenated public-private sector educational campaign that would engage unvaccinated Americans to get vaccinated. Is this possible? A recent Economist/YouGov poll suggested that 25% of unvaccinated Trump voters and 50% of unvaccinated Biden voters remain open to vaccination, which amounts to millions of Americans who could still be reached and protected from Covid-19.
At the same time, we need to make sure that vaccinated Americans most vulnerable to the omicron variant are boosted; unfortunately, only half of adults over the age of 50 and only 60% of seniors have received booster doses. We need the campaign to specifically focus on boosting these populations. Finally, we must ensure that therapeutics which work well against omicron, while in scarce supply, are distributed to states based on a formula which takes into account high-risk populations most likely to benefit from their use.
The CDC Needs To Offer More And Clearer Communication
While the White House has done a yeoman’s job—with the exception of getting ahead of booster shots last summer—in coordinating the federal response, on matters of public health guidance, it’s time that the American public hear directly from CDC leaders in Atlanta. Too often, important CDC recommendations are communicated through press release, without supportive scientific data being immediately available, and not put into real-world settings and context. Announcements are then often followed by periods of confusion with questions from all sides, followed by officials appearing on network telecasts having to explain the guidance or backpedal. This only reduces trust in our scientific institutions and emboldens skeptics and conspiracy theorists.
It is time that we hear on a regular basis from CDC’s world class scientists in an effort to provide the media and stakeholders, such as the business community, an opportunity to ask questions. The public needs to hear about issues such as the importance of wearing higher quality masks, the utility of rapid antigen tests, and the most important mitigation practices to keep our schools open safely. Two years into the pandemic, it is imperative that public health communications improve now.
Congress Needs To Provide Sustainable Funding For Covid Response
Congress deserves answers to legitimate questions being asked about how federal agencies have spent coronavirus dollars to date. That said, it’s highly likely that additional investments will be needed, not only for the current wave but also for the longer-term, prior to the pandemic becoming endemic.
Resources are needed to stockpile and distribute surgical masks and respirators for the public. No longer can we rely on cloth-based masks given the transmissibility of omicron. Second, additional rapid antigen tests should be procured to support businesses and schools in keeping their doors open. Third, more resources will be needed for next generation therapeutics and vaccines; this is particularly true given the likelihood of new and emerging variants. Fourth, though we have made strides with respect to genetic surveillance, more investment will be necessary given CDC’s recent experience initially reporting large fluctuations in the prevalence of the omicron variant versus delta variant which made it difficult to track the current wave as well as allocate effective therapeutics to high-risk patients.
Finally, broader funding to support local and state public health departments and pandemic preparedness is caught up in deliberations over the Build Back Better Act but deserves bipartisan support moving forward as well. It’s not a question of if but when the next pandemic will occur and thus enhancing foundational public health capabilities will help save future lives and reduce the strain on our health care system.
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