Within hours of that variant’s discovery, President Joe Biden banned travel from several South African nations, and New York Gov. Kathy Hochul declared a “disaster emergency.” She later revived a statewide mask mandate, as did the California governor.
Before succumbing to a repeat of the panic of last year’s holiday season—a time before vaccines, unlike today, when nearly 203 million Americans, or more than 61% of the population, are fully vaccinated—let’s try to sort out what we know and don’t know about the rise in COVID-19 cases, the emergence of a new variant, the effectiveness of vaccines, and the prospect for new treatments.
- COVID-19 cases are rising again. This year began with the hope that vaccines would end the pandemic; 2021 concludes with another surge in infections. While scientists have not declared COVID-19 endemic—a disease that, like the flu, will always be out there—it will still be with us in 2022 and perhaps beyond. That would mean adjusting our expectations from eradicating COVID-19 to coexisting with it.
- COVID-related hospitalizations and deaths are also rising, but hospital capacity remains robust. Hospitalizations increased by 50% between Nov. 6 and Dec. 9, from nearly 40,000 to nearly 60,000. That number, though concerning, must be placed in context. As of Dec. 11, the Department of Health and Human Services reported that just 79% of hospital beds were filled, and COVID-19 patients occupied only 9% of them. Intensive care unit occupancy rates also were at 79%, with 19% of the beds filled by COVID-19 patients. ICU capacity is still solid, even in states tested by surges in COVID-19 hospitalizations. Michigan ICUs were operating at 88% capacity (39% with COVID-19); Maine at 68% capacity (38% with COVID-19); and Missouri at 89% capacity (27% with COVID-19). Spikes in cases can create episodic crises for hospitals confronting twin challenges of supply (fewer workers) and demand (more patients). But the U.S. is not facing a widespread hospital crisis.
- Vaccines may be less effective against COVID-19 infection and transmission than initially advertised. In July 2020, FDA official Dr. Peter Marks said that if 70% of the population were vaccinated against COVID-19, that would “help wipe that infectious disease out.” With cases still rising in the U.K., which is fast approaching the 70% threshold, public health officials rarely talk about wiping out SARS-CoV-2. The Centers for Disease Control and Prevention acknowledges that vaccinated people can contract and transmit the disease, although their risk of infection with the delta variant is lower than for the unvaccinated.
- Vaccines significantly reduce the risk of COVID-related hospitalization and death. If vaccinated people still can be infected and spread disease, why get jabbed? Because scientists continue to believe that vaccines greatly reduce the risk of severe illness and death. There’s great value in a product that makes it less likely that COVID-19 will land you in a hospital bed, on a ventilator, or in a morgue.
- The Food and Drug Administration may soon authorize medications that reduce the risk of COVID-related deaths. Last December, the FDA authorized two vaccines against the virus that causes COVID-19. This December, it may clear two new COVID-19 treatments. An interim analysis found that Pfizer’s oral COVID-19 medicine (paxlovid) reduced hospitalizations and deaths by 89%. Merck reported that its oral antiviral (molnupiravir) reduced COVID-19 hospitalizations and deaths by 30%. An FDA advisory panel recommended authorization of Merck’s medicine, and Pfizer has asked the FDA to review its product. If soon after being infected, patients can take pills that fend off severe illnesses, COVID-related hospitalizations and deaths could plummet in 2022, even if infections rise.
- Scientists don’t know much yet about the omicron variant. The South African government reported it on Nov. 24. Since then, scientists have produced some very preliminary information about the variant, leaving three questions unanswered:
1) Is omicron more contagious than previous variants?
New COVID-19 cases in South Africa, where omicron likely accounts for most new infections, rose from fewer than 300 per day in mid-November to more than 19,000 on Dec. 12.
Scientists report that two vaccinated people quarantining in separate hotel rooms in Hong Kong both tested positive for the omicron strain, although they had no contact with one another, suggesting that even quarantine may 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 provides plausible evidence that it might.
2) Is omicron as lethal as previous variants?
The preliminary information on severe illness is more heartening. One study found that most patients in a South African hospital diagnosed with the omicron strain of the pathogen were not oxygen-dependent. This is the opposite of the pattern the hospital observed during previous COVID-19 outbreaks. Hospitalizations in South Africa remain very low despite a surge in COVID-19 infections.
There were no deaths and just one hospitalization among the first 43 U.S. cases reported to the CDC. That patient, who was vaccinated, was released after two days. Although that’s not nearly enough evidence to conclude that the omicron variant is less likely than earlier strains to cause severe sickness, the early data suggest it might infect many people, but produce milder illnesses.
3) Do natural immunity and vaccines protect against infection with the omicron variant?
Several early studies suggest they may not.
A study out of South Africa examined 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 “substantial ability to evade immunity from prior infection.”
A study involving laboratory samples from 12 patients who had received the Pfizer vaccine found that the omicron variant has “considerable escape from vaccine-elicited immunity.”
An unpublished study out of Israel found that a full course of the Pfizer vaccine did not protect against omicron, but that a third dose provides some protection, albeit four times less than against delta. The CDC study of the first 43 U.S. cases found that 34 were fully vaccinated, 14 of whom had received boosters.
While vaccines may be less effective against infection with omicron than with previous strains, there’s evidence that they do protect against severe illness. Discovery Health, a firm that helps administer South Africa’s health system, found that the Pfizer vaccine reduced hospitalizations by 70% among those infected by the omicron variant.
These results are still preliminary and hardly definitive, but they suggest that although omicron is more likely than previous strains to infect vaccinated and previously infected people, vaccines still greatly reduce the risk of hospitalization and death.
People respond differently to uncertainty and risk. For some government officials, rising cases and the specter of a new variant prompts a return to familiar restrictions and mandates.
The alternative to the heavy hand of government? Candor, honesty, and trust. Provide Americans with truthful information, acknowledge that much remains unknown and remind them that the disease continues to pose grave risks to the elderly and those with certain underlying medical conditions.
Government officials should note that vaccines provide the best protection against the worst outcomes. They should equip individual Americans to learn their COVID-19 status by making rapid, self-test kits ubiquitous and affordable. And, pending FDA authorization, they should enable widespread production and distribution of medicines to treat COVID-19 patients.
In short, communicate clearly and honestly, treat people as adults, and facilitate informed decision-making.
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