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What the President Could Have Done Today to Counter the Pandemic
A Call for Proactive Boldness
President Biden announced solid plans to support American hospitals with staffing and equipment, enhanced accessibility of vaccines, and the beginning of improving access to free testing, including 500 million rapid tests to be distributed by request starting in January 2022.
That’s good, but a far cry from what should have been announced in light of uncontrolled spread of the Delta and now Omicron strains throughout the country, with a reported 268,000 new cases yesterday (excluding backlog), and more than 1,700 deaths. We have only 61% of Americans 2-shot “fully” vaccinated (that includes millions with J&J one shot), and only 1 in 7 with a 3rd shot booster. Among our highest risk group of people, age 65+, only 55% have received a booster shot. For perspective there are many countries with >80% of their population vaccinated and >90% of their highest risk boosted.
Each day more people have waned their protection from vaccines compared with the number of those getting their 1st shot, so that we are actually losing ground, an effective vaccine protection far short of 61% of the population now. And we’ve already learned that prior Covid alone (without any vaccination) is insufficient to defend against Omicron, as manifest by the first death in the United States in a man in his 50s with a previous infection.
Look at how poorly we are positioned for a new, major surge in cases, not just alarming rates in Wisconsin and parts of the Northeast, but greater than 300 per 100,000 people in a large portion of the country. There are already health systems that are overrun in the midst of the second Delta surge, and now with Omicron becoming dominant, well over 95% of new cases in large cities like New York and Houston, we’ll see more of this situation arise.
Admittedly, there are many things the White House and President Biden cannot control. Like the opposition to vaccines, masks, science, and our main defense tactics to counter the pandemic. Like facing very challenging versions of the virus that are hyper-contagious and evade our immune system. Yet there are certainly several strategic points that could have been enacted today, such as:
Booster shots at 4 months after the 2nd dose, not 6 months. The data are overwhelming and many countries have already switched to 3 months. Here’s a recent summary graph from Nature
Redefine “fully vaccinated” as 3 shots, unless it is after J&J for which we do not have data for a 3rd shot, or Prior Covid with uncertainty as to whether more than 1 or 2 shots is necessary. Maybe these data will help get the point across about the value of boosters for protection vs infection.
This is important since it will help get our inadequate booster protection up where it needs to be, fully backed by the extensive data for protection vs Delta (such as 90% reduction in death for age 50+, marked reduction in hospitalizations for age 40+, 95% protection vs symptomatic infection for all ages in a large randomized trial). That’s even more an issue for Omicron, for which protection drops to ~35% without a booster, but increases vs. symptomatic infection to about ~75%.
No airplane passengers who are not fully vaccinated, or having medical documentation for why that is not the case, such as the policy in Canada and many other countries. The federal government should have authority for any interstate transportation.
500 million free rapid tests by request sometime in January is totally inadequate. We need several billion of these, and have needed them for over a year to help prevent spread, as validated and relied upon in many countries throughout the world. It’s good that the Administration has finally responded to the loud voices of frustration but it’s an exemplar of too little, too late.
Distribute KN95 masks to all households. The US government can purchase these for very low cost (i.e. pennies) and get them widely distributed as has been done in other countries to enhance protection.
Rapidly scale the production of the anti-Covid pill Paxlovid, which is about to get FDA emergency authorization and the topic of my last post here. There will be a large number of non-mild infections going forward and we now have a treatment that is expected to work extremely well against Omicron, but the supply is dreadfully short. I wrote more about this today Enacting the Defense Production Act, as the President has done for rapid test production, is one way to solve this shortage problem. Our healthcare workforce, already compromised in numbers and morale, will likely be hit hard by Omicron infections. Having a pill treatment that knocks viral load down by 10-fold quickly, to potentially get them back in action in a short time lag (e.g. 2 days instead of 10) may prove vital. We need to get studies on transmission of Omicron done ASAP, and particularly with Paxlovid treatment to nail this time interval down, as discussed in my recent Q&A with New York magazine.
Fix the data mess. The CDC is apparently unable to track hospitalizations and deaths by vaccine status, timing, age of the patient and their relevant co-existing medical conditions. Secretary Xavier Becerra of HHS hasn’t yet shown up for the pandemic but has authority to mandate such data collection across the country. We are trying to determine the clinical severity of Omicron but have no ability to track the data here! The inability for CDC to see what was happening during the Delta wave, and their >2-month delay in recommending boosters for all adults, resulted in a large number of unnecessary cases as shown here, on the CDC website just published over the weekend, with only 1 of 3 snapshots since May, already a month old, with only a bit of data tracking cases and deaths, but not hospitalizations, in a limited number of regions of the country. In not a single speech that President Biden has given since taking office has he mentioned any effort to improve data collection and reporting. Just crickets on this issue. How can you navigate in a pandemic without data?
All of these are eminently doable. But our Administration continues to take a reactive stance, seemingly incapable of aggressive, bold initiatives that are under their control. Our house of Covid is not in order. We are contributing more Covid than any country to the rest of the world, and have been for months. We can indeed turn this around and show leadership. Show the world how to prevail over this pandemic. It’s never too late.