You Can’t Be Too Careful

Earlier this week President Biden addressed the nation about the new Omicron Covid variant. While acknowledging that Omicron poses a new and serious threat, he gave assurances that we are now in a far better position than we were in March 2020 when the World Health Organization first labeled Covid-19 as a pandemic. It wasn’t just that when the virus first struck we didn’t have face masks, ventilators, and personal protective equipment for our healthcare workers, we knew next to nothing about the virus. How lethal is it? How is it transmitted? We didn’t even know what parts of our bodies it would attack, much less how to combat it. By contrast, we now have a relatively full understanding of these issues. In addition, we now have ample medical supplies, four proven vaccines and a growing list of therapeutics to combat Covid including the one developed by Pfizer and approved this week by the FDA. Thus, the President’s message was that Americans should be concerned but should not panic. He also warned those Americans who have not been vaccinated that they would be likely targets of Omicron and he excoriated those media outlets that have been sowing anti-vaccination sentiment by disseminating lies.

To underscore his generally upbeat message, President Biden went on to itemize some additional measures the federal government is taking to address the current surge in Covid cases. He announced that he is invoking the Defense Production Act to produce five hundred of million test kits and millions of high-quality face masks and intends to make them readily available to the public. In addition, he’s expanding the nation’s network of Covid vaccination and testing sites. He is also making available armed forces medical personnel to assist in treating patients in hospitals already hard-pressed by the pandemic. The President concluded by asking Americans to unite behind him in this effort and by assuring them that together our nation can defeat this latest threat.

While the nation in all probability will overcome the Omicron variant, it’s difficult to share the President’s optimism that the process will be either short or without considerable casualties. A number of factors underlie my pessimism, many of which are outside of the President’s control. It’s for that reason that I suggest that even those who have been fully vaccinated cannot be too careful. Those who eschew the warning of public health officials will only have themselves to blame.

The threat posed by the Omicron variant shouldn’t be underestimated. Yes, according to recent studies it may not be as lethal as its predecessor, the Delta variant. But it is at least three times more transmissible than the Delta variant and as much as ten times more transmissible than the original version of the virus that arrived here in January 2020. This can best be understood by comparing the pace of its spread against that the Delta variant that became dominant this past summer. The Delta variant reached our shores in early March of this year and by early July it was responsible for roughly 10% of the Covid infections in this country. By mid-August, it was producing 93% of our nation’s new Covid cases. By contrast, the Omicron variant was first identified in South Africa less than three weeks ago and two weeks later it represented over 70% of the newly confirmed cases in this country even though the Delta variant was continuing to thrive here.

It’s not just that the Omicron variant is far more transmissible than the Delta variant, it is far more capable of evading the immunity shield created by our current vaccines. Whereas the Delta variant on occasion has been able to break through the immunity barrier created by current vaccines, the Omicron variant seems to do so with impunity. That doesn’t mean that the current vaccines are not helpful. Even in breakthrough cases involving fully vaccinated individuals, there are relatively few severe infections and hospitalizations. This is why public health officials are currently advocating that Americans who already have been vaccinated should get booster shots. In Israel, citizens are already being encouraged to get a second round of booster shots. Although the Omicron variant could severely affect elderly individuals as well as those with compromised immune systems, its principal danger doesn’t lie in the severity of the infections it can cause, but rather in the burden it will place on the nation’s healthcare facilities.

With the onset of winter in 2020, the daily number of new confirmed cases started to rise and they peaked on January 8, 2021 with over 300,000 new cases on a single day. To be sure, the cold weather was an important ally of the virus which seems to be more transmissible in winter temperatures. In addition, in winter people spend more time indoors where they are more closely congregated and the virus is less dissipated as it travels through the air. In addition, the holiday season tends to bring larger numbers of people together further facilitating the spread of the virus. While the cases of last year involved the far less transmissible original strain of the virus, that surge benefitted from the fact that the vaccines had only just been approved and there were over 300 million Americans remaining vulnerable.

The Delta variant, which grew rapidly during the six weeks between July 1, 2020 and August 12th, never achieved this level of daily infections largely because the number of vulnerable Americans had been reduced to approximately 100 million by the nation’s highly effective vaccination program. In fact, the surge in infections caused by the Delta variant never exceeded 164,000 confirmed cases on a single day. In its short tenure, the Omicron variant has already recorded over 230,000 new cases in a single day, up from approximately 180,000 the day before. This is a strong indication that the available vaccines are far less effective against it. In that respect, President Biden’s boast that there are now approximately 200 million fully vaccinated Americans is largely meaningless as the Omicron variant has clearly changed what it takes to be effectively immunized. In short, there could still be as many as 200 million Americans who remain vulnerable to infection by the Omicron variant which seems well on its way to surpassing the previous single-day record of new infections.

While it’s true that vaccinated individuals are significantly less likely to require hospitalization than unvaccinated individuals and far less likely to die, even vaccinated individuals could die if the nation’s hospitals become overwhelmed with Covid patients. When that occurs, many patients will not receive the medical attention they need to fight off the virus and death rates soar. This is already happening in the State of Rhode Island and is likely to happen in virtually all of the nation’s northern tier states.

When the first wave of Covid infections hit in the spring of 2020 the capacity of the hospitals in the New York City metropolitan area were quickly exceeded. The Army Corp of Engineers stepped in to create additional hospital facilities in the Javits Convention Center and in a tent erected in Central Park. It is likely that the Corp will again be called upon to expand the physical facilities of hospitals to meet the influx of Covid patients from the current wave of cases.

Now the problem is that the principal shortage will not be physical facilities, ventilators or even personal protective equipment, but rather medical personnel. Two years of having fought Covid has significantly diminished the ranks of skilled medical professionals available to handle an expected influx of new Covid patients. According to a poll published in early October, 18% of healthcare workers had quit their jobs since February 2020 and another 12% had lost their jobs or been laid off (principally because they had become infected). Among those who had remained in their jobs an additional 19% said they had considered leaving their job. The Bureau of Labor Statistics has estimated that 450,000 of the nation’s healthcare workers have left the health care industry since the pandemic began, approximately 180,000 of whom have died as a result of treating Covid patients.

Many departing hospital employees have become disillusioned or depressed as a result of seeing patients die and their bodies pile up in refrigerated trucks parked outside their hospitals. Others have been driven out of the medical profession by grueling and unsafe working conditions. In a recent article in The Atlantic, Ed Young highlighted a host of problems encountered by hospital workers. Specifically, they complained that their hospitals cut salaries, reduced benefits, and canceled raises. They have also charged that their employers have forced them to work more shifts with longer hours, failed to provide them with adequate personal protective equipment, and downplayed the severity of their experience.

The problems cited by departing hospital workers go well beyond the conditions imposed upon them by their employers. They explained that the nature of their jobs had changed. At the outset of the pandemic, they were hailed by their patients as national heroes in the battle against the most devastating enemy this nation has ever faced. More recently, they have had to deal with patients who are less appreciative of their services and are harder to deal with. Most are unvaccinated and tend to be belligerent, resisting basic medical procedures. Some even insist on being treated with unproven drugs like Ivermectin and hydroxychloroquine. Still, others have assaulted nurses and thrown trash around their rooms.

To address the problem of depleted and over-worked hospital employees President Biden has ordered 1,000 military medical professionals to augment the staffs of hospitals experiencing personnel shortages. While this will certainly help, it seems far too little to make a significant difference considering the potential number of Covid cases and the current personnel shortages. What might be more effective would be to establish a system for transferring personnel from those hospitals that are not being pressed to those that are. The fact remains that Covid patients in understaffed hospitals will face a greater danger than previously notwithstanding our better understanding of the virus and the availability of proven therapeutics.

The President’s program to greatly increase the availability of test kits is also likely to do little to stem the immediate oncoming crisis. The first problem is that those kits will not be available for at least 30 days by which time the daily number of new Covid cases may have already peaked. Perhaps even more importantly, the Omicron variant is likely to spread faster than infected persons can be identified and quarantined. It’s akin to trying to run away from a hungry lion. You can’t outrun the lion and will only succeed in exhausting yourself by trying to do so. The current circumstances, therefore, call for a different strategy. What is needed are measures that will retard the spread of the virus-like mandating mask and social distancing requirements. To its credit, the Biden administration is also implementing a plan to make high-quality masks available to the public. The problem is that those masks also may not be available before our hospitals become overwhelmed. Moreover, the Biden administration seems unwilling to impose further mandates. That may be because in our current politicized environment too many Americans are likely to ignore them and render them ineffective.

While the President is correct that we will eventually overcome the Omicron variant, we will incur a lot of fatalities before doing so. It’s altogether understandable that the President wants everyone not to panic and stay focused and work together in combatting the spread of Covid. Still, there is a clear line between fear and panic. Unfortunately, his suggestion that those who are “fully vaccinated” (whatever that now means) should not interrupt their daily routines seems counterproductive. In this case, a little fear seems to be called for. Our nation can best get through this wave of the virus by recognizing the danger posed by this new variant and limiting all social interactions to a bare minimum until the danger has passed as measured by the availability of hospital capacity.