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Omicron is spreading.  Resistance is futile

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Omicron is spreading. Resistance is futile

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As the Omicron Wave crests, there is bad news and good news. The bad news is that the main strategies for slowing its spread – repeated testing, masks and vaccine boosters – are largely useless for this purpose. The good news is that while protecting the vulnerable remains vital, slowing the spread of the virus need not be the priority. Probably the biggest danger from Omicron is the acute shortage of hospital staff, in part due to asymptomatic employees staying home after testing positive.

Although Covid tests can be useful, they also have important limitations. Gold standard PCR tests are often too sensitive; research has shown that in many cases people who test positive are no longer contagious. Increasingly used rapid antigen tests have the opposite problem, often failing to detect infections during the first part of the five-day isolation period of suspected infectiousness.

This coronavirus, especially the Omicron variant, is moving so fast that mass testing and contact tracing, and probably even isolation and quarantine, cannot significantly slow it down. The UK and other countries, unlike the US, already had widespread rapid testing capacity in their recent surges, but have seen the same meteoric rise in cases. As with other interventions such as booster shots, the tests are most useful for people at high risk of serious complications, who could benefit from early treatment.

When it comes to masking, the Centers for Disease Control and Prevention recently acknowledged that cloth masks do relatively little to prevent the spread. Some coronavirus experts, including epidemiologist Michael Osterholm, have questioned the effectiveness of masks for nearly two years. A recent rigorous review by his University of Minnesota research group concludes: “We are well past the emergency phase of this pandemic, and it should be well known by now that wearing cloth face coverings or masks surgical, universal or not, has a very small role to play. . . . It’s time to stop overestimating their effectiveness and unrealistic expectations of their ability to end the pandemic.

The first large community-level randomized study, published last month in Science, found that while generic surgical masks offered a modest reduction (about 10%) in the risk of Delta infection, cloth masks did not significantly reduce the risk of Delta infection. risk. Masks may be even less protective against a highly contagious variant like Omicron.

This has led to calls for mandatory N95-type masks, which are more effective but more difficult to use. Some schools have even made them compulsory for children. Yet two years is a long time for someone’s face to be covered for many hours a day, and it’s a long time for young children, which can lead to lasting psychosocial and other harm. Like Delta and its earlier variants, Omicron does not pose a serious threat to the vast majority of children; preliminary evidence suggests far less risk for young people than those in Delta. A growing number of public health experts, including infectious disease specialist Monica Gandhi, have called for an end to school mask mandates soon.

And although vaccines and boosters continue to offer strong protection against serious illness and death – and are therefore vitally important for those at high risk – they are less effective in preventing infection, especially with the Omicron variant. While a new CDC study finds that recalls significantly reduce the risk of infection as well as Omicron hospitalization, countries like the UK and Israel that had extensive recall coverage before Omicron hit have also seen an unprecedented rise in cases.

In any case, even if you receive a booster now, the current surge will likely have subsided by the time immunity kicks in. It is possible that future variants will emerge against which the boosters currently given would still be useful, although d ‘by then, immunity may have waned. significantly. The European Medicines Agency recently warned that repeated boosters could weaken the immune system over time.

Which brings us to the good news: given that the new variant is relatively mild and so many people already have some immunity to vaccines, previous infection, or both, the explosive spread of Omicron is far less threatening than previous waves. A recent study from Southern California examined more than 50,000 patients infected with the new variant. None required mechanical ventilation and only one died, compared to 14 deaths and 11 ventilations out of some 17,000 infected with the Delta variant during the same period. Consistent with evidence from other countries, hospitalizations were significantly lower and average hospital stays significantly shorter in Omicron patients than in Delta patients.

Although the reported number of “Covid hospitalizations” is on the rise nationally, these figures include patients admitted for other reasons who incidentally test positive. Based on data from several states and the UK, it appears that around half of these admissions are unlikely to be caused primarily by the virus. Data from the Department of Health and Human Services indicates total number of patients in US hospitals has barely budged in the past six months.

Since the new variant primarily targets the upper airways instead of the lungs, doctors report that few patients need ventilation or even supplemental oxygen. Christopher Murray of the Institute for Health Metrics and Evaluation estimates in the Lancet that the death toll from Omicron “appears to be similar in most countries to the level of a poor flu season in countries in the northern hemisphere”. In 2017-2018, the flu caused some 52,000 deaths in the United States, likely peaking at more than 1,500 a day.

Public health authorities are beginning to accept the passage of the Covid emergency. Six experts who have advised the Biden transition, including Mr. Osterholm, called earlier this month for a pivot toward accepting Covid as an endemic disease, like several European countries. As Anthony Fauci acknowledged, “almost everyone” will eventually get infected. Some scientists have even suggested that Omicron may end up providing a kind of global “superimmunity” against serious diseases caused by future variants.

It is high time to move from trying to eradicate all new infections to directly protecting the most vulnerable people from serious diseases through vaccination and other evidence-based measures and reducing hospital staff shortages. . Ending mask mandates, reducing isolation and encouraging vaccination should be a compromise most of us can accept.

Mr Halperin is an adjunct professor at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill and author of “Facing Covid Without Panic”.

Journal editorial report: Paul Gigot interviews Dr. Marty Makary. Images: AP/AFP/Getty Images Composition: Mark Kelly

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