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With Omicron, a Chance for a Public Health Reboot

Vaccinations are rising in response to the new variant. While much is unknown, health officials hope the public — and politicians — will be inspired to get back to the basics of protection.

People lined up outside of a COVID-19 vaccination site in Washington, D.C.
People line up outside of a COVID-19 vaccination site on Friday, Dec. 3, 2021, in Washington, D.C. The omicron variant appears to be scaring people into getting vaccinated, as appointments suddenly are hard to come by in parts of the country.
(Samuel Corum/Getty Images/TNS)
Much more is unknown than known about the omicron variant of COVID-19 at this point. It could be more transmissible and better able to evade immune defenses from vaccination or prior infection than the delta variant. It might also lead to milder cases. But none of that is certain right now.

As a result, the best advice from public health officials is to stick to the basics: Get vaccinated and, if you are vaccinated, get boosted. Wash your hands frequently. Avoid crowded indoor spaces and otherwise distance when possible. Wear a mask. “The basic messages are still the same and they’re still the most useful,” says David Fleming, a distinguished visiting fellow at the Trust for America’s Health, a nonprofit that promotes public health.

Although omicron’s ultimate course is unknowable, we understand a lot more about COVID-19 than we did at the start of the pandemic. The basic techniques still can help people avoid getting sick. And the days of widespread lockdowns are long over.

“When it comes to the really aggressive moves that we had to make early in 2020 around stay-at-home orders and things like that, I think that ship has sailed,” says Chrissie Juliano, executive director of the Big Cities Health Coalition, a forum for the largest metropolitan health departments. “There’s not public or political will to do that, and I think that’s okay.”

But if the remaining tools around messaging should be clear enough, they’ve been undermined by the media and political environment. Social media remains rife with misinformation about vaccines and the disease, while mainstream media outlets rush to hype the potential dangers from omicron — or, alternatively, speculate that it could be such a mild form that it ends the pandemic.

It’s impossible to know how a variant that’s just starting to spread in this country will play out. “The massive amount that we don’t know dwarfs what we do know at this point,” John Moore, a professor of microbiology and immunology at Weill Cornell Medicine, said last week, speaking to doctors at the University of California, San Francisco.

Moore offered a reminder that while omicron is coming, delta isn’t done. He predicted that as many as 150,000 more Americans will die by March due to another winter surge.

It appears that omicron has done the job of scaring more people into getting vaccinated, with appointments suddenly hard to come by in parts of the country. But one consistent storyline throughout the pandemic has been that many Americans become frightened and more cautious in response to rising caseloads and deaths, only to let down their guard soon after.

Health officials want people to remain vigilant, but they know they face challenges in maintaining trust when so many competing voices are offering contradictory, often false information.

“We have tried and true ways to slow this down,” says Phil Huang, director of health and human services in Dallas County, Texas. “Definitely, the conflicting messages complicate the job of just getting out basic public health prevention messages to slow down the spread.”

Aligning the Message

Last week, President Biden outlined a plan to address the omicron threat, including testing of international travelers and making at-home rapid tests more widely available. He reiterated his desire for employers to require vaccinations, although courts last week blocked the administration’s vaccine-or-frequent-testing mandates for government contractors and health-care workers.

The legal battles continue, but in the meantime local health officials have called on the administration not to rely so heavily on vaccinations in its public messaging, wanting further promotion of non-pharmaceutical interventions such as hand washing and social distancing.

“The messaging from the administration — CDC, HHS, the White House task force — straight down to governors and state health directors needs to be aligned at all times,” says Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials. “Keeping that information aligned and flowing at all times has really been the ultimate challenge of this pandemic.”

To say that information has not been aligned is an understatement. Citizens living in different jurisdictions have heard different messaging from the beginning of the pandemic. “The noise matters in that the public pays attention to all kinds of sources of information, even if it’s not always accurate,” Freeman says.

Most Republican leaders continue to emphasize the need for vaccinations, but nearly all of the party is opposed to vaccine and mask mandates. At times, such oppositional messaging has drowned out any call for continuing prudence, even as a choice.

Last week, the Missouri Independent reported that the state health department had conducted a study finding that jurisdictions with mask mandates had lower per capita case and death rates, but Gov. Mike Parson’s office — which requested the study — failed to make it public. Parson said that the report had failed to account for other local variables, such as vaccination rates. “I have consistently said that I am not anti-mask; I am anti-mask mandate,” Parson wrote on Twitter.

It’s not hard to find examples of Republican officials offering false information about infection providing stronger immunity than vaccination, or casting doubt on the efficacy of vaccination or masking. Since vaccines became widely available in the spring, death rates in counties that supported President Donald Trump last year have far outpaced those in counties that voted for Biden.

“We’re fortunate we have the availability of vaccines,” says Huang, the Dallas County health director. “Many countries don’t have that luxury. It’s just a shame that there are other forces that are not allowing us all to take advantage of this.”

He calls it “frustrating” that public health measures have become so politicized and that the focus on the “common enemy” of the virus appears at times to have been lost.

The Need for Leadership

Polls have shown that a majority of Americans support measures such as mask and vaccine mandates, although there are marked partisan differences. “The number of people that are really dead set against what we’re doing and proposing is smaller than people think, but have a bigger megaphone and a short, pithy message,” says Georges Benjamin, executive director of the American Public Health Association.

During the pandemic, legislatures have enacted dozens of laws limiting the authority of state and local health officials. Benjamin contends they’ll come to realize they’ve made a mistake. “Anyone who changed things to make it more difficult to vaccinate, to wear a mask, who have basically put a barrier in place, will make more people infected, more people sick and they can actually kill people,” Benjamin says.

Winning back political trust is a project for the longer term. More immediately, Benjamin along with other public health experts reasserts the need for basic precautions. “We just need to think about simple public health measures like masking and washing your hands and distancing when you can, and not conflating those with shutting down the country,” says Juliano, of the Big Cities Health Coalition.

People who have grown tired of pandemic-related habits need to be inspired by political leaders to stay vigilant, says Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. He notes that the divergence of caseloads in red and blue America — already pronounced in 2021 — could grow worse in 2022, unless there’s a pullback from politicizing public health approaches.

“The basics will help us, even if the new variant is a threat,” he says. “It’s the right moment for leaders to give the right advice to the people who are supporting them and potentially saving their lives.”

There are reasons to be “cautiously optimistic” that the omicron variant “won’t be any worse than what we’ve already been dealing with,” says Jessica Justman, an expert on infectious disease and epidemiology at Columbia University’s Mailman School of Public Health. But there are also reasons to worry, particularly with people traveling and families gathering for the holidays.

It’s a time not just for vigilance but more testing, including easier access to rapid self-tests, Justman says. She also would like to see more effort expended when it comes to sequencing — DNA testing of live viruses of the kind South African scientists performed to identify the omicron variant.

The share of samples that are sequenced in the U.S. have gone from about 1 percent a year ago to about 15 percent now, she says — but with wide variation among states. “There should be a national system in place with a threshold of 10 or 20 percent of all samples randomly selected for sequencing,” Justman says. “It maybe seems like a very technical or nerdy thing to focus on, but if we don’t have a good system to detect the variants, we really get surprised.”

In the meantime, the current state of affairs — with misinformation rampant and broad political differences around the right approaches — does not appear promising, particularly with a new variant spreading rapidly. Already, the average number of cases is exceeding 100,000 per day, for the first time in two months.

“We certainly can’t look at our track record in the U.S.,” Justman says, “and say what we’ve been doing is really working well so we need to continue doing it.”
Alan Greenblatt is the editor of Governing. He can be found on Twitter at @AlanGreenblatt.
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