The United States is at what appears to be the beginning of a significant winter Covid-19 wave, with cases and hospitalizations both clearly on the rise over the past couple of weeks. Significantly, we see cases rising not only in the Northeast and Midwest where the weather is getting truly wintry but also in the South where conservative political leaders spent much of the fall taking victory laps after the region’s massive Delta wave burned out.
Part of the context for this is seasonality, part is the holiday travel and gatherings that inevitably spread pathogens, and of course, part is the new Omicron variant, which based on what we can see in South Africa appears to have considerable ability to re-infect people with acquired immunity from previous infections. We also know that vaccinated people experience waning unless they get a booster shot, and a large share of the American public remains unvaccinated.
All told, I think this adds up to a pretty scary picture.
Deaths fell this fall after the peak of the southern Delta wave, but they never fell all the way back down to their pre-Delta level. They are now rising again from their current level of two 9/11s per week.
For a whole bunch of reasons (primarily because people can and should get vaccinated), I am not a proponent of trying to return to mandatory social distancing measures. But that doesn’t mean we should minimize the scale of suffering or loss of life. A lot of people have been dying through the low ebb. More people than that died during the Delta peak. And it seems likely to me that even more people will be dying this January and February when Omicron wreaks havoc on an under-vaccinated country. The Biden administration is over-indexing on signaling Covid-19 caution with things like having the vice president wear a mask during an outdoor photo op. But that doesn’t mean there’s nothing we can or should be doing to save lives.
As a person with a platform, the best thing I can say is that you should get vaccinated and boosted, you should get your kids vaccinated, and you should encourage others in your lives to do the same.
Vaccines offer meaningful protection at such low cost that it’s clearly worth it even for people in low-risk categories. Something we all knew and took for granted before Covid-19 is that getting sick sucks and is worth trying to avoid, even if you’re not worried about hospitalization and death. And there are externalities in play, so the sensible thing is to lean in the direction of protecting yourself and thereby protecting the community.
A policy no-brainer — repeal travel bans
The other no-brainer is that the Biden administration should admit the horse is out of the barn and remove the Omicron-related travel restrictions it imposed on South Africa and its neighbors when the variant was first discovered.
I think we learned over the course of the pandemic that the expert consensus against travel restrictions was misguided. But the handling of Omicron has confirmed exactly the ideas that gave rise to that consensus in the first place:
South Africa is worse off than it would have been if it did not have good genomic surveillance in place and didn’t warn the world about Omicron.
The travel restrictions imposed were on South Africans (and citizens of other nations in southern Africa) rather than travelers from South Africa as if viruses care about citizenship and pandemic prevention can be treated as an immigration policy.
Containment of Omicron has already failed and the new variant is clearly spreading inside the United States. Even if it wasn’t, it’s clearly spreading in a bunch of European countries that aren’t under travel restriction.
That’s the risk with travel restrictions — you create perverse incentives for countries to cover up public health problems while doing nothing to safeguard your population.
The administration wasn’t necessarily wrong to give this a shot, but it didn’t work. They ought to reverse course and try to do something nice for South Africa to thank them for their excellent surveillance work. Fauci says the administration is reviewing this, but honestly, what’s to review at this point? Omicron is clearly spreading globally.
The good Covid-19 intervention: vaccine mandates
I’ve gone back and forth inside my own head in terms of how enthusiastic I am about vaccine mandates.
But here’s what I am sure of — to the extent that you want to deploy coercive public health measures to combat Covid-19, the thing you should be doing is mandating vaccination. Vaccination is a much more effective intervention than mask-wearing or half-assed quarantines. And even though not everyone believes that vaccines are safe, objectively, they are in fact safe.
Here are some things that I believe, and that most Democratic Party elected officials say they believe:
The Pfizer and Moderna vaccines are safe.
The Pfizer and Moderna vaccines are effective.
There is some collective obligation to reduce the burden of Covid-19 on our community.
If you believe all of those things, then mandating the vaccines makes a lot of sense. The really nutty voices on the right are spending time denying (1) and (2). The moderates are holding the line at (3), and I think that’s a somewhat reasonable debate to have — most people are pretty selfish, and conservative politics appeals to people’s sense of selfishness. Personally, though, I don’t think an ethic of selfishness is admirable or appealing.
But I really do not think it’s reasonable to require masks on planes but not vaccination. Or to have very strict quarantine rules in schools but not require vaccination. If you want to go Republican and just say it’s everyone for themselves, that’s bad, but it’s at least logical. If you want to take collective action, it should focus on vaccination.
The Biden administration tried to do the right thing here and ran into two problems. One is that the politics simply haven’t worked out as well for them as they hoped. The other is that Trump appointees in the courts may toss the whole thing out. I don’t have any solutions to offer for the problem of the judiciary. Politically, though, I think the White House erred by not pairing its mandate efforts with a promise to lift other restrictions. How do you get an already-vaccinated person enthusiastic about the prospect of coercing other people to vaccinate? With the promise that this means more freedom for the already-vaccinated in the form of reduced restrictions in other areas.
Unfortunately, though, the politics of this have gotten even dicier because the vaccines are markedly less effective against Omicron.
Omicron has weakened our vaccines
Hannah Kuchler, Donato Paolo Mancini, and Oliver Barnes at the Financial Times did a write-up of data from the UK Health Security Agency that I think really clarifies the vaccine situation.
I’m going to steal their chart because it’s good. The key points are that vaccination works against both Delta and Omicron, but it works significantly less well against Omicron. Boosters work against both variants, but again less well against Omicron. A boosted person has similar protection against Omicron as a non-boosted person has against Delta.
So I’m boosted, you should boost, we all should boost. At the same time, this is telling us we should expect a lot of symptomatic infections even among boosted people.
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