A Blog by Jonathan Low

 

Dec 22, 2021

What Vaccinated People Need To Do About Omicron

At the same time there is heightened anxiety about Omicron, there is also a collective, societal shrug. For instance, airline reservations are continuing to go up. 

The answer for vaccinated people, who are in the US, by definition, sensible, is to continue to take logical precautions (better masks, more testing, careful socializing) both to protect themselves and to prevent yet another, more deadly variant from emerging. JL  

Shannon Palus reports in Slate:

Many who were at relatively low risk before are armed with tools that place us at even lower risk—namely vaccines, better masks and tests The goal during this wave should not be to avoid getting the virus completely. It may well be OK if you get the virus—at least, for you. The goal now is maybe to avoid spreading it. Realistically, this involves some socializing, with sensible precautions like masks, and testing before a gathering and after. Perhaps right now it looks like some scaling back on activities before the holidays. If you get the virus, it means doing your own DIY contact tracing.

Here is a thing that a growing number of Americans who were until recently very risk-averse are learning, as a new, highly contagious variant makes its way around our social circles: Getting COVID might not be such a big deal anymore. Maybe it’s time to realize that it’s just part of life.

That’s the reality for many people right now. And it is reasonable. Short of going into a strict lockdown, there is no way to guarantee that you won’t get the virus, which, fueled by the omicron variant, is now causing New York City’s case count to shoot straight up, with cases climbing faster and higher than at any other time during the pandemic. Precautions like masks and socializing outside when possible can help your chances of avoiding infection; more importantly, vaccines, especially with a booster, can bolster against severe illness. But you can do many things “right” and still get a positive test (this has actually always been true).

Which is why the goal during this wave should maybe not be to avoid getting the virus completely. It may well, in fact, be very much OK if you get the virus—at least, for you. The goal now is maybe to simply avoid spreading it.

This has long been the point of the precautions many of us have been taking. It’s true that we’ve been warned again and again and again that young and healthy people can end up on ventilators or with long COVID, that even a “mild” case can feel shockingly terrible. But even with all that, the greatest risk of illness is far and away borne by people who are older, people who have compromised immune systems, and people who cannot avoid going into crowded workplaces. Perhaps the easiest way to make people care about those groups during a disaster was to make people feel that they are in grave danger themselves. But the directive was always to stay home to flatten the curve, to wear a mask to protect others from any dangerous aerosols floating on your breath.

Now, many of us who were at relatively low risk before are armed with tools that place us at even lower risk—namely vaccines, but also better masks (remember the N95 shortage?) and tests (yes, the lines are long and rapid tests are criminally hard to find—but remember the beginning when we didn’t have any tests?). And while the healthy and vaxxed and boosted among us are not at zero risk of bad outcomes, and there are certainly still things to learn about omicron, many, many health experts are advising that we are pretty well protected from the worst of the disease. And so the question has become: If we are somewhat safe and comfortable with the risk ourselves, what are we supposed to do in the face of this new wave? The answer to that question can be found in this one: How do we protect older people, the immunocompromised, the hospital system at large?

That is, once again, a question that we are being forced to answer individually even though it would be best addressed collectively. What we really need right now is national leadership defining goals and strategies, supported by widely available tools. I think a lot of people would be up for hard work right now, if only someone could explain what the hard work should be and how we could measure success—one only needs to look at the enormous lines of people waiting for tests in New York to know that people are still taking the virus seriously. Yes, maybe this is a bit geographical—but as my colleague Tim Requarth argued recently, there are Americans everywhere who are interested in protecting themselves and their communities against COVID. Moreover, people will follow mandates for masking and testing when they have to, and when doing so is made easy.

But instead of trying to rally the collective toward any kind of group effort, the White House issued a statement that essentially said that vaccinated people could continue on with their lives, and unvaccinated people likely face a winter of death. This misses the many targeted tools it could have suggested as methods for controlling the virus, an obvious one being providing communities with war chests of antigen tests and well-fitting masks (on Tuesday, Biden did say the government will be providing 500 million more rapid tests—after the holidays). Some experts have floated the idea of “circuit breakers,” geographically targeted mini-lockdowns lasting five to 14 days that go into effect to keep hospitals from spilling over—a clever framing for what is, yes, a period of intense restrictions, but with a clear end date. But it is almost impossible to see who, at the government level, would actually implement this.

In lieu of leadership, we’re each left to our own devices—even as our internal compasses for what is safe and what is risky and what harms other people become increasingly worn out, as our own personal safety has perhaps become disconnected with the safety of the population at large. Here is what I have settled on as a vaccinated person in this clusterfuck: In the face of omicron, I have to do basically a more considered and test-filled version of how I was living this fall. It is my responsibility to try to avoid giving the virus to anyone else, to the greatest extent possible. This is separate from attempting to avoid getting the virus (though, sure, never leaving your house may accomplish both). But more realistically, this involves some measure of socializing, with sensible precautions like masks, and testing to the extent that is possible before a gathering and after. Perhaps right now it looks like some scaling back on activities before the holidays, to help keep older family members safe. If you get the virus, it means doing your own DIY contact tracing. Epidemiologist Eleanor Murray has suggested that if we all make one small tweak to our December holiday gatherings—a better mask on the trip there, cracking the windows, or attending virtual religious services—that can collectively make a difference. I keep thinking about a piece pediatrician Aaron Carroll wrote in August 2020 about making trade-offs, back when the trade-offs were pretty big.* Avoiding the virus isn’t black-and-white, he emphasized: “Each decision we make to reduce risk helps.”

We are in yet another strange moment of the virus, where everything feels like a repeat of some other period in the virus, and yet things are, once again, distinctly different. We are once again facing a very large public health crisis and overflowing hospitals with burned-out staff, and yet increasingly many people are realizing that their personal risk of severe illness is lower than it has been in any other similarly dire stage of the pandemic. For those of us who are habituated to being careful, but sick of adjusting our lives so extremely when so many people are behaving so recklessly, we are in a moment of having to once again reevaluate our choices. This entails reaching once again into a toolbox that has been expanding for the past nearly two years, and coming up with a new set of personal parameters. In doing so, we are forced to grapple with the reality that we cannot solve the pandemic ourselves—and that, given everything, the coronavirus may not be “solved” for a long time. But we can continue to figure out how to live with it—in fact, that might be all we can do.

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