William Miller, MD
COVID Pandemic on the Decline
While there are a few hot spots still in the world where death rates from COVID are climbing, the overall national picture is one for careful optimism. The indicators that matter most, hospitalization rates and death rates, are both on the decline in the US. There are several reasons for this. First, it has now been shown for certain that Omicron is in fact less virulent. The death rate from Omicron is only about one quarter that of Delta; 75% less lethal according to one large study recently published from the United Kingdom. This is independent of the effect from prior immunity, which was adjusted for in the study. Immunity, both from vaccination and prior infection, is also contributing to a significant decrease in the severity of illnesses. We now have out-patient anti-viral medications and monoclonal antibody treatments, both of which reduce progression to serious illness. However, they remain in short supply and the need to start them within the first few days of symptoms limits eligibility for many patients.
A further indicator of the direction the pandemic is taking is to look at ICU rates over time. In California, we can compare the COVID surge of January 2021 from Delta with the surge we just saw in January 2022 from Omicron. During the peak in January 2021 (Delta), there were 4,850 patients admitted with COVID to California ICUs, while during January 2022 (Omicron) there were only 2,533 COVID patients in our ICUs. This, even though Omicron’s higher contagion gave new case rate of infections that was 3 times higher. In other words, we would have expected the ICU rates this past January to have also been 3 times higher if the pandemic was still as deadly as it was the year before. Instead, there were only about half as COVID ICU admissions.
These trends have prompted many to call for relaxing public health restrictions. The White House is expected to release new guidelines this week aimed at just that. These new guidelines will attempt to move our nation forward in a safe manner while transitioning to policies that are less disruptive. The CDC has also recently updated its guidelines to be more heavily weighted on hospitalization rates and less on new case rates. As a result, about a third of the US would no longer need to mask indoors in public places. For another third, the recommendation would be that folks at high risk consider wearing a mask indoors in public. For the remaining one third, the recommendation is to continue indoor masking requirements. These relaxed guidelines also extend to US schools. However, guidelines pertaining to places of high risk of transmission, such as healthcare settings, homeless shelters, public transportation, and correctional facilities, remain unchanged.
Something that could change all of this is if a new variant that is both highly contagious, more virulent, and evades our immunity develops. If that happens, then we will have to again examine our guidelines. Yet, to maintain previous restrictions out of fear of this developing seems unnecessary.
So, where do we go from here? For one thing, we will have to figure out the most appropriate way to pull back our public health response. An entire bureaucratic industry has been built up around COVID and its momentum may be difficult to shift. At the same time, we must be cautious that our desire to put this pandemic behind us not lead to being too hasty to abandon measures that may still be beneficial. Striking the balance between public safety and saving lives versus personal liberty and the impact on our economy has been a debate that continues to be as relevant as it was at the start of the outbreak. All aspects of that debate are valid.