The omicron variant will bring a Covid-19 wave this winter. What can we do to stop it?

As an ongoing wave of delta collides with the new omicron variant just as people are traveling and gathering for the holidays, all signs now point to a massive wave of Covid-19 in the coming months.

The question is what, if anything, we can do to prevent a worst-case scenario.

Just a few months ago, people in America were dying because hospitals had been overwhelmed with Covid-19 patients and couldn’t find a bed for them. This was what more than a year of public health interventions had tried to avoid, and it was happening well after the vaccines had become widely available. Now there is the distinct possibility of a repeat of the same catastrophe.

Meanwhile, the country’s tolerance for public health interventions appears to be shrinking. Most people say they are still planning to travel to see family and friends for the holidays and they consider those activities to be a small or moderate risk. Sporting events, concerts, and other large gatherings are happening every day. Just nine states currently have any kind of mask mandate in place. A return to more drastic lockdown measures appears to be off the table — and some experts think they would be inappropriate now because those policies can have their own negative effects and because vaccines are widely available.

The federal government has limited authority to impose its own mask and vaccine mandates, as President Joe Biden’s winter plan for the pandemic tacitly acknowledges. It can offer carrots — mobile clinics and ride-sharing programs to vaccine sites — but wields few sticks.

Now that the vaccines are available and most US adults are vaccinated, even some Democratic leaders don’t sound interested in any new suite of public health measures that would hit vaccinated and unvaccinated adults alike.

“It’s scary. But I think our relatively lax response to the rise of omicron is not unexpected,” Kumi Smith, a University of Minnesota epidemiologist, told me. “People build up a tolerance to risk over time, and I think as Covid deaths keep climbing we’re also getting numb to the tragedy as well. And the helplessness we all feel from the country’s inability to unite against Covid also probably contributes to the collective apathy.”

So: Nearly two years into the pandemic, a lot of people are simply burnt out. But that doesn’t mean we are powerless. Covid-19 will always be circulating and the world isn’t going to shut down every time cases rise. But that doesn’t mean apathy is the solution. Individual people making individual decisions to take the virus seriously — by wearing masks, getting vaccinated, and being thoughtful about what activities they participate in — can help slow down the virus, at least a little bit, and give the health system a fighting chance.

“Fatalism is not an effective means of infection control or public health,” Bill Hanage, a Harvard University epidemiologist, told me.

It’s time to flatten the curve again

The omicron variant could definitely push the health system into crisis. Even if the variant does tend to cause milder illness on average, as some early indications suggest, a certain percentage of infected people, especially unvaccinated people, is going to end up getting really sick. The bigger the denominator (infected people) gets, the bigger the numerator (hospitalized patients) will too. The more hospitalizations we see, the more deaths will be added to the 800,000 American lives lost so far. It’s a matter of math.

So the goal of a successful pandemic response now is the same it was in early 2020: to “flatten the curve” and prevent hospital systems from becoming so inundated with Covid-19 patients that they can’t give everybody — Covid-19 and other patients alike — the medical care they need.

We know this can happen because it already has. This summer, doctors called facility after facility, looking for beds for patients experiencing a cardiac emergency. Some of these patients died waiting for medical attention. The risk that someone will show up at their local ER with symptoms of a heart attack or appendicitis and be unable to get treatment because of staff shortages, bed shortages, or both will grow as case numbers rise.

In early 2020, the best ideas for flattening the curve were extraordinary measures never seen before in the US: widespread business closures, social distancing requirements, and mask-wearing. Now there are vaccines.

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Vaccination remains the best guard against severe outcomes from a Covid-19 infection, and vaccinating more people is the best way to flatten the curve collectively. The vaccines still provide strong protection against hospitalization and, if a vaccinated person does fall sick and needs hospital treatment, they usually have shorter stays. With a booster shot, experts expect that protection to hold up against omicron.

Governments should do everything they can to get more people vaccinated and boosted. The Biden administration has already tried to force large employers to require vaccinations. That did prompt a slew of company mandates and an uptick in new vaccinations, but it has also been blocked in federal court, losing the force of law. The administration is also trying to make vaccines more accessible, encouraging more outreach from Medicare and AARP, and setting up mobile clinics. Some big cities are going even further by requiring people to be vaccinated if they are going to go to a restaurant or another business.

The country has a lot more tools now to track and treat Covid-19. But they come with caveats. At-home tests can sometimes be hard to find, and experts worry the Biden plan to let people submit the cost of tests to their insurer for reimbursement is too cumbersome. New antiviral medications appear promising, but experts worry they won’t be available in large enough quantities to help with the imminent omicron wave.

There are also limits on what Americans will tolerate. Countries in Europe and East Asia are starting to close businesses and putting more restrictions on unvaccinated people as the omicron variant takes hold. US public health experts, meanwhile, generally acknowledge those policies being implemented widely in this country is essentially a fantasy.

There are good reasons not to revive lockdowns and other blanket restrictions, which have their own costs — and in theory, we shouldn’t need them. Vaccines are available; doctors understand the virus much better and have more effective treatments. But there is still a lot the US could do short of locking down to slow the virus and give hospitals and their staff members a better chance to handle any surge in Covid-19 patients without sacrificing care for all of their patients.

Vaccines, testing, and masks work, and they work best if everyone — not just the cautious — employs them. Without collective action, it seems likely the onus will continue to fall on individuals: to get vaccinated and boosted, and to encourage their loved ones to get vaccinated and boosted, and to take tests and isolate themselves if they show symptoms.

“The default now in most places is reliance on individuals taking preventive steps on their own,” Joshua Michaud, associate director of global health policy at the Kaiser Family Foundation, told me. “In the face of the combined delta and omicron threat this winter, we’ll probably end up where we’ve been for much of the pandemic: different jurisdictions approaching the problem in their own way, which will lead to a chaotic patchwork of mostly half-measures or no real measures at all.”

This is a collective reality that requires collective solutions. Where are they?

Other countries are taking more aggressive steps. The UK reinstituted its mask mandate and is requiring vaccine passes for large events. Denmark and France have closed their nightclubs again. Germany and Italy are putting new restrictions on their unvaccinated residents, barring them from indoor dining and other activities. South Korea has limited private gatherings to no more than four people and established a new curfew as its delta-driven wave puts a strain on its hospitals.

These measures represent governments’ attempts to grapple with the pandemic with the tools we have now, in addition to the tools we’ve had all along. But such measures seem unlikely in most of the United States, which is stuck in a public health morass. (The exceptions are big coastal cities like San Francisco and New York, which are getting more aggressive with vaccine mandates and other interventions: San Francisco is requiring people to show proof of vaccinations to enter many businesses, and New York has mandated private businesses to require vaccination and will send tests and masks to many residents.)

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There’s no publicly agreed-upon goal for managing the ongoing pandemic. Experts don’t even agree on how to measure its severity. Even if the federal government established a clear strategy, it would have limited ability to enforce that plan across state borders, and for the most part, there is little political will to impose new restrictions.

Other countries have already experimented with refocusing their Covid-19 strategies and defining a new normal: Singapore, for instance, has begun to use hospitalization numbers, instead of case numbers, to determine when to impose new restrictions. Some experts are calling for the same in the US, including Monica Gandhi, an infectious-disease professor at the University of California San Francisco, who wrote in the New York Times this week that hospitalizations should be the most important metric going forward.

But other scientists disagree and argue that case numbers still matter. This is part of the reason it has been so difficult for the US to come up with a long-term Covid-19 plan: Even experts who want better pandemic management disagree on what the approach should be.

America’s fractured government and polity also contribute to the inertia. States and localities hold a lot of the power to impose meaningful public health measures. Many of the adults who have not gotten vaccinated appear very committed to that position. Vaccine mandates can have a positive effect, and a majority of voters appear to support them, but they also invite backlash and have been blocked in some cases in federal courts.

Polarization has not bent but rather hardened throughout the pandemic. Republican politicians are, generally speaking, opposed to new pandemic interventions. In Wisconsin, where hospitalizations are up 23 percent over the last two weeks and one-third of all ICU units have Covid-19 patients in them, the GOP House leader dismissed the need for any new measures.

Even in blue states, politicians seem to be bowing to pandemic fatigue: Colorado Gov. Jared Polis, a Democrat, drew attention this week for saying that the public health emergency “is over.” He said he doesn’t want to impose new restrictions on vaccinated people who have done their part to try to get the pandemic under control.

If the policy landscape remains relaxed, then each person will be left to assess their own particular situation when deciding what precautions to take, once again weighing familiar questions: What is my personal risk? Am I in regular contact with people who don’t have the full protection conferred by vaccines, like elderly or immunocompromised people as well as unvaccinated children? What is the level of Covid-19 spread right now in my community?

“The reality is that we are all going to be infected at some point with omicron or something else, but we can do things to control how that happens to us and to our communities,” Hanage said. “That includes stuff like getting boosters and thinking about ways to reduce transmission in our communities. They won’t reduce it to nil. They will slow it and give more people the chance to have the benefit of vaccination before they get infected.”