For the first time in a long while, there’s good news about COVID-19. The omicron wave is cresting in the U.S., and in many states is already receding. A respite from SARS-CoV-2 could well follow. And if new variants eventually emerge, it may be possible to live with them — that is, without shutting businesses, always wearing masks and social distancing.
A return to normal — that modest but elusive goal — should be possible once COVID-19 hospitalizations fall from thousands each day much closer to the hundreds associated with a bad flu season. Ensuring it lasts will require careful monitoring, better data collection, and a nationwide effort to prevent another crisis.
Five things in particular need to be monitored:
1. Surges in COVID-19 cases and deaths anywhere in the world. Working with the World Health Organization, the U.S. should help other countries keep a close eye on COVID-19 outbreaks (as well as outbreaks of other contagious respiratory illnesses) and report data quickly and publicly, as the Centers for Disease Control and Prevention does in the United States.
2. Genomic changes in the coronavirus. To detect the arrival of new variants, the CDC must improve its efforts to analyze the genetic code of the virus found in people who test positive. The agency conducts such testing in certain areas, but it has yet to build out a sufficiently extensive and geographically representative system, leaving the U.S. dependent on other countries for news of emerging variants. All patients who experience severe breakthrough infections should have their viruses analyzed.
3. Vaccine effectiveness. Working with vaccine makers and independent scientists, the Food and Drug Administration and the CDC need to jointly monitor Americans for waning immunity, especially as new variants arise. All the existing vaccines are expected to lose some of their power with time. It’s crucial to continually assess their effectiveness and have boosters available as needed.
4. COVID-19’s presence in sewage. Measuring the level of coronavirus in public wastewater systems can provide an early warning of COVID-19 surges and likewise indicate when infections are waning. The CDC created the National Wastewater Surveillance System in 2020 to work with state and local health departments to test wastewater. In the process, it needs to strengthen standards for sewage testing and ensure that measurements from various systems are comparable.
5. Hospital bed availability and staffing levels. Accurate and timely information from states on hospital capacity can also indicate when viral infections are surging. The CDC already compiles such data, but state-level statistics aren’t always up to date or consistent. Refining this system can help ensure that the country’s hospitals are prepared to handle an outbreak.
All this information should be uploaded to public databases. Also needed is a clear sense of how much COVID-19 Americans are willing to live with. Ezekiel Emanuel, of the University of Pennsylvania, suggests setting a risk threshold for COVID-19, flu and other viruses together of about 35,000 hospitalizations and 3,000 deaths in a week. Beyond those levels — or similar benchmarks — elected officials could consider reimposing mask mandates and other restrictions to protect health care systems from overload.
Of course, COVID-19 alone caused about four times that many hospitalizations and five times that many deaths in late January. But the numbers are falling, and with luck the omicron wave will have receded by spring. It’s time to look ahead with cautious optimism, and to put sensible measures in place to end the permanent crisis.
