The science says we need to remain vigilant about COVID

If there is one thing we have learned about COVID-19, it’s that the virus continues to evolve, and as much as we would like certainty and stability, we need to keep changing ourselves and our response to it.

This is true for both the science and for public leaders’ response to the pandemic. As we enter the third year of COVID-19, there are new twists and turns in the science, and public policy has also shifted dramatically with the end of government mandates and strict guidelines. We need to adapt rapidly to both.

On the science, a new COVID variant, BA.2, also known as “stealth Omicron,” already accounts for more than half of new infections in New England. It’s 30 percent more transmissible than the original Omicron. How concerned should we be?

The science says we should be vigilant but not panic because we have far more information than we did previously, and it shows that the recent variants are highly contagious but generally cause milder disease than their predecessors. Vaccines and treatments work to prevent and attenuate the vast majority — but not all — new cases.

Europe has always been a few weeks ahead of us during the pandemic, and their recent experience offers important clues for what could happen here in Massachusetts.

Like the United States, Denmark, Switzerland, Germany, and Britain have high rates of vaccination, but also got hit badly by BA.2 right as the original Omicron wave started to ebb. Also like the United States, these countries loosened remaining restrictions at the end of the original Omicron wave, which contributed to faster transmission of BA.2.

COVID cases have rebounded quickly in Europe, surging even higher than the original Omicron wave in Germany and Austria. Hospitalizations have also increased as have deaths, but not to crisis levels.

This “de-coupling” of cases from hospitalizations and deaths is due to the durability of vaccines to provide broad protection against serious illness from all the variants, and also the high rate of natural immunity from the high number of infections that have occurred in Europe.

We can expect the same here in Massachusetts.

On the policy side, the state is entering a new phase and brave new world where government mandates on masks, distancing, and keeping businesses closed are over. Governor Charlie Baker is no longer providing COVID guidance. You’re on your own and need to figure out what’s best for you and your family.

Here are three things we suggest you should do.

Watch the waste. Wastewater is one of the most powerful leading indicators for rising COVID cases, and we are lucky that Boston was one of the first cities to adopt this early-warning system. Because it is a totally passive monitoring approach (everybody poops), viral copies shed by everyone infected within a catchment system give a clear signal of how much COVID is circulating. (Wastewater data are posted at the MWRA site.)

Wastewater started showing that Omicron was on the rise almost a month before reported cases started to increase in Boston. Levels have been pretty steady through March, but still five times higher than they were last summer.

Track case positivity. Since rapid tests have become widespread, more people are testing at home, so the published daily case counts don’t give an accurate picture of how much COVID is out there. However, the percentage of reported positive cases still gives a rough idea. During the height of Omicron, test positivity was as high as 23 percent; it has since fallen to 2 percent. This data is reported on the Covid-19 interactive dashboard.

We recommend that you monitor at least once a week the wastewater and test results for Massachusetts, and resume indoor masking and avoid higher-risk activities like indoor dining and movies when wastewater levels exceed 1,000 copies/mL and test positivity rates are above 5 percent.

Get boosted. One of the reasons Massachusetts weathered Omicron better than other states was because of our high vaccination coverage — but this protection fades over time. While 5.3 million Massachusetts residents have received two shots, only about half have received a third one. Booster shots are crucial for obtaining maximum protection against serious illness from COVID; they can reduce the time you’re sick with even mild symptoms and lessen the risk of passing it on to others. Studies have shown that boosters reduced the risk of hospitalization by five times and the risk of death by seven times for those over 65, compared with those who received only two shots. Boosters are free, safe, and plentiful — get one.

While being self-empowered to fight COVID is vital, there is still a role for the government to play. Baker and his COVID team should publicize the wastewater and testing data more widely and make it easier for lay people to understand the numbers. They should set clear threshold levels for wastewater virus levels and for test positivity rates, above which mandates should be reinstated. And they should launch a major booster campaign to reach the remaining 25 percent of people over 65 who still haven’t received a third shot.

Unfortunately, COVID isn’t over, but we are learning how to live with it. The Omicron subvariant won’t be the last variant to hit us, but by watching wastewater levels and COVID test results, by changing our behaviors when the numbers rise, and by getting boosted, we can keep ourselves safer and reduce the strain on our health care system.

Shan Soe-Lin is managing director of the Boston-based Pharos Global Health Advisors and a lecturer in global health at the Jackson Institute for Global Affairs at Yale University. Robert Hecht is president of Pharos Global Health Advisors and a clinical professor of epidemiology at the Yale School of Public Health.

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