- Sep 13, 2002
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These guys are right, I like their approach:
By Benjamin Wallace-Wells
January 8, 2022
On Thursday, six medical experts close to the White House published three op-eds in the Journal of the American Medical Association, arguing that the time had come for a new approach to the pandemic—one that sets aside the campaign for eradication in favor of living with the disease. covid-19, one op-ed argued, should no longer even be tracked on its own but monitored together with other respiratory viruses, such as the flu—the sort of thing that might be done by epidemiologists rather than by all of us refreshing graphs on the Times’ Web site day and night. The argument was particularly notable because the six experts had all been advisers to President Joe Biden’s covid-19 transition team. “A ‘new normal with COVID’ in January 2022 is not living without COVID-19,” Ezekiel Emanuel, of the University of Pennsylvania, Celine Gounder, of N.Y.U., and Michael Osterholm, of the University of Minnesota, wrote. But they believed that the long era of emergency—the one defined by a wartime feeling and frequent briefings from Anthony Fauci—should draw to a close.
That same morning, I spent half an hour interviewing Fauci by Zoom, to try to understand how the Administration saw the current state of the pandemic. Lately, he had been dropping some hints that his view might not be too different from that of the JAMA experts: on ABC last Sunday, he’d said that it might make sense at some point to focus not on covid cases but on hospitalizations, a change that would organize policy around the medical effort to identify and treat the very sick rather than a social campaign to stop the spread of the disease. I asked him what time line he had in mind. “It’s not necessarily something that we’re going to do—or even seriously consider doing—tomorrow,” Fauci said. But eventually the Omicron wave would come to an end, and the sheer contagiousness of the past two waves, combined with the vaccination campaign, would leave a broad protective “immunological memory,” as Fauci put it, throughout the population. “Then you start to think about what being infected means regarding closing down indoor events, impact on the economy, impact on travel, impact on schools.” At that point, he said, if there are very few hospitalizations compared with the number of cases, “the impact on society should be measured not on how many people are blowing their nose but on how many people are really getting sick.”
During this pandemic, Fauci has often been tasked with explaining things that are in tension with one another. Right now, the tension is temporal, between a present in which the number of deaths remains intolerably high—on average, about fourteen hundred per day—and a likely, but not certain, near future in which the emergency has retreated, even if the disease remains. “Let me give you a confounding issue, which I find really interesting,” Fauci said. The first country known to have gone through an Omicron wave is South Africa, which experienced a sharp peak in cases followed by a quick decline—a heartening scenario, if applicable to the U.S. But South Africa, Fauci went on, had very few cases of the Delta variant at the time. “So when we were looking at South Africa, we were looking at a pure Omicron situation. In the United States, we still have a lot of people in the hospital who are Delta people. So right now it’s a little muddy.”
This week, Fauci said, he was watching the situation in London, which he thought might provide a better model for the American experience of the variant. In late December, London hospital admissions were increasing by as much as fifteen per cent a day, but that rate has since dropped dramatically. “Sometimes you have a sawtooth—it goes up and then it looks like it comes down, but then it goes back up again. So, if London does that, that’s what I’m really keeping my eye on,” he said. If the peak in London turned out to be real, I asked, how would he feel about the American wave? “Absolutely more optimistic,” Fauci said.
Fauci, in other words, sounded far more hesitant than the JAMA experts to declare a “new normal.” There were, he said, “too many unknowns.” We don’t know the number of people in the country with no experience of the virus—who haven’t been vaccinated or infected. We also don’t know what level of protection an Omicron infection might provide against the next variant. “Because we will undoubtedly get a next variant,” he said. He spoke for a little while about the differing severity of various kinds of respiratory infections and the challenge of predicting how further covid variants would fit in. “I mean, for people who are not responsible for policy, it’s very easy to make a prediction,” he said. “Because if you are right you’re a hero, and if you’re wrong nobody cares.”
n November, as news of the Omicron variant broke, the White House moved into something like a war-room phase. A daily deputies meeting was established at 8 a.m., in which “our white coats,” as one Administration official described Fauci and the other leading medical advisers, analyzed the newest data on the disease. Five interagency “work streams” were established, two of them devoted to mapping the evolution of the disease and the other three to organizing the provision of needed supplies: one for vaccines, another for therapeutics, the last for tests. Despite the urgency of the planning, when I spoke to White House officials before Christmas, they sounded fairly optimistic about it; one suggested that an “operational” phase of the fight against the new variant was under way. Natalie Quillian, the White House’s deputy coördinator of covid response, mentioned that many Americans could see new local masking requirements. I asked whether they might also expect the sorts of lockdowns that had accompanied mask mandates during the pandemic’s earlier phases. “We’re pretty confident that we don’t need to reënact lockdowns,” she said. “We have tools now that we didn’t have at the beginning of the pandemic.”
Much of the White House’s energy—and some controversy—has focussed on supplying those tools. Dawn O’Connell, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, told me that the initial question the government had to answer was whether the existing vaccines and therapeutics would hold up against the new variant. Fortunately, she went on, scientists found that they mostly did. The first studies, even before samples of the variant could be examined in a lab, were conducted on a synthetic virus, and they gave the scientists an early indication that the vaccines and boosters were likely to work, a finding that was borne out by the eventual laboratory research. In those early days, O’Connell said, her team was also talking with pharmaceutical manufacturers about how long it would take to craft a new vaccine if one were needed, and to test what she called the “medicine cabinet”—the set of therapeutics, most essentially monoclonal antibodies, that the government was buying. The news there wasn’t so good. Two of the three monoclonal antibodies proved ineffective against Omicron, leaving just one, manufactured by GlaxoSmithKline.
www.newyorker.com
How Soon Will COVID Be “Normal”?
Even as the Omicron wave spikes, some outside experts believe that the time has come for Anthony Fauci and the White House to declare a new phase in the pandemic.By Benjamin Wallace-Wells
January 8, 2022
On Thursday, six medical experts close to the White House published three op-eds in the Journal of the American Medical Association, arguing that the time had come for a new approach to the pandemic—one that sets aside the campaign for eradication in favor of living with the disease. covid-19, one op-ed argued, should no longer even be tracked on its own but monitored together with other respiratory viruses, such as the flu—the sort of thing that might be done by epidemiologists rather than by all of us refreshing graphs on the Times’ Web site day and night. The argument was particularly notable because the six experts had all been advisers to President Joe Biden’s covid-19 transition team. “A ‘new normal with COVID’ in January 2022 is not living without COVID-19,” Ezekiel Emanuel, of the University of Pennsylvania, Celine Gounder, of N.Y.U., and Michael Osterholm, of the University of Minnesota, wrote. But they believed that the long era of emergency—the one defined by a wartime feeling and frequent briefings from Anthony Fauci—should draw to a close.
That same morning, I spent half an hour interviewing Fauci by Zoom, to try to understand how the Administration saw the current state of the pandemic. Lately, he had been dropping some hints that his view might not be too different from that of the JAMA experts: on ABC last Sunday, he’d said that it might make sense at some point to focus not on covid cases but on hospitalizations, a change that would organize policy around the medical effort to identify and treat the very sick rather than a social campaign to stop the spread of the disease. I asked him what time line he had in mind. “It’s not necessarily something that we’re going to do—or even seriously consider doing—tomorrow,” Fauci said. But eventually the Omicron wave would come to an end, and the sheer contagiousness of the past two waves, combined with the vaccination campaign, would leave a broad protective “immunological memory,” as Fauci put it, throughout the population. “Then you start to think about what being infected means regarding closing down indoor events, impact on the economy, impact on travel, impact on schools.” At that point, he said, if there are very few hospitalizations compared with the number of cases, “the impact on society should be measured not on how many people are blowing their nose but on how many people are really getting sick.”
During this pandemic, Fauci has often been tasked with explaining things that are in tension with one another. Right now, the tension is temporal, between a present in which the number of deaths remains intolerably high—on average, about fourteen hundred per day—and a likely, but not certain, near future in which the emergency has retreated, even if the disease remains. “Let me give you a confounding issue, which I find really interesting,” Fauci said. The first country known to have gone through an Omicron wave is South Africa, which experienced a sharp peak in cases followed by a quick decline—a heartening scenario, if applicable to the U.S. But South Africa, Fauci went on, had very few cases of the Delta variant at the time. “So when we were looking at South Africa, we were looking at a pure Omicron situation. In the United States, we still have a lot of people in the hospital who are Delta people. So right now it’s a little muddy.”
This week, Fauci said, he was watching the situation in London, which he thought might provide a better model for the American experience of the variant. In late December, London hospital admissions were increasing by as much as fifteen per cent a day, but that rate has since dropped dramatically. “Sometimes you have a sawtooth—it goes up and then it looks like it comes down, but then it goes back up again. So, if London does that, that’s what I’m really keeping my eye on,” he said. If the peak in London turned out to be real, I asked, how would he feel about the American wave? “Absolutely more optimistic,” Fauci said.
Fauci, in other words, sounded far more hesitant than the JAMA experts to declare a “new normal.” There were, he said, “too many unknowns.” We don’t know the number of people in the country with no experience of the virus—who haven’t been vaccinated or infected. We also don’t know what level of protection an Omicron infection might provide against the next variant. “Because we will undoubtedly get a next variant,” he said. He spoke for a little while about the differing severity of various kinds of respiratory infections and the challenge of predicting how further covid variants would fit in. “I mean, for people who are not responsible for policy, it’s very easy to make a prediction,” he said. “Because if you are right you’re a hero, and if you’re wrong nobody cares.”
n November, as news of the Omicron variant broke, the White House moved into something like a war-room phase. A daily deputies meeting was established at 8 a.m., in which “our white coats,” as one Administration official described Fauci and the other leading medical advisers, analyzed the newest data on the disease. Five interagency “work streams” were established, two of them devoted to mapping the evolution of the disease and the other three to organizing the provision of needed supplies: one for vaccines, another for therapeutics, the last for tests. Despite the urgency of the planning, when I spoke to White House officials before Christmas, they sounded fairly optimistic about it; one suggested that an “operational” phase of the fight against the new variant was under way. Natalie Quillian, the White House’s deputy coördinator of covid response, mentioned that many Americans could see new local masking requirements. I asked whether they might also expect the sorts of lockdowns that had accompanied mask mandates during the pandemic’s earlier phases. “We’re pretty confident that we don’t need to reënact lockdowns,” she said. “We have tools now that we didn’t have at the beginning of the pandemic.”
Much of the White House’s energy—and some controversy—has focussed on supplying those tools. Dawn O’Connell, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, told me that the initial question the government had to answer was whether the existing vaccines and therapeutics would hold up against the new variant. Fortunately, she went on, scientists found that they mostly did. The first studies, even before samples of the variant could be examined in a lab, were conducted on a synthetic virus, and they gave the scientists an early indication that the vaccines and boosters were likely to work, a finding that was borne out by the eventual laboratory research. In those early days, O’Connell said, her team was also talking with pharmaceutical manufacturers about how long it would take to craft a new vaccine if one were needed, and to test what she called the “medicine cabinet”—the set of therapeutics, most essentially monoclonal antibodies, that the government was buying. The news there wasn’t so good. Two of the three monoclonal antibodies proved ineffective against Omicron, leaving just one, manufactured by GlaxoSmithKline.
How Soon Will COVID Be “Normal”?
Even as the Omicron wave spikes, some outside experts believe that the time has come for Anthony Fauci and the White House to declare a new phase in the pandemic.
