22 Time January 31/February 7, 2022
HEALTH
We need to rethink
COVID-19 restrictions
BY MONICA GANDHI AND JEANNE NOBLE
hospitalized for other reasons, but
testing positive on admission, with
minimal or no COVID symptoms.
With this sharper focus, our time
can be better spent on vaccinating
the unvaccinated and boosting the
most vulnerable, such as residents
of nursing homes, persons over 65
and those with chronic health issues.
However, this new strategy highlights
the need for the CDC to increase
its tracking and reporting of severe
breakthrough infections by the health
status of individuals so that the most
vulnerable can be rapidly identified
and prioritized for lifesaving
treatment, such as Paxlovid and other
powerful anti viral therapies.
Protecting those at risk of severe
breakthroughs also means the end
of blanket mask mandates. Our
adult population has had access to
highly effective vaccines for almost
a year, and more recently, all children
ages 5 and older became eligible
for vaccination. Use of N95, KN95,
KF94, FFP2 or even double surgical
masks should be encouraged
among select high-risk populations,
but perpetual masking of entire
populations is not sustainableThe rapid spread of omicron, The laTesT and mosT
transmissible COVID-19 variant to date, underscores the
tremendous need for updated COVID-19 policy in the U.S.
No longer should we be guided by case counts, because
(owing to vaccination, the nature of the variant, or both)
relatively few cases produce severe illness. The most im-
portant metric now is hospitalizations, and those are ris-
ing at a far lower rate than infections. Public-health mea-
sures should adjust accordingly. It is time to move beyond
the cycle of asserting, removing and reinstating COVID-19
restrictions based on metrics that are no longer clinically
relevant, and concentrate instead on protecting those at risk
of severe infections.
Highly transmissible variants, such as Delta and Omi-
cron, will lead to high numbers of asymptomatic or mild
infections among the vaccinated. These breakthrough infec-
tions should not be considered “vaccine failures.” Instead,
they should be recognized as the hallmark of highly effec-
tive vaccines that are operating precisely as intended—
to prevent serious illness or death. It is also important to
note that long COVID-19 symptoms seem to be very rare in
fully vaccinated individuals.
We must ensure that Americans understand this is a
very different time than March 2020, especially in highly
vaccinated regions, and that there is no need to resort to
closing schools today. A strategy of examining who is at
risk of severe breakthrough infections and to focus on
protecting that population at all costs will help us make this
critical transition.
This new strategy means using different metrics as
the basis for COVID-19 restrictions. In a vaccinated
population, the relationship between case counts and
hospitalizations has been uncoupled. Because so many
vaccinated individuals may test positive for COVID-19
with few or no symptoms, the number of infections
in a community no longer predicts the number of
hospitalizations or deaths. This uncoupling means that
we should no longer focus on the number of COVID-19
infections as predictive of the need for lockdowns, physical
distancing or mask use. Instead, we could follow the path
of Singapore, which changed its metrics from cases to
hospitalizations in September both to protect the country’s
population and to avoid unnecessary harm to the economy,
which in turn has a direct impact on health. A similar path
was recently embraced in Marin County, California.
If public-health officials tie policies to hospitalizations,
not cases, the media’s obsession with case counting will likely
abate and help refocus attention on serious illness alone.
But it is vitally important that reported hospitalization rates
represent serious COVID-19 illness and exclude patients
THE VIEW ESSAY
JOE RAEDLE—GETTY IMAGES