WASHINGTON – As the United States faces the potential for catastrophic coronavirus spikes fueled by highly infectious variants, public health authorities remain wary of imposing stricter measures adopted by other nations. Instead, they continue to embrace a stick-to-the-basics strategy of promoting mask-wearing, avoiding crowds and getting vaccinated quickly.
The restrained approach differs from strict preemptive measures taking place in Europe, including lockdowns, classroom closures and requirements to wear medical-grade masks. It also illustrates the realities of the pandemic response in the United States, where there is little appetite for more limitations to curb viral spread.
“The public doesn’t tolerate lockdowns very well anymore,” said Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials. “You may have states that are aggressive sooner, but on the whole, a lot of them are not going to take those kinds of steps until it’s clear they have to.”
The vaccination drive marks the best path to ending the pandemic, despite complications posed by new variants. Masks and social distancing, even if they sound mundane after a year of relentless repetition, remain the best weapons to control the spread of the virus. And the bluntest instruments cannot be wielded lightly.
Public health authorities, some of whom are lifting restrictions rather than imposing new ones, have a difficult challenge communicating the dangers of variants.
All viruses change as they replicate, but virologists most fear the mutations that make it easier for viruses to spread, to evade vaccine protection and to cause deadlier disease. Variants first identified in the United Kingdom, South Africa and Brazil are suspected to be more transmissible and are driving spikes overwhelming hospitals.
But the United States has a much harder time detecting similar problems because the country conducts little genetic sequencing that would reveal proliferating variants. Experts say the federal tally of nearly 500 variant cases across 32 states – including the variants first found in the United Kingdom, South Africa and Brazil – is a sliver of the real picture.
The federal government and individual states have taken steps to expand genetic monitoring, but authorities are flying blind in the meantime.
States cannot point to specific data to justify aggressive measures to contain the spread of dangerous mutations. And by the time they can, it may be too late.
Josh Michaud, associate director for global health policy at the nonprofit Kaiser Family Foundation, compared the country’s situation to February 2020, when testing was sparse and the official coronavirus case count stayed low even as the virus rapidly spread.
“Just like the original wave, acting early, acting forcefully, is going to save more lives than waiting until you have just in-your-face evidence,” Michaud said. “I don’t want to say that there’s huge amounts of all these variants across the United States right now. But we just don’t know. So it makes it hard to convince policymakers that action needs to be taken.”
The country sits at a precarious moment.
A winter surge driven by holiday gatherings and by colder weather driving people indoors appears to be falling from its peak, with hospitalizations returning to November levels and caseloads lowering in the vast majority of states. Vaccine distribution is escalating, stopping millions of potential new infections. But new variants of the virus can erase that progress.
“We are in a bit of a grace period,” said Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. “Cases are starting to fall, and we have a chance to push covid down even further. But if we miss this opportunity, we might get not only a surge in cases like we have before, but a surge in cases of dangerous new variants.”
States have been announcing the arrival of new variants without much drama, emphasizing the lack of data suggesting vaccine resistance and reiterating their existing calls for masks and social distance from others. An Alabama announcement, for example, advised residents “to continue practicing the usual mitigation standards” while the Vermont Health Department said the variants make “following the prevention guidance more critical.”
The best way to stop a variant from spreading like wildfire is it to take away its tinder by preventing new infections, so mutations do not proliferate and viruses have fewer opportunities to multiply.
“Everything we have been preaching from the public health pulpit for the last year here is still going to be effective against variants,” said Philip Chan, a consultant medical director with the Rhode Island Department of Health, which has not detected new variants. “We haven’t sheltered in place again, and part of that is people are losing their jobs and livelihoods, and we can’t lock down forever.”
Nathan Grubaugh, an epidemiologist at the Yale University school of public health who co-wrote an article urging public health restrictions to contain variants, said governments should use sequencing data to impose targeted restrictions that stop the variant where it is spreading.
The idea is to slow it until enough of the population has been vaccinated, he said, comparing it to early efforts to reduce spread and prevent hospitals from being overwhelmed.
“We need to buy some time,” Grubaugh said. “We have to take that same approach again with these variants and it might get to a situation where states or smaller level health departments may have to implement stricter measures again and maybe even broad measures if it gets to that point.”
States have instead relaxed public health measures. California lifted stay-home orders and curfews last week after high hospitalization rates dipped, while New York is on track to resume indoor dining by mid-February.
Robert Wachter, chief of the medicine department at the University of California at San Francisco, said the sharp decline of cases in the Golden State and beyond suggests that variants are not the primary drivers of new outbreaks.
“It would be very, very difficult politically for states and counties to go on stricter lockdown in anticipation of the variants before there really is much evidence they are tearing through our communities,” said Wachter. “It may be within a few weeks we find ourselves in a situation where variants are beginning to spike, and we may need to go into lockdowns.”
The University of Michigan was one of the first high-profile institutions to implement such measures in response to a variant, urging students to stay home last week after one of their classmates contracted the B.1.1.7 variant that British scientists believe can be as much as 70% more transmissible.
There are now 14 known cases of the variant associated with the university, which also suspended athletics for 14 days.
Preeti Malani, the university’s chief health officer and a professor of medicine, said the two-week recommendation is a way to interrupt spread.
“The two-week pause is sort of a time to figure out what’s happening, what’s the landscape going to look like,” she said. “It might be something that was just a handful of cases because the mitigation is happening.”
In any congregant setting, there is a higher risk of transmission, and the county health department and university “have tried to convey the seriousness of this current strain,” said Juan Luis Marquez, medical director for the Washtenaw County Health Department. But they’ve also tried to strike a balance, deciding on a recommendation rather than an order.
“People are quite tired, so I think that if we are a bit too aggressive, we may also lose buy-in from the community we’re trying to work with,” Marquez said.
Colleges and universities across the country are on high alert for the viral variants as they begin the spring term. Many have at least some students on campus but are operating with most or all of their classes delivered through digital platforms, adapting to an education crisis that is nearly a year old. Some campus leaders worry that lessons learned from the fall term are not enough to guide their decisions in a fast-moving public health emergency with new revelations emerging practically every day.
“Obviously any kind of mutation of this virus is very disturbing and problematic,” said Robert Robbins, president of the University of Arizona, which started its winter semester with almost all classes taught remotely. He said schools must “keep our eyes wide open and remain vigilant.”
Elsewhere in the country, the discovery of variant-driven outbreaks may have come too late.
Researchers at the Cedars-Sinai health system in Southern California announced last month that they found a growing share of samples linked to a new variant that was not discovered overseas, a potential driver of the skyrocketing caseload in California.
“It’s really a very important component of that public health measure to survey this so we are not flying blind,” said Jeffrey Golden, the vice dean of research and graduate education at Cedars-Sinai. “We didn’t recognize it until it already had its foothold, because it was novel and we weren’t looking for it. We were actually surprised.”
In the absence of widespread genetic surveillance, hospitals are bracing to be blindsided by variant-related surges.
The Johns Hopkins Center for Health Security distributed a memo last week urging hospital and government officials to prepare for oxygen shortages everywhere. The advice for shoring up oxygen delivery systems range from lowering the threshold for acceptable patient oxygen levels to improvising warm-water sprinkler systems to prevent vaporizers from freezing.
“Throughout the pandemic we have been behind the eight ball in planning and helping our health-care system,” said Janis Orlowski, chief health care officer for the Association of American Medical College, which represents teaching hospitals and distributed the memo to its members. “Hospitals do have to plan for the worst because we don’t have the information we need.”
Other hospitals say the rise of the variants have added additional urgency to vaccination efforts because they see inoculations as a tool of keeping contagious variants at bay.
“Vaccination now is a key bulwark against continuing to get more variants because the less virus circulating, the less chance for variant,” said Amy Compton-Phillips, president and chief clinical officer at Providence, a network of 50 hospitals in the West that is considering a double-mask requirement for employees because of the variants.
Plescia, of the health officials association, said the first wave of shots may come too late for variants taking hold now.
“What’s looking in front of us with the variants is not going to be solved with the vaccine, no matter how fast we go,” Plescia said.
But injections today will pay dividends through the summer, he added, if new variants fail to take off because they had too few unvaccinated hosts to let them replicate and multiply.
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The Washington Post’s Nick Anderson and Jacqueline Dupree contributed to this report.