On the menu today: Did you hear about that group of former Biden advisers publicly pitching “A National Strategy for the “New Normal” of Life With COVID”? Yeah, don’t get your hopes up. It’s not a path back to normalcy, it’s a hodge-podge of common sense and deeply controversial ideas that would probably make virus-driven closures a regular feature of American life for the foreseeable future. Also, with more than 3.3 million new Covid-19 cases reported in the U.S. from Monday to Thursday, it’s probably time to retire the phrase, “a pandemic of the unvaccinated.”
So Much for Getting Back to Normalcy
It is easy to get excited about a group of former Biden advisers publicly pitching “A National Strategy for the “New Normal” of Life With COVID,” particularly when it begins by saying that, “The goal for the ‘new normal’ with COVID-19 does not include eradication or elimination, eg, the ‘zero COVID’ strategy.”
From that title and opening declaration, you might get the idea that they want the government to pull back from its mandates, restrictions, and quarantines and allow you to assess the risk for yourselves, make your own decisions, and live in a world where SARS-CoV-2 is endemic — the virus is still around, but much less likely to cause severe health consequences.
But that’s not really the philosophy at work in these proposals, from six different advisers, spread over three essays in The Journal of the American Medical Association. They’re a hodge-podge of noncontroversial common sense — “institutionalizing telemedicine waivers, licensure to practice and enable billing across state lines, and other measures that allow the flow of medical services to severely affected regions should be a priority” — and some ideas that would dramatically expand the government’s role in your health: “The US needs to establish a real-time, opt-out digital surveillance system to monitor all vaccinated individuals for the frequency and severity of adverse effects, postvaccination infections, and waning immunity.” As Ed Morrissey succinctly put it, these ideas aren’t a return to normalcy, they’re making the state of emergency the new normal.
The first surprising proposal, in the essay from Dr. Ezekiel Emanuel, Dr. Michael Osterholm, and Dr. Celine Gounder, is to shift the definition of the problem from Covid-19 to all respiratory diseases:
The “new normal” requires recognizing that SARS-CoV-2 is but one of several circulating respiratory viruses that include influenza, respiratory syncytial virus (RSV), and more. COVID-19 must now be considered among the risks posed by all respiratory viral illnesses combined. Many of the measures to reduce transmission of SARS-CoV-2 (eg, ventilation) will also reduce transmission of other respiratory viruses. Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections.
Before March 2020, the American people and their government dealt with the flu by urging people to get flu shots and treating the elderly who arrived in hospitals with serious or life-threatening infections. The likelihood of catching the flu or a winter cold was just part of life in most of the country — a pain in the neck, but manageable, and not the sort of menace we shut down society over. Maybe if there was a particularly bad flu outbreak in a community, the schools would close for a few days.
The last two years have demonstrated that public-health officials are some of the most risk-averse human beings on the planet. If you expand the definition of the problem, then you’re even less likely to get back to “normal.” If public-health officials are required to measure threats to public safety from not just Covid-19 but also the flu and all respiratory-virus infections, how likely are they to ban or permit large gatherings? How likely are they to limit capacity in businesses? How likely are they to strictly enforce mask mandates? How likely are they to keep schools open, or keep college students restricted to their dorm rooms?
Before March 2020, respiratory-virus infections were a potential risk we all lived with and dealt with as best we could, going about our lives. Telling public-health officials to focus on a new measurement of “aggregate risk of all respiratory virus infections” is inviting them to shut down more aspects of our lives.
The advisers want a whole lot more tracking and monitoring of potential cases and a lot more sharing of information: “The US must establish a modern data infrastructure that includes real-time electronic collection of comprehensive information on respiratory viral infections, hospitalizations, deaths, disease-specific outcomes, and immunizations merged with sociodemographic and other relevant variables.”
This is all fine, and no doubt, the first weeks and months of this pandemic were hindered by how little we knew about the virus, who had it, and who didn’t. But if this pandemic had first started in, say, Atlanta, the whole world would have known a lot more about the virus early on. We wouldn’t be reading, years later, in books by former FDA commissioner Scott Gottlieb and CNN chief medical correspondent Sanjay Gupta, that the CDC was basically begging China for more information about what the world was facing. About a year ago, Bill Gates proposed a “Global Alert System” for the world to more quickly recognize and respond to future pandemics. But the problem with the Covid-19 pandemic wasn’t really that we didn’t have enough well-trained doctors looking for answers when an unusually high number of patients showed up with coughs. The problem was that when those doctors in China tried to pull the alarm, the government authorities above them kept shutting down the alarm until it was too late. The best shot at containing a contagious pathogen is in the first cases, days, and weeks. If SARS-CoV-2 had first appeared in any non-authoritarian country, the world would have known a lot more about it, a lot quicker.
In addition, to facilitate verification of vaccination status and to better track postvaccination infections, there needs to be an electronic vaccine certificate platform. Relying on forgeable paper cards is unacceptable in the 21st century. Current state immunization information systems are incomplete, fragmented, and not interoperable, hindering national efforts to control the virus. A national electronic vaccine certificate platform is needed, such as the SMART Health Card, that ensures interoperability across states and countries, safeguards individual privacy, and is based on open-source technology publicly available for vetting to help satisfy any concerns over government surveillance. While controversial, this is not unprecedented. State and national databases are in use for other information, including for driver’s licenses, Social Security, voter registration, and specific health purposes, such as organ donation.
Earlier in that essay, they argue that, “Vaccination should be required for school attendance” as well as use of public transportation and indoor events. The doctors’ vision is that you will carry around an electronic card with your vaccination information and will be required to show that card everywhere you go — to get on a bus or train, or to go into a restaurant or store. This is their vision for the “New Normal.” (I wonder if these doctors ever watched the show Counterpart.)
(That essay begins by stating, “To minimize the effects of COVID-19 on daily life and return to normalcy, some estimates suggest that 90 percent or more of individuals in the US are likely to need some immunity to SARS-CoV-2, whether from vaccination or prior infection.” We’re not that far away — 74 percent of all Americans have at least one shot, and remember that figure includes about 24 million children from birth to age five who can’t get vaccinated yet. We’re at 78.7 percent of everyone who is eligible, 84 percent of those age twelve and up, 86 percent of adults and 95 percent of seniors — and this is just vaccination, not counting those who have some degree of immunity from prior infection.)
I try not to dismiss a proposal out of hand because of who’s making it, but if you recognize the name, “Dr. Ezekiel Emanuel,” it’s probably because you’ve heard of him before. He’s Rahm Emanuel’s brother, one of the architects of Obamacare, and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. While Emanuel insists that he opposes euthanasia and denies that he ever recommended anything akin to “death panels,” in a 2014 essay in The Atlantic, he explained why he hoped to die at age 75, and why he finds the idea of living past that date to be morally problematic. (Mark your calendars: On September 9,
2032, we can all show up at Emanuel’s house, awkwardly clear our throats, and ask him if he has any upcoming plans.)
These proposals would be difficult to enact for even the deftest, clearest communicating, and widely trusted administration — and the Biden administration is not deft, clearly communicating, or widely trusted.
The president himself keeps settling into verbal autopilot, declaring on Tuesday that, “This is still a pandemic of the unvaccinated.”
Well, yes and no. It is indeed true that the majority of hospitalizations are among the unvaccinated, and the percentage of hospitalized Covid-19 patients who are fully boosted is particularly small. But the percentage of vaccinated-but-not-boosted people ending up in a hospital is starting to creep up during the Omicron wave. About 32 percent of the Covid-19 patients in Connecticut hospitals have at least one shot, and Alabama has similar numbers. It’s about 10 percent at a hospital in Washington, about 20 percent in Oregon, and 36 percent at one hospital in Michigan.
But the U.S. added a million new cases Monday, 885,000 on Tuesday, 704,000 on Wednesday, and 727,000 on Thursday. Most of those folks are vaccinated, and quite a few are boosted. Hospital capacity is starting to be a problem, but another widespread problem is what happens when so many Americans get sick with mild Covid simultaneously. You’ve got workers staying home sick, and everyone else in their household is supposed to either isolate or minimize their contact with others for at least five days (and as we discussed earlier this week, it’s really six days, because the day you test positive or develop symptoms doesn’t count). Covid-19 is starting to become a problem or complication for the fully vaccinated and boosted. Thankfully, it’s not a life-threatening problem, except in exceptionally rare cases. But we’re about to conduct a giant unplanned experiment in how many Americans can stay home sick simultaneously and still keep the country running.
When Biden runs around using the same rhetoric that he did in midsummer — and when he speaks off the cuff and falsely says the vaccinated “do not spread the disease to anyone else,” it confirms the dreadful sense that we’re being led by President Mr. Magoo.
ADDENDUM: In yesterday’s Morning Jolt, writing about the still-unsolved case of the Capitol Hill pipe bombs, I was tempted to go on a long tangent about the notorious but usually forgotten unsolved mysteries in recent U.S. history . . . but I put those extraneous thoughts on Twitter.