One item that should be noted in the midst of all the resulting panic: South Africa is currently one of the few nations in the world where rates of COVID-19 are much lower than they have been through most of the pandemic. Though case counts there have seen a notable spike in the last week, it’s not immediately obvious that this travel ban is running in the right direction.
Some points worth recognizing:
- While there has been a rise in cases in South Africa from a low of around 300 a day at the start of the month to nearly 3,000 a day at the end of the month, it’s unclear how much of this increase relates to the new omicron variant. The relatively low rate of vaccination there leaves the possibility that delta, or the also worrisome C.1.2 variant, could be behind most of those cases.
- The head of the South African Medical Association told the BBC that the omicron cases identified so far “were not severe”; it is still early, however, and it’s not certain how long any of those patients have been infected.
- Despite the disturbing number of changes to the spike protein (and other areas of the virus), there is as yet no indication this variant is more evasive of the vaccines. Those who have been fully vaccinated, especially those who had received a booster, produce a wide variety of immunological responses that could still provide strong protection against this variant. At the moment, most of the South Africa cases are among the unvaccinated.
For the world as a whole, this is an opportunity to demonstrate that it’s possible to learn from experience. There is no reason to throw up our hands and surrender to some inevitable new wave of disease. Steps exist that have proven to be effective. And none of those steps should wait until we’re sure about the threat this variant represents.
The only way to detect the presence of the new variant is to conduct tests. While a specific genetic test for the omicron variant is not yet widely available, this variant can be detected through a standard PCR test, due to a feature called S gene dropout. That means there are already tests available that can effectively separate omicron from delta and other widespread variants. The U.S. needs to step up its testing regime to identify potential omicron cases.
When cases of omicron are detected, active and professional case management needs to take place. That includes case tracing of contacts. Everyone who possibly can be identified as coming in contact with a positive case needs to be identified, tested, and quarantined. Then tested again, at least twice, over the next 10 days.
For those thought to be in contact with known cases of the omicron variant but who test negative for COVID-19 at the time of first contact, a quarantine for a period of 10 days should be mandatory. Not suggested. Not advised. Mandatory.
Don’t isolate people at home
Those who do test positive should be isolated in a facility, not at home. Evidence from around the world has demonstrated that sending people home with COVID-19 has limited benefit, because it results in their families getting ill. For those who live in apartment buildings or other high-density situations, it can lead to their neighbors getting ill. For the homeless, it can mean many people in a shelter (or community) getting ill. While images from China of people being taken from their homes to “dormitories” at the start of the pandemic were viewed in the West as authoritarian terror tactics, putting people into facilities where they can be isolated from their families and others—until they either recover or need more medical care—saves lives and limits spread. It also allows the infected to get more frequent and effective care, even when suffering relatively mild symptoms.
Have a national strategy, but utilize local tactics. Use the county health system. Use local organizations. Use volunteer groups. Go door-to-door—not as “government agents,” but as good neighbors. Engage the local government, the Elks, the Kiwanis, and the high school football team into being part of the solution. Testing, case tracing, quarantine, and isolation are effective steps for breaking community spread, but it takes a community.
Yes, you’re tired. We’re all tired. But we’ve already seen what happens if we flunk this test. Omicron isn’t exactly a do-over. Unfortunately, it is a required course.
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