As US faces new COVID variant, calls for patience and prudence

One week after the omicron variant was publicly identified, the message from American political leaders and public health officials has been consistent: Be watchful, but not alarmed.

The new coronavirus variant, about which much is still unknown, is “cause for concern but not panic,” President Joe Biden said Thursday from the National Institutes of Health. The president promised to fight the new variant “with science and speed, not chaos and confusion.”

Many of the new White House measures announced Thursday aimed at combating both the delta and omicron strains of the virus this winter build largely on existing government strategies. They include urging vaccination and boosters, expanding the supply of at-home COVID-19 tests and making them reimbursable through private insurance, and strengthening testing protocols for all inbound international travelers. The administration notably did not announce more drastic measures, such as lockdowns or other hard-line mandates. It did extend the requirement to wear a mask on airplanes, rail travel, and public transportation through March 18.

The administration’s biggest mandate initiative – requiring businesses with 100 or more employees to require vaccination – has been temporarily blocked by a federal appeals court. On Tuesday, a federal judge blocked the vaccine mandate for health care workers.  

The first American omicron case was announced Wednesday, in a person in San Francisco who had recently traveled to South Africa, where the variant was first identified. The news was not a surprise; public health experts had widely assumed omicron was already in the United States. The case is reported to be mild. By Thursday, cases had been identified in two more states.

This new variant emerged just as many Americans were fully resuming elements of pre-pandemic life, such as plane travel, cruises, and large indoor gatherings. And “pandemic fatigue” is a growing challenge for political and health leaders, who once again are urging the public to take additional measures to protect themselves and others.

“People just are over it,” says Céline Gounder, an infectious disease specialist at New York University and Bellevue Hospital. Cases were already surging before omicron, and many Americans don’t want more restrictions, notes Dr. Gounder, a member of the Biden-Harris COVID-19 transition team. “This is one of the main challenges.”

Keeping communications clear and factual remains a paramount goal. On the initial omicron messaging, some experts give the Biden administration high marks. 

“Their communication has been quite good on this – and that is, wait and see what the science shows,” says Kenneth Bernard, an epidemiologist who ran the office on global health threats in the Clinton and second Bush White Houses. “We’re not going to do anything drastic out of fear.” 

“Noise ... from a lot of different directions”

But critics say other administration efforts to communicate clear guidance to the public have fallen short, as with the rollout of a campaign to encourage those already fully vaccinated to get booster shots, which some compared to the Trump administration’s “chaotic” pandemic messaging.

In September, the director of the Centers for Disease Control and Prevention, Rochelle Walensky, overruled her agency’s own vaccine advisory panel’s recommendations by expanding the categories of people eligible for boosters – a decision that was released at 1 a.m. Last month, the CDC further expanded eligibility, by saying all adults over age 18 who were more than six months out from their second mRNA vaccine dose (or two months out from a dose of the Johnson & Johnson vaccine) “may” get a booster. This week, the agency’s guidance changed again, from “may” to “should.”  

“There was just a lot of, in my opinion, noise coming from a lot of different directions,” says Elizabeth McNally, director of the Center for Genetic Medicine at Northwestern University’s Feinberg School of Medicine.

Dr. McNally thinks the Biden administration took an appropriate, proactive approach to boosters, given the information it had at the time. But the confusion was undeniable. Her own patients and colleagues didn’t know whether to get a shot. Public health departments across the country faced a deluge of similar questions.

“They keep saying it’s essential now for everybody to get boosted who can without really explaining how that fits with the overall control strategy,” says Ira Longini, professor of biostatistics at the University of Florida.

Some experts take issue with how public health officials have broadly approached pandemic messaging – by telling people what to do, rather than explaining the science behind the guidance. 

Baruch Fischhoff, a professor at the Institute for Politics and Strategy at Carnegie Mellon University in Pittsburgh, says there are two kinds of scientific communication: “risk communication,” which entails giving people the information they need to make choices for themselves and evaluate the government’s decisions; and “health promotion,” in which the government tells people what to do based on expert advice, such as “wear a mask.”

Ideally, Professor Fischhoff says, the two approaches complement one another, but so far the administration has focused more on health promotion. 

“It’s just a continuing failure,” he says. 

Health promotion only works if people trust the expert or institution giving the advice, but there’s no person or group with that kind of sway in the U.S. today, he says. 

“There’s lots of people giving advice in the health promotion area,” Professor Fischhoff says. “It’s often contradictory. You have no idea what facts they’re working on. You have no idea what their values are.”

“The idea that the public could not understand this information is just not true,” he adds. 

Political polarization and public health

Adding to the challenge of public health communication during a pandemic is the parallel development of political polarization. 

When the pandemic shut down normal life in March 2020, partisan patterns in personal behavior became clear early on, and have stuck, according to a forthcoming book, “Pandemic Politics: How COVID-19 Revealed the Depths of Partisan Polarization.” Such behaviors include mask-wearing, social distancing, and later, a willingness to be vaccinated. 

“There are these big gaps between Republicans and Democrats that we see in our survey data very early on in March 2020, and which don’t go away over time as the virus starts to move across the country,” says Shana Gadarian, a political scientist at Syracuse University in New York and one of the book’s co-authors. “Those patterns have locked in.”

The overall argument of the book is that “elite” messaging on the part of politicians matters a lot, she says. And it mattered early on, as conservative media and the Trump administration played down the risks of the virus. 

“Democrats very early on were in line with public health officials,” Professor Gadarian says, noting that some Republican state leaders also took the virus seriously from the start. 

With omicron, the immediate challenge around addressing it – including public communication – remains its unique nature and the lack of understanding about its properties. 

“The right thing to do right now is to have an all-hands-on-deck response, where we are preparing for the worst case but hoping that the worst case never arises,” says Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium. 

“I think Biden’s tone was right in saying now is not the time to panic,” he says. “But I do think it is the time to make those necessary preparations.”

Dr. Fox adds that Americans’ “pandemic fatigue” ties the president’s hands to a large extent when it comes to new restrictions. The alternative, he suggests, is local action: “There actually needs to be a really strong kind of local community involvement to reenergize people in the face of a surge.”