Omicron, the new Covid-19 variant, has put a pandemic-weary public into survival mode. Heading into our third year of this, with delta still wreaking havoc in parts of the Midwest and Northeast, the American public had already had enough. And yet the available evidence suggests that omicron is likely more transmissible than even delta was. Within two weeks of its emergence, omicron overtook all other variants to become the dominant strain in South Africa—and is spreading quickly around the world.
Following the knee-jerk responses of European countries, the United States was quick to issue a travel ban on noncitizens from South Africa and seven other southern African countries. It’s an echo from the earliest days of the pandemic. The last time around, the U.S. utterly failed to leverage basic public health tools in the fight against the virus, choosing blunt and ultimately less effective tools like travel bans. They didn’t work last time, and they won’t work this time. In addition to obvious measures like vaccination and masking, what we need now are approaches in the public health toolbox we’ve yet neglected to leverage at scale: contact tracing, rapid testing, and genomic surveillance.
First, let’s consider why the travel bans are such a bad idea. They punish South Africa and neighboring countries for doing the right thing. They invested in the infrastructure for genomic surveillance—the capacity to track subtle changes in the virus’s evolution from patient samples—and notified the international community when they identified a new variant. These travel bans send the wrong message should another variant emerge in the future.
But there’s also the fact that the virus doesn’t discriminate by passport. In issuing a travel ban for noncitizens only, we’ve incentivized U.S. citizens living in South Africa to hurry home, possibly importing the virus with them. Rather than a blunt travel ban, the U.S. should have long ago built the capacity for enforcing 10-day quarantines for international travelers from heavily affected countries, whether they’re American citizens or not. This was standard practice in other countries with far more effective Covid responses, like Australia and New Zealand.
But that kind of infrastructure was never built. Indeed, rather than scale up our disease-fighting capacities, our rickety public health infrastructure creaked under the weight of the pandemic. Built as an interconnected web of over 3,000 local health departments, dozens of state and territorial departments, and major federal public health agencies like the Centers for Disease Control and Prevention and the Health Resources and Services Administration, or HRSA, our system was designed to maximize the benefits of federalism—national guidance and local control. Yet Great Recession–era budget cuts at every level had rendered the system a shell of what it was supposed to be. The Trump administration’s ineptitude at the start of the pandemic exacerbated the system’s limitations.
One of the first failures was contact tracing, the painstaking process of tracing chains of exposure following infection. From the jump, contact tracing has been stymied by roadblocks inside our highly disjointed public health system, politicization and distrust of public health officials, burnout among the public health workforce, and regular surges that overwhelm our abilities. But contact tracing is critical now. If we are to have a shot at containing omicron, contact tracing is going to be a linchpin.
So will rapid testing. These kinds of tests allow relatively accurate point-of-contact verification that enables activity at schools, workplaces, and other potentially high-risk sites to go forward with far less risk and anxiety. To this day, rapid tests remain hard to come by and far too expensive in the U.S. Germans can purchase rapid tests easily for under a dollar. They’re free in the U.K. Though the Biden administration leveraged the Defense Production Act to make 280 million more tests available, that’s less than one test per American. We need far more. Indeed, prices remain high in the U.S. for the same reasons too many other things are too expensive here: Individuals are competing with large corporate purchasers, and test manufacturers know they can get away with charging higher prices, so they do.
Another standard practice in the U.K. is genomic surveillance, or identifying the genetic footprint of Covid-19 as it spreads; it’s the reason why South Africa, a global leader in genomic surveillance, was so quick to identify omicron in the first place. The U.S. has been slow to the party, and we remain behind owing to roadblocks emerging from the fact that our public health system is both disjointed and underfunded. At the beginning of the year, the U.S. had only uploaded 0.3 percent of its total infections to a global genomic database, compared to 60 percent in Australia. Since then, our genomic surveillance capacity has increased substantially. However, it continues to lag considerably behind global leaders’: The U.S. figure is still at only 5 to 10 percent of cases. As omicron spreads, first into the U.S. and then regionally, keeping tabs on it will stress our system’s capacity. The simple answer is that we need yet more.
Finally, we have masks and vaccines. Perhaps no terrain has been fought over quite like these. Whether in schools, workplaces, airplanes, or public transit, the politicization of mask and vaccine requirements has been effective. The pushback they have motivated has been fierce. But requirements work. More than 90 percent of the federal workforce has complied with a federal vaccine requirement. And evidence has demonstrated that school masking policies are associated with lower Covid spread. In the face of a yet more transmissible variant, these requirements are even more important now.
There remain more questions than answers. How much more transmissible is omicron? How effective are our vaccines? How severe are the symptoms? We will learn more about this variant over time. And yet throughout this pandemic, the countries that have fared best have been the ones that have deployed fundamental public health tools like testing, tracing, surveillance, and mask and vaccine requirements most effectively. Our response throughout this pandemic, unfortunately, has been characterized by a failure to do just that. More than three-quarters of a million of us have died because of it. Yet again, we have the opportunity to pick up the tried-and-true public health tool kit.
This time, I hope we do. The good news is that the Biden administration has done yeoman’s work to improve public health coordination among the federal, state, and local governments. But more is needed. Pummeled by the last 18 months, local and state health departments are struggling to staff up. In the same way the administration deployed federal personnel to staff spillover hospitals during previous Covid surges, it needs to staff local and state health departments to increase contact tracing capacity right now. In addition to state and local public health laboratories, university and hospital laboratories should also be recruited in the effort to genomically surveil Covid specimens. Finally, rapid testing manufacturers, many of whom have received billions in funding and support from the federal government, cannot be allowed to fleece consumers by raising prices and filling corporate orders first. Though we know yet little about omicron, the sine qua non of public health is preparedness. This is, after all, what we should have been doing in the first place.
