SEATTLE — Dr. Jeff Duchin, the public health officer of Seattle and King County, Washington, has become accustomed to delivering bad news.
King County has been among the country’s most aggressive jurisdictions with pandemic restrictions, from stay-at-home orders to closures of restaurants and bars.
But at a news conference Friday about how Covid-19 case numbers could soon reach new heights, Duchin had no such announcements of mandatory restrictions — only a warning about the new omicron variant of the coronavirus.
“It’s real,” he said. “It’s here, and it’s moving fast.”
Duchin said a wave of omicron infections could soon overwhelm area hospitals, depending on the severity of the disease it causes compared to that of previous strains of the virus.
But in Seattle — where vaccination rates are high, masks cover almost everyone’s faces in public places, including grocery stores, and public health rules are generally followed — there was little to do but ask people to trust vaccines to prevent severe disease, beg the unvaccinated to get doses and ask residents to think twice before they host holiday parties that end up sickening Grandma.
With hospitals on edge, public health experts say the extreme measures of earlier in the pandemic — such as lockdowns, school closures or business shutdowns — remain unlikely in the U.S., for now. The sheer speed of the spread of the omicron variant, combined with the lack of widespread public will for shutdowns, leaves the most drastic options off the table.
“I just don’t know what the intervention is that’s going to slow it, short of staying home, and I don’t think that’s practical,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health in Baltimore. “I don’t think there’s much appetite for that after two years of this.”
Some local officials agree. New York City Mayor Bill de Blasio said Monday that a shutdown isn’t on the table.
“I do not see a scenario for any kind of shutdown, because we are so vaccinated as a city,” he said. “We don’t want to shut down. We want to vaccinate. Simple as that.”
Health officials continue to emphasize that vaccinations — especially among people who have received their booster shots — should prevent many patients from being hospitalized. And Duchin and other health officials continue to encourage wearing masks and limiting social interaction.
Almost everyone will eventually be exposed to the virus that causes Covid, experts said. And while it’s important to dampen infections now so hospitals aren’t overrun in the coming weeks and months, the variant is spreading so fast that there might not be enough time — or public patience — for interventions to land with the right impact, they said.
The omicron variant is spreading exponentially in the Seattle area, with total cases from the variant doubling about every 2.4 days, Trevor Bedford, a computational biologist and expert on viral evolution, said Friday. The pace of spread echoes observations from South Africa and Denmark, and it tracks with the spread in other U.S. communities with widespread testing.
“We don’t know what case counts will be in January in King County and the U.S., but I’m certain it will be the highest we’ve seen in the pandemic,” he said.
In areas like King County, where 4 out of 5 eligible residents are fully vaccinated, it’s likely that only a small fraction of cases will require hospitalization. Still, the magnitude of the overall case spike could be so large that it overwhelms the health system, Bedford said.
Many hospitals are operating in a weakened state. About 98 percent of critical care beds were spoken for in King County, Duchin said Friday. Omicron infections are likely to keep some hospital workers home.
“I’m not feeling good,” said Cassie Sauer, the president and CEO of the Washington State Hospital Association. “There’s so much unknown about how serious the illness is, which is key, but the math is terrible.”
Shuttering schools, closing businesses and ordering people to stay home are public health tools of last resort.
“It’s different than March of 2020. We had no other tools. We had no choice but to wield the damaging sledgehammer of shutdowns. We couldn’t test. We couldn’t vaccinate. We didn’t know about the protective measures of masks,” Nuzzo said. Vaccines remained months away from use.
Extreme measures also come with economic, social and mental health costs.
“We have to say those harms are worth it,” Nuzzo said, adding that nationally, “I just don’t think there’s political appetite, public appetite.”
For Duchin, the costs of more restrictive measures still outweigh the benefits.
“Things change very rapidly,” he said.
The omicron variant will enhance risk, in particular, for the minority of people who remain unvaccinated, experts say.
Treatments like monoclonal antibodies could be less effective against the variant, and the quality of care offered by hospitals could suffer under the strain.
For those holding out on getting the shots, “that calculus has gotten a lot riskier,” Nuzzo said.
And although most people won’t outrun an encounter with the virus forever, taking precautions now will help.
“You do not want your first encounter to be without vaccine in you. You probably don’t want to get it right now for the sake of the rest of society,” said Dr. Helen Chu, an immunologist at UW Medicine in Seattle.
Experts said that means we need to redefine how we live with this disease and reset our national strategy.
“We’ve created the expectation that we’re going to dodge this virus and the goal is to get to zero cases. I don’t see that as a viable vision of success,” Nuzzo said.
She said the federal government should outline strategies to reach the unvaccinated, increase the availability of rapid tests, prevent Covid in nursing homes, keep schools open and speed turnaround times for molecular tests.
“The goal should be keeping hospitals able to manage cases and not going into crisis,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
President Joe Biden plans to discuss steps to combat the omicron variant in a national address Tuesday.