December 4, 2022

“If you’ve said the same thing over and over about getting vaccinated, getting a boost, that if you’re vulnerable and you’re in with people who aren’t part of your household and you can’t distance yourself, you have to wear a mask – I mean , the message hasn’t changed since the very beginning,” Louisiana Governor John Bel Edwards, a Democrat, told POLITICO. “But the receptivity to the messages, I mean, there’s only so much of it that people are going to consume, and it also becomes diminishing returns at some point.”

There are no new plans or bold initiatives on the horizon, officials in 10 states told POLITICO, even if much of the South is unvaccinated and vaccination is used among children across the country is far below what state and federal officials would want. Instead, state and federal strategies for managing 130,000 new daily Covid cases in the US are largely the same as they were for managing 30,000 new daily cases four months ago.

The fear, expressed in both red and blue states, is that if state officials sound the alarm too early about this Covid wave, the public will not listen later as hospital capacity comes under pressure or the number of daily deaths starts to rise rapidly. For example, Louisiana has the second highest number of cases in the country per capita, but sees only a quarter of new daily hospitalizations during the Omicron wave and about 15 percent of deaths.

“If you press a full court 100 percent of the time, no matter what your numbers look like, people are more likely to reject you,” Edwards said. “While if you wait until there’s an obvious worsening problem, specifically hospital capacity, I think your coverage will actually do better.”

Rather than hitting the panic button, governors are closely following their long-term Covid response plans announced this spring and, in some cases, are continuing to phase out their pandemic response.

Last week, Illinois Democratic Governor JB Pritzker, who tested positive for Covid this week, announced he was easing testing and vaccination requirements for workers in certain industries, even as the daily number of cases rose 30 percent. Health officials in Hawaii said they have dropped their mandate for statewide school masks, the latest in the nation, as of August. And in New York, where cases have risen more than 70 percent in the past two weeks, Governor Kathy Hochul, a Democrat, said she has no plans to change her government’s approach to Covid-19.

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“We are on top of it. We’re not changing our policy at this time — we always reserve the right to do so,” Hochul said. “Right now, we just want people to be smart and would recommend in various environments — including transportation — that we always want everyone to wear a mask.”

While BA.5, now responsible for at least 78 percent of U.S. infections, is the most contagious and immune-evasive strain of Covid-19 to date, doctors have not yet seen an increase in serious illness caused by the disease. Hospital admissions – now hovering around 40,000 in the US, according to the The New York Times tracker – have been increasing steadily, not increasing exponentially, as they did with Omicron in the winter, and there has been no dramatic increase in people needing ICU care or ventilators.

Daily Covid deaths are over 400, up 25 percent from a month ago, but there is growing recognition there’s little left to do — even if, as previous waves of the virus have shown, a more communicable strain means more cases, more cases, more hospitalizations, and more hospitalizations, more deaths.

“Each of those people… has a family, has colleagues, has friends. There’s an empty seat at the dinner table for those people,” David Scrase, chief of staff for the New Mexico Department of Health and Human Services, told reporters last week. “I don’t think any death is acceptable, and I’d rather the target be zero. But there is also a dynamic in society between freedom and public health.”

The official number of cases is still below the peak of last summer’s Delta wave and well below Omicron’s winter wave, but it is widely acknowledged that current numbers are being counted too low due to the increase in home testing, for those testing at all. .

Still, the rise has alarmed Biden’s health officials, who have spent recent weeks trying to determine how much more BA.5 could drive hospital admissions.

“There is concern, and I think that is universal,” a senior government official said of the vote within the government’s Covid response operation.

The White House’s Covid team is investigating whether Americans under 50 could receive a second booster shot to provide additional protection in the coming months, two knowledgeable people said.

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But they’ve taken no action, as officials still debate whether it’s worth rolling out the shots just weeks before a fall campaign to offer revamped vaccines that they hope will better tackle the current strain.

There hasn’t been much renewed interest in mask mandates either, though the Centers for Disease Control and Prevention’s community-level map now shows that more than a third of counties are experiencing “high” levels of Covid-19 transmission, meaning that the agency advises people to wear a mask indoors in public. While many state and local health departments are individual: recommend wearing a maskfew have entertained a return to mandates like Los Angeles County is considering.

An Axios/Ipsos poll released on Tuesday and taken over the weekend found that just 13 percent of Americans think the government should increase mask mandates and vaccine requirements, up from 21 percent in February.

“Policy makers, politicians are highly attuned to public opinion. And right now, the public opinion is that we’re kind of done with it,” said Marcus Plescia, medical director of the Association of State and Territorial Health Officials. “It would take a pretty brave politician or policymaker to go against that, and there’s not much reason to do that now.”

The White House has instead attempted a minor approach in recent weeks, targeting individual communities most at risk from the virus. Covid coordinator Ashish Jha has made several media appearances highlighting the need for older people to get their boosters and for everyone to consider masks in high transmission areas.

But public health officials say recommendations just don’t seem to carry the same weight as mask mandates, even in blue states where mask-wearing acceptance is higher. Paul Cieslak, senior health consultant and medical director for communicable diseases and vaccinations at the Oregon Health Authority, said few people have returned to masks in Portland, although Multnomah County has strongly encouraged people to do that.

“Honestly, wearing masks hasn’t changed much since April,” Cieslak said.

In addition to encouraging more vaccines and boosters, White House staffers argue that there is little more they can or should do at this point. White House Covid funding has become scarce due to Congress’ months-long refusal to allocate more money, government officials say. And like state health officials, Biden’s team recognizes that there is limited value in persuading people to treat each new variant as a national emergency.

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“It’s difficult to strike that right balance between protecting people from this unsightly disease and making sure the other aspects of their health aren’t affected as well,” said Nancy Foster, vice president for quality and patient safety policy at the Department of Health. American Hospital Association. “I’m not sure if anyone thinks they know exactly the right strategy.”

Hospitals say they are not overwhelmed, but are watching the course of BA.5. While Covid-19 admissions are rising, both ICU occupancy and ventilator use have fallen dramatically from the Omicron peak earlier this year. Now about 6 percent of ICU beds in use for Covid-19 are below 5,406 hospitals that report that data to HHS.

Hospitals count both patients admitted for Covid-19 and patients admitted for other reasons who test positive for Covid-19 when reporting their results. Hospital administrators say it can be tricky to untangle the two groups, and that, in practical terms, once a patient tests positive for Covid-19 in a hospital, they need the same monitoring as a Covid-19 admission.

In parts of the country where fewer people are vaccinated, hospitals are taking more precautions, stocking PPE for staff and making sure they have more Covid-19 treatments like Paxlovid for patients.

“Where we have high vaccination levels, healthcare providers, especially hospitals, are a little more confident that they won’t be overwhelmed with patients,” Foster said. “Where we have lower vaccination levels, there is more concern.”

And while they may not be swamped with Covid-19 cases, hospitals are plagued by ongoing staff shortages across all functions, due to a combination of pandemic burnout and staff getting sick from Covid during peaks.

Some who work in large hospital systems would like to see a much stronger message from public health officials about masking while transmission is high, and for officials to strongly encourage boosters.

“Even if it’s in an echo chamber,” said David Wohl, the infectious disease expert who leads the Covid-19 response at UNC Health in North Carolina, where the cases with 26 percent more than two weeks ago.

Instead, he said, public health officials have the push to get people to push themselves — and others — into the background. “It’s like they’re saying, ‘We’re out of this fight.’”