In the age of omicron, individual choices have societal consequences

As we enter the third year of the most impactful pandemic in a century, more than 900,000 Americans have died of COVID-19. Affected family members and close friends remain emotionally devastated by personal losses. The ongoing specter of long COVID and COVID fatigue adds to the human misery of the unforgiving coronavirus.  

Remarkably safe and effective vaccines are available. Until mid-December, the unvaccinated comprised 97 percent of patients hospitalized and 99 percent of deaths due to COVID-19. With the more easily transmitted omicron variant there are more breakthrough cases among the vaccinated today, but the proportion dying is still almost all among the unvaccinated. The Moderna and Pfizer vaccines have reduced efficacy against the omicron variant to around 50-60 percent protection from its high with the delta variant of 94 percent. However, a booster shot increases protection from symptomatic infection to 90 percent.  

Recently, The Centers for Disease Control and Prevention (CDC) announced that the risk of hospitalization with omicron among unvaccinated people over age 50 was 45-fold greater than for those fully vaccinated who also received a booster. Vaccines work. 

We also know that well over 90 percent of COVID-19 transmissions occur indoors, and masks — especially N-95 versions — reduce transmissions as much as 85 percent. They should be broadly encouraged for public indoor venues. Masks work. 

Virginia Governor Glenn Youngkin (R) signed executive orders removing vaccine and mask mandates, placing in sharp relief the tension between individual rights and the public’s health. He and his supporters argue that personal freedom needs to be prioritized. 

Freedom of choice is a long-held value for Americans, who don’t like to be told what to do. Of interest, our Founding Fathers drew up the Declaration of Independence during the period of Enlightenment, the intellectual movement stressing liberty, science and human progress. Philosophers at the time influenced the acceptance of the social contract — to create a stable society, individuals would give up some personal rights to benefit the group. Today, for example, we agree with the law that says we will not drive while intoxicated —  protecting not only the individual but also others who might be victims of an accident.  

In his 2018 book, “Enlightenment Now,” the modern thinker Steven Pinker writes, “when we sympathize with others and apply our ingenuity to improving the human condition, we can make progress.” Fiercely independent Americans are generous, often reaching out to their communities.  

The decision against vaccination places an individual at substantial risk of infection and complications. Unfortunately, with a highly transmissible virus, it also places the individual’s family, friends and neighbors at risk. So the exercise of personal freedom creates an unfreedom among those exposed to the infected person. The only way a personal choice is linked only to the individual is if that person isolates herself from society. For example, a family could argue that their child will not wear a mask but would elect to have homeschooling and quarantine.  

Many of us wrestling with the tension between individual freedom and the public’s health favor public safety during a relentless once-in-a-century pandemic. For the social contract, the common good, advocates for the public’s health tip the balance toward generous policies affecting the welfare of Virginians still exposed to this unique virus.  

Many Americans have lost confidence in the government’s ability to control the pandemic. The early miscommunications about the value of masks and testing and the more recent confusing communications about the period of infectivity after symptom onset eroded confidence in public health. But it should not be lost that pandemics are complex, not simple.  

No easy solutions exist: Multiple practices and policies need to be in place for effectiveness. We need to avoid political statements that divide us, especially those offering binary responses — all good or not good. They’re unhelpful. A backstory is that as citizens feel let down by the government, commentators surface with comforting simple declarations and solutions. Desperate citizens with COVID fatigue and real pain may not recognize the risk to a stable society and line up along those offering simple resolutions. But there are none.  

Similarly, thoughtful responses to opposing forces regarding vaccines are not simple. We’re close to the recession of the pandemic and need to avoid preventable infections, hospitalizations and deaths.  

With all respect to those prioritizing individual choice, we should press on with what we know works until we arrive on the other side of the COVID-19 trajectory.  

Richard P. Wenzel, M.D., M.Sc., is an infectious diseases epidemiologist at Virginia Commonwealth University. He is editor-at-large of The New England Journal of Medicine. Wenzel also serves as emeritus professor and chair of the Department of Internal Medicine at VCU and has been president of both the Society for Healthcare Epidemiologists of America and the International Society for Infectious Diseases. He is a current trustee of the MCV Foundation.