Biden should throw this ‘Hail Mary’ against omicron

President Biden knows that he is in charge of a viciously divided nation where even the most basic public health directives provoke counter-productive rage. That’s why his plan to fight omicron leans on more testing and hospital capacity than restrictions for public or private gatherings.   

Unfortunately, this will mean a tsunami of new cases.   

Omicron is astonishingly contagious. Some experts are now likening it to measles, long thought to be the most “catching” virus of all. The new variant transmits with incredible speed and efficiency within family groups. So if someone comes to Christmas Eve dinner with the virus, then chances are everyone will have it by the time the meal is over — and that two or three days later, everyone will feel sick.  

How sick? Initial news from South Africa was hopeful on this front, but a recent British study argues that omicron causes hospitalizations at roughly the same clip as Delta. The new bug is already killing Americans, suggesting that it can move quickly to serious disease among the unvaccinated, of whom there are over 60 million across the country.   

We’re all tired of doomsday scenarios, but we must be clear about what we are facing. With some projections showing 500,000 new cases a day by late January, and with our doctors and nurses already exhausted, we are on the brink of disaster.   

What can Biden do to head it off? In the short term, the only answer is a quick, easy treatment that can prevent most of the coming infections from flooding our ERs, then our ICUs, and finally our morgues. Treatments are far less controversial than vaccines, so this option is politically as well as medically viable.   

Since the beginning of the pandemic, scientists have looked for generic drugs that might help against COVID-19. Alas, the two leading candidates here, the anti-depressant Fluvoxamine and the anti-cholesterol Fenofibrate, have only shown promise in laboratory studies, not yet in real-world trials. Merck’s treatment, Molnupiravir, is only modestly effective.  

The last, best hope is the new anti-viral pill from Pfizer. (Full disclosure: Neither author has any interest or investment in Pfizer.) This drug, Paxlovid, inhibits the ability of the SARS-Cov-2 virus to reproduce itself. In clinical trials, the pill, taken every 12 hours for five days, dramatically reduced serious disease. It appears to work against omicron.  

Pfizer has begun production in Europe and hopes to have 180,000 pill packs ready by New Year’s Day, and the Biden administration has secured a deal for 10 million doses later in 2022: Too late, if not too little.  

Hence our Hail Mary proposal.  

With fresh approval by the FDA, the U.S. government could buy the patent for Paxlovid, turning it from a company product into a public good. (Pfizer has already agreed to a license-sharing deal to enable cheaper production around the world.) Biden could then invoke the Defense Production Act of 1950 to churn out as many pills as possible, as quickly as possible.   

These treatments could be sent to vaccination centers and pharmacies. If a patient with any risk factor — unvaccinated, elderly, obese, etc. — tests positive, they could receive the drug free of charge. Once production accelerates, anyone could get a prescription.  

We are aware that this idea departs from long-standing principles of both clinical medicine and public policy. With such a fast and massive rollout of a drug, the data on its safety and efficacy may be blurry. Other pharmaceutical companies will cry foul over government intervention.  

But imagine the suffering that will otherwise descend upon us. Think about the many millions of fellow Americans who will start out with a scratchy throat around New Year’s Day, then find that they cannot stand up or catch their breath a week or two later.   

Now imagine those people taking these pills when symptoms appear. They will still feel sick, sometimes very sick, but unless all of Pfizer’s data is wrong, the vast majority will recover at home. Our hospitals will stagger but survive, and we will live to fight on with new vaccines and more treatments in 2022.  

The hour is grim, and it calls for bold action — right now.   

J.M. Opal is associate professor in the Department of History and Classical Studies at McGill University in Montreal, Quebec. Dr. Steven M. Opal just retired from the Warren Alpert Medical School of Brown University.