The Omicron surge has triggered a mutation in the conventional wisdom about Covid-19. The virus “is here to stay,” oncologist Ezekiel Emanuel and two other experts who advised the Biden transition proclaimed in a Jan. 6 article for the Journal of the American Medical Association, “A National Strategy for the ‘New Normal’ of Life With Covid.” That means no more “perpetual state of emergency”: “The goal for the ‘new normal’ . . . does not include eradication or elimination.”
Joseph Ladapo reached the same conclusion almost two years earlier. “Please don’t believe politicians who say we can control this with a few weeks of shutdown,” Dr. Ladapo, then a professor at UCLA’s medical school and a clinician on Covid’s frontline, wrote in USA Today on March 24, 2020. “To contain a virus with shutdowns, you must either go big, which is what China did, or you don’t go at all. . . . Here is my prescription for local and state leaders: Keep shutdowns short, keep the economy going, keep schools in session, keep jobs intact, and focus single-mindedly on building the capacity we need to survive this into our health care system.”
“That was before it became political,” Dr. Ladapo, 43, says in an interview conducted in person, indoors and unmasked. An orthodoxy soon hardened in the medical establishment and most of the media. He says his UCLA faculty colleagues’ reactions to his commentaries went from “Thanks, Joe, for providing us another perspective” to “How can we make Joe stop writing?” He believes USA Today “would never have published anything along that vein later in the pandemic.” But the Journal would: Since April 2020, I have accepted a dozen of Dr. Ladapo’s articles for these pages. One of them, in September 2020, was headlined “How to Live With Covid, Not for It.”
As policy makers’ views began to converge with Dr. Ladapo’s, he became a policy maker. His writings caught the attention of Florida Gov. Ron DeSantis, who in September 2021 appointed him surgeon general, the state’s top health official. “It’s fun that I’m sitting here because of you,” Dr. Ladapo tells me—though he’s also sitting here because Mr. DeSantis had been quicker than most politicians to see the folly of lockdowns and the necessity of living with Covid.
The governor declared a state of emergency in early March 2020, followed in April by the first in a series of executive orders reopening the state. Restaurants, bars, gyms and movie theaters were back in business by June 2020, and public schools were in session that fall. In May 2021 Mr. DeSantis suspended all local Covid-19 restrictions, including mask mandates, and signed legislation ending them permanently. Last summer’s Delta wave hit Florida hard, but the Sunshine State imposed no new restrictions. The state became a punching bag for journalists and other enthusiasts for harsh Covid policies. The hashtag #DeathSantis periodically trended on Twitter.
In Florida as elsewhere, Omicron has brought an unprecedented explosion in reported cases but a considerably smaller increase in severe ones. “It’s been really a blessing that the Omicron variant is less virulent,” Dr. Ladapo says, though he cautions: “We don’t know what’s around the corner, because these case counts are still very high.” Florida recorded an average of 65,551 cases a day for the week ending Jan. 12, up 165% from the Delta wave’s August peak. But hospitalizations of Covid-positive patients, at 10,526, were 41% lower than the August high.
One way to bring the case count down is by testing fewer people. “Historically in public health, for respiratory viruses in the general population, we consider ‘cases’ to be people who have symptoms, not a PCR test,” Dr. Ladapo says. “But during the pandemic, you can have a positive PCR and be completely healthy but be considered a case and be required to behave like a case, which is to isolate and those types of things.”
On Jan. 6 Dr. Ladapo issued guidance that only people who have Covid symptoms and a risk factor (old age, certain diseases, or current or recent pregnancy) “should” get tested. Those with symptoms but no risk factors are advised to “consider” a test. For the asymptomatic, the guidance discourages testing, saying it “is unlikely to have any clinical benefits.”
“A test is most valuable when it’s most likely to lead to a change in a decision, a change in management,” he says. “I mean, that’s so basic.” To keep hospitalizations down, he adds, the state has made clear “that we expect clinicians to treat patients with risk factors” using therapies including monoclonal antibodies, new antivirals from Pfizer and Merck, and fluvoxamine and inhaled budesonide, two medications that have shown promise in off-label use against Covid-19.
He describes the asymptomatic as “a very special group, because this group—you can’t feel any better than not having symptoms. So this group can only be harmed from treatment”—not to mention the “personal downside to them” of being expected to isolate.