President Joe Biden’s recent bout of COVID drew immediate comparisons with President Donald Trump’s experience. Biden had mild symptoms and worked at his desk, while Trump developed a severe respiratory condition requiring helicopter evacuation and three days of urgent treatment at Walter Reed Army Medical Center. The experiences of these two men reflect changes in COVID risk that actually impact all of us.
Although the administration designed procedures to protect Biden, his aides viewed his infection as a near inevitability. CNN reported that aides “saw the illness as a sign that even the most protected person can come down with COVID and be just fine.” For similar reasons, Americans are becoming increasingly burned-out on precaution. Many are skeptical of COVID prevention measures altogether. Still others think that when it comes to mental health, educational and other opportunity costs, “returning to normal” is less damaging to individuals and society than stringent precautions - those beyond vaccination, using Paxlovid appropriately and selectively practicing social distancing and mask-wearing.
However, there’s little practical understanding or consensus regarding what returning to normal means for us—individually or for society at large. It’s worth reflecting on the dominant pandemic narratives that have played out to date, and to note that to thrive in our current environment we must construct a new narrative that both more closely reflects observable facts and helps us to live with uncertainty.
Humans know so much more now about the coronavirus that causes COVID and how it plays out in those infected. How we think about COVID needs to reflect this new knowledge.
As a medical epidemiologist, and member of the COVID Collaborative, I have been following this research and the evolving recommendations from the Centers for Disease Control and Prevention, experts and the media. That experience suggests that now society should help to protect people who are most vulnerable (the elderly, immunodeficient or those with specific conditions) to help them avoid exposure; the rest of the population, in my opinion, should go about business as usual. With this caveat: where the welfare of people who could get seriously ill intersects with those who likely won’t, we must look out for the needs of the former. Balancing freedom to live without restrictions with the freedom from being needlessly exposed to disease should be the through line of our national narrative, policies and practices.
Here’s why: early on, two dominant narratives emerged. One called the virus no more dramatic than the flu, and that people urging us to be cautious sought to undermine our politics, security and economic prosperity. The other championed the idea that the virus could attack and kill anyone and potentially lurked in every breath. Most people fell into one of these groups, absorbing the consequences of these beliefs and behaviors in their own group and shunning the other.
The central question in constructing a new COVID narrative is whether we can say that the virus no longer poses a major public health threat. What does it mean that the disease is still around but is not causing significant disruption in our daily lives? When and how does a virus migrate from being “pandemic” to “endemic”? There is no clear epidemiologic definition of “endemic” relative to “pandemic.” Some think that this milestone has already passed; others think it’s achievable in the near term; and still more believe it’s in the indefinite future.
About 850,000 Americans are being infected daily, nearly 2 percent of the entire U.S. population every week. These are likely to be your relatives, friends, neighbors, public figures and even yourself. This is on top of the 82 percent of the country estimated to have been infected at least once as of mid-July.
Despite this firestorm of spread, classical herd immunity leading to eradication is unlikely (in contrast to its achievement with smallpox, for example, where both natural infection and vaccination eliminated virus transmission). SARS-COV-2 produces only a steadily waning natural and vaccine-induced immunity and does not eliminate transmission. But it does maintain high levels of population immunity that protects against serious illness from widespread sporadic and epidemic waves of infection and re-infection.
Yet, while about 22 percent of eligible Americans are unvaccinated, almost all of this group are vaccine skeptics, who are unwilling or uncertain about getting vaccinated. Expanding new vaccinations alone is unlikely to be a major successful control strategy.
At no time during the pandemic has there ever been a more dramatic disconnect between infections and serious disease. Given a high background of incidental asymptomatic cases, this translates to current hospitalization and death rates for COVID being at or near the lowest levels of the pandemic. Still, death rates remain stubbornly high for older people; this year about 77 percent of all COVID deaths have occurred in those age 65 and above.
Vulnerable people will need to continuously and vigilantly try to prevent infection and have access to early treatment to keep them out of the hospital. Protecting them, for example, with masks or reliable testing, is the shared responsibility of both society and the affected people themselves. For most others, except when they cross paths with vulnerable people, life can go on pretty much unaffected.
As philosophers of science have noted, challenging narratives isn’t something that comes readily to the human mind. Through the many tortuous turns of the pandemic, the “follow the science” mantra has become as contentious as the tenets of any other belief system. While there have been many incremental tweaks in expert and resulting media guidance, the bifurcation of camps around “fear the virus” and “full speed ahead” continues.
The status quo, abundance-of-caution, stay-scared narrative is still reverberating through media and expert commentary. The list of ominous headlines is lengthy: the specter of new variants, increased virulence, rising wastewater virus levels, maskless passengers, a new surge of cases, unvaccinated preschoolers, superspreader events, waning booster immunity, vaccine escape, likely ongoing reinfection, and long COVID.
These are not invented concerns, but they should not be invoked as a barrier to a new normalcy.
Unlike in football, the end of the pandemic will not be signaled by a sharp whistle clearing the playing field and audible to all. It will instead look exactly like our current percolating and—almost imperceptible—daily shift to a new way of living.
When do we stop running from a virus that is not going to disappear and will likely become a ubiquitous state of nature? Given the history of pandemics, we know that this change will inevitably occur. The uncertainty is how much individual and societal damage we can avoid in the interim.
When we do resume unencumbered lives, it will not be because we have pandemic burnout. It will be because we have embraced a new narrative to support our risk-tolerant behavior and adopted better strategies to protect the vulnerable.
Civilization has been knit together since prehistory by shared narratives. As the historian and philosopher Yuval Noah Harari observed, “Homo Sapiens is a storytelling animal that thinks in stories rather than in numbers or graphs, and believes that the universe itself works like a story.”
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.