Will the Coronavirus Pandemic Ever

End?
If Americans decide too soon that it is over, it could paradoxically drag on even
longer.

COVID-19 is no longer an acute emergency, but public weariness and the emergence of highly
transmissible variants may spark intermittent surges long into the future.

Twenty-seven months into the covid-19 pandemic, our defenses against the
coronavirus seem at once stronger and more penetrable than ever. A growing
majority of the U.S. population now has some immunity to sars-CoV-2, the virus that
causes covid-19, whether from vaccination, past infection, or both. However,
staggeringly infectious members of the Omicron family have demonstrated an ability
to evade some of those protections. Since April, they have led to a quadrupling of
daily coronavirus cases; the U.S. has been reporting more than a hundred thousand a
day, but, because widely used at-home tests don’t show up in official tallies, the true
number could be five or even ten times higher.

When the original Omicron, BA.1, swept the country this winter, it was by far the
most contagious variant to date. But a subvariant that emerged more recently, BA.2,
appears to be thirty per cent more transmissible, and one of its descendants,
BA.2.12.1, is more contagious still. Unfortunately, people who have recovered from
BA.1 infections can be reinfected by Omicron subvariants. According to some
estimates, the U.S. could see a hundred million coronavirus infections this fall and
winter. “This is approaching one of the most transmissible pathogens in history,” Eric
Topol, the director of the Scripps Research Translational Institute, told me.

Yet the country’s response has been one of indifference. No state currently requires
masks in public places, even though the director of the Centers for Disease Control
and Prevention has said that a third of Americans should consider wearing them, and
New York City recently recommended them indoors. When a judge struck down a
federal mask requirement for trains and airplanes, the Biden Administration
appealed, but did not seek to immediately reinstate the mandate. In April, less than a
third of Americans said that they were even “somewhat worried” about getting
covid-19, the lowest proportion since July, 2021, and fewer people were socially
distancing than at any time during the pandemic. A third of the population believes
that the pandemic is over, including more than half of unvaccinated Americans and
nearly six in ten Republicans.

This attitude is attributable, in part, to an indisputable reduction in the most serious

consequences of covid-19. Although new variants are causing more breakthrough
infections, vaccines remain protective against severe illness. During the current
surge, covid deaths have been steady at around three hundred a day—still too many,
but near pandemic lows—and hospitalizations have risen modestly. But our apathy
also seems related to a pandemic malaise—an inability or unwillingness to devote
more cognitive and material resources to a problem that refuses to leave us alone.
Congress has so far failed to fund an adequate supply of vaccines, tests, and
treatments this winter, suggesting that the country has retreated not only from
controversial mandates but from the most basic tools of public health.

As a physician, I have struggled to know what to make of this moment in the

pandemic, and I fear that it will last a long time. “We may be in this phase forever,”
Robert Wachter, the chair of the department of medicine at the University of
California, San Francisco, told me. Lately, I’ve been seeking out people who have
shaped the covid discourse—experts who have not only shared and interpreted
information but helped to construct a pandemic narrative and, in doing so, influenced
policymakers and the public. I wanted to understand how their thinking has changed
on key questions now facing the country: How should we live? Who should decide?
How long will this last? As the coronavirus has become less deadly yet more difficult
to contain, they told me, strategies that defined the early pandemic have fallen away,
and responsibility for our everyday behavior has shifted away from public-health
officials and toward individuals. In the coming months, we’ll learn the consequences
of this approach.

Doctors often categorize medical conditions as acute, subacute, or chronic. A patient

with crushing chest pain and an alarming EKG is experiencing an acute emergency,
meaning that, within minutes, they need a specific series of drugs and a team of
medical professionals to unclog the culprit blood vessel. Another patient may feel his
chest tighten when he walks up stairs, but the discomfort fades when he rests, and it’s
been this way for years. His angina is said to be chronic: it’s serious and needs
medical attention, but can usually be managed with medications and checkups. The
subacute condition is somewhere in between. Last month, a man could climb three
flights; last week, only two; and today, his torso feels heavy when he walks to the
bathroom. Subacute illnesses are hazardous in their own way. They can often be
mitigated if treated appropriately, but they may be difficult to diagnose, and, if you
ignore or mismanage them, they can spiral out of control.

I sometimes think of this period as a subacute phase of the pandemic. covid-19 is no

longer an acute emergency, but it’s not yet clear how it will become an endemic
disease that we are ready to live with. Public weariness, highly transmissible variants
that evade some of our immunity—these factors may condemn us to intermittent
surges long into the future. “Within the realm of my imagination, I can no longer see
a true game changer that alters the fundamental dynamics from where we are today,”
Wachter told me. “For me to say otherwise would be some combination of wishful
thinking and reacting to my own internal pressure, and pressure from those around
me, not to be a bummer.” This is, of course, a bummer. Still, it might not be as bad as
it sounds. “We’re not going to see another million covid deaths in the United States,”
Wachter said. “The vast majority of severe illness will be fully preventable. We’ll
probably wear masks in some places, maybe get regular boosters. It’s not the end of
the world. It doesn’t diminish my life significantly.”

The experts I spoke to seemed to accept that, as a society, our options for containing
such a transmissible virus are limited. “If cases were falling and there were not new
variants that are so highly contagious, then suppressing infection would actually be a
viable path,” Leana Wen, the former health commissioner of Baltimore, told me. “We
have to recognize that the price of prioritizing low infection rates would be
astronomical.” In her view, the U.S. can’t afford to close schools, restrict travel, or
shutter businesses for long periods, and those stringent measures might not work
anyway. “Even China, with the strictest lockdown in the world, is struggling to
contain these hyper-contagious variants,” Devi Sridhar, a professor of public health at
the University of Edinburgh and the author of “Preventable: How a Pandemic
Changed the World and How to Stop the Next One,” told me. “We have to pivot
away from the idea that we can avoid getting infected.”

Wen once advocated for strict measures to suppress the virus, but now argues for a
return to something like normal life. She told me that she changed her mind in part
because infections have grown less punishing with time, as more people acquire
immunity and gain access to effective drugs. In two years, the infection fatality rate
of sars-CoV-2 has fallen dramatically. For people who’ve received a booster shot, it
now really is on par with the flu. (Of course, the coronavirus is still infecting a lot
more people.) As the risk of severe covid-19 falls, Wen said, the threshold for
policymakers to impose restrictions should rise. She argued that mandates would
become appropriate only if a new and deadlier variant emerges. “Reintroducing them
now would erode trust in public health and weaken our ability to respond to future
emergencies,” she said. “As soon as the emergency fades, individual choice is again
the key decider.”

Wen frequently hears the criticism, sometimes in the form of online vitriol, that her
position does not fully account for the roughly seven million Americans who remain
at higher risk for serious covid-19, even after vaccination, because of compromised
immune systems. Although she thinks that more should be done to protect the
immunocompromised, she also believes that most Americans should be allowed to
return to their pre-pandemic routines. In my clinical practice, I often care for
immunocompromised patients who express fear and frustration that the country
seems determined to move on from the pandemic—and, in their minds, to leave them
behind. ​Having treated the devastating consequences of infections in these patients, I
find it hard not to empathize with them, and I don’t have easy answers. Wachter told
me that he is sympathetic to the idea that we’re not doing enough to protect
vulnerable people—but in a country where many people don’t even have access to
medical care, he said, “the idea that, all of a sudden, everyone in society is going to
do everything possible . . . that strikes me as seeking a perfect world that we’re
awfully far from.” In his view, “most immunocompromised people now have the
tools to keep themselves relatively safe.” He pointed to vaccines, boosters, antivirals,
N95 masks, and Evusheld, a preventive monoclonal antibody authorized for people
who are moderately or severely immunocompromised. And, of course, we should all
be encouraged to get tested and mask up before we spend time with someone who’s
at high risk of a serious infection.

If we’re all likely to get covid at some point, should everyone still try to avoid it?
Wachter thinks so, and called for individuals to take precautions—masks, tests,
steering clear of large indoor gatherings—in places where the coronavirus is highly
prevalent. “For me at least, the long-covid risk makes the benefits of reasonable
amounts of caution outweigh the downsides, but I could see others making different
choices,” he told me. “In the future, antivirals are likely to get better. Vaccines may
be better. We’ll understand more about long covid and how to manage it. At some
point in my life, I know I’m going to get some terrible disease, whether covid or
something else. I’d like it to be as far down the road as possible.” He pointed to a
recent estimate from the C.D.C. that nearly sixty per cent of Americans have been
infected by the coronavirus, which suggests that more than a hundred million
Americans have not.

The virus will continue to evolve, but so will our tools for fighting it. “It’s going to
be innovation, not behavior change, that gets us out of this mess,” Topol, the Scripps
director, told me. “You can’t keep people in a cave forever.” Topol fears that a future
variant will be more virulent. “It pains me to say it, because I’m an optimist,” he
said. But he argued that the U.S. still has the power to change the course of the
pandemic, by continuing to invest in scientific research.

So far, new variants have tended to become more transmissible and better at getting
around our immune defenses, but not more lethal. This makes sense from an
evolutionary perspective—the virus faces selective pressure to find new ways to
spread, not kill—and sars-CoV-2 could go the way of other coronaviruses that cause
the common cold. Then again, it might not. “People have this delusional idea that
somehow the variants are just going to get milder over time—wrong!” Topol said.
“They could easily become more pathogenic.” He pointed out that, compared with
prior variants, Omicron has spawned more sub variants, which are chipping away at
the “immunity wall” of vaccination.

In addition to advances such as better antiviral drugs, several types of vaccine

innovations would be especially valuable. The first is a universal coronavirus
vaccine. Such a vaccine could potentially give us some immunity against all
sars-CoV-2 variants, as well as other coronaviruses. (A research group at the
California Institute of Technology, for example, has used a vaccine platform called a
“mosaic nanoparticle,” which incorporates proteins from up to eight types of
coronaviruses and has shown promising results in mice.) A second transformative
innovation would be a vaccine that produces “sterilizing immunity”—that is, in its
ideal form, an antibody response so potent that it prevents the pathogen from
infecting and reproducing within us at all. This would dramatically slow the spread
of the virus, but, for covid-19 and many other pathogens, sterilizing vaccines have
remained elusive. A vaccine that’s sprayed into the nose might be one path toward
something closer to it. Because nasal vaccines produce high levels of antibodies
inside the nose, where the virus often enters the body, they could be more effective at
preventing infection altogether. There are now three such vaccine candidates in
late-stage clinical trials; they present the body with many viral proteins, not just the
spike, and could therefore produce broad, variant-resistant immunity. “Many people
have needle-phobia and would probably say, I don’t want any more booster shots, but
I wouldn’t mind taking a nasal spray every four-to-six months,” Topol told me. “We
should be getting the nose and mouth Teflon-coated.” He’s troubled by a “profound
lack of investment” in these kinds of advances.

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Most pandemics come to an end. They can end biologically, in the sense that
infections slow to a trickle or cause less and less harm, according to Nicholas
Christakis, a Yale physician and sociologist who wrote “Apollo’s Arrow,” a book
about how pandemics change societies. They can also end socially. “Humans are
animals capable of social construction: we can define away the problem,” Christakis
told me. We can convince ourselves that a new, higher level of preventable death is
acceptable, and turn our attention to something else. “As bad as covid has been, it
could have been much worse,” he added. “covid’s relative mildness, compared to
smallpox or bubonic plague or cholera, gives us the luxury of moving the social end
earlier in chronological time.”

We often think that the covid-19 pandemic is unique because scientists were so quick
to influence its biological end, by developing vaccines and therapeutics at an
unprecedented pace. But it is also unique in its social dimensions. Never before have
we tracked a pathogen’s every mutation in real time, shared so much information and
misinformation about it on social media, stalked its daily, even hourly, spread from
one place to the next. The abundance of data has allowed different people to tell
different stories about the pandemic. In the U.S., the pandemic is not the emergency
it once was, but neither is it over. A subacute condition may be less dramatic, but no
less damaging. It requires care, attention, and investment. If Americans decide too
soon that the pandemic has come to a social end, we may risk pushing its biological
end further away. Where we go from here depends on the narrative we construct
next.
Seeing America, Again, in the Texas
Elementary-School Shooting
Nineteen children and two adults were murdered in Uvalde. This is the country
that gun-rights advocates have chosen.

People wait to hear news after the mass shooting at Robb Elementary School, in Uvalde, Texas.

On Tuesday, the Federal Bureau of Investigation released a report titled “Active

Shooter Incidents in the United States in 2021,” which logged sixty-one mass
shootings last year. The deadliest of these was at a supermarket in Boulder, Colorado,
where ten people were killed, a death toll that was matched ten days ago, at a
supermarket in Buffalo, New York, and then exceeded, at Robb Elementary School,
in Uvalde, Texas, where an eighteen-year-old shot and killed nineteen children and
two adults. Early reports indicate that he used a handgun and a rifle. Families who
gathered at the local civic center, which was used as a reunification site, were asked
for DNA swabs to assist investigators in identifying their loved ones. The shooting
began around eleven-thirty in the morning; as darkness fell, many families were still
waiting outside the civic center, without word of their children.

This is the second-deadliest K-12 school shooting in U.S. history, after the
December, 2012, massacre at Sandy Hook Elementary School, in Newtown,
Connecticut, where twenty children and six educators were killed. Eventually, Sandy
Hook also came to be seen as the graveyard of the gun-control movement: in 2013, a
new assault-weapons ban, and also a bill to require universal background checks for
firearm sales, failed in the Senate. If an entire classroom of dead first-graders could
not spur even remedial action in Congress on gun control, nothing would. And
nothing has.

A few months after Sandy Hook, the agitprop-documentary-maker Michael Moore,

writing in HuffPost, imagined a scenario in which the parents of the victims leaked
photographs of the classroom crime scenes to the press. If that were to happen,
Moore argued, the horrifying images would have the same galvanizing effect on
activist movements and public opinion as those of Emmett Till, in 1955, or Phan Thi
Kim Phúc, in 1972. “There will be nothing left to argue over,” Moore wrote. “It will
just be over. And every sane American will demand action.” (Just like that!) Sandy
Hook parents swiftly shut Moore down, but there was a kernel of sense in his
proposal—he was grasping for some method of defibrillation for a movement in
arrest. Published images that represent school shootings are always heartrending and
always the same: the surviving children filing out, some in tears, others in shock and
excitement; the desperate parents; the sorrowful reunions. One of the many
unforgivable obscenities of America’s gun obsession is how it can render the image
of an anguished child and her caregiver, captured in real time as they absorb a
life-altering trauma, as commonplace, interchangeable, even banal. Wait, which one
is this again?

On Tuesday night, the poet Jana Prikryl shared the “Alas, poor country” passage
from “Macbeth,” in which Ross laments that Scotland has become not a place to live
but merely a place to die: “Almost afraid to know itself. It cannot / Be call’d our
mother, but our grave . . . where violent sorrow seems / A modern ecstasy.” A
modern ecstasy—and a habit, or a ritual, with its attendant ceremonies and scripts
and rites. These always include cut-and-paste expressions of sympathy and concern
from various bridesmaids of the National Rifle Association. Mitch McConnell, the
Senate Minority Leader—who once said, following a school shooting in his home
state of Kentucky, “I don’t think at the federal level there’s much that we can do
other than appropriate funds” for school safety officers and counselling—tweeted
that he was “horrified and heartbroken” by the tragedy at Robb Elementary School.
Ted Cruz, the junior senator for Texas—who once ran a campaign ad that boasted,
“After Sandy Hook, Ted Cruz stopped Obama’s push for new gun-control
laws”—tweeted that he and his wife were “fervently lifting up in prayer the children
and families in the horrific shooting.” Governor Greg Abbott—who last year signed
seven pieces of gun-rights legislation into law, including one that permitted Texans to
carry handguns without a license and another exempting the state from future federal
gun restrictions—said that he and his wife “mourn this horrific loss and we urge all
Texans to come together to show our unwavering support to all who are suffering.”

Politicians like these are routinely criticized for their hypocrisy and empty
gestures—their “thoughts and prayers.” But, if only for the sake of rhetorical
hygiene, we should go a step further. Republicans, as we know, get what they want. It
is their best feature. They have vacuumed up the state legislatures, gerrymandered
much of the country, stacked the Supreme Court and the federal judgeships, turned
back the clock on L.G.B.T.Q. rights, paralyzed entire school districts with engineered
panics over critical race theory and “grooming,” ended (or so it seems) reproductive
rights as a constitutionally guaranteed freedom, and blocked all attempts at
gun-control legislation. If the leaders of this political movement, which in Texas
managed to ban most abortions and criminalize health care for trans kids in the space
of a school year, took real offense to murdered children, they would never simply
accept their deaths as the unfortunate cost of honoring the Founding Fathers’ right to
take up muskets against hypothetical government tyranny. They would act. If
America were not afraid to know itself, we could more readily accept that gun-rights
advocates are enthralled with violent sorrow. This is the America they envisaged. It is
what they worked so hard for. Their thoughts and prayers have been answered.