Even as cases decline again and vaccination numbers rise, a once-unthinkable idea is breaking through any assumptions that we would vanquish COVID-19. Dr. Anthony Fauci laid it on the line at a White House press briefing this month: “It is going to be very difficult — at least in the foreseeable future and maybe ever — to truly eliminate this highly transmissible virus.” That SARS-CoV-2 could be with us forever is a dark thought. But pulling that mental lever may be just what we need to organise effectively for the very long haul, dramatically improve our pandemic response and embed safeguards into our everyday lives. “It’s an unpleasant message,” said Dr. Matthew Hepburn, who, since we spoke, has become a special adviser at the White House Office of Science and Technology Policy. “We all want it to be over. But contingency planning for long-term response is absolutely essential.”
Indeed, optimism could serve as “one of the biggest obstacles” to making those plans, said Dr. Jeremy Farrar, the director of Wellcome, a health foundation in London. If we think COVID-19 is going away, then we will drop our guard and not make essential investments now. Rather than debate how to end the pandemic, we need to debate how to live with it. “We have to start thinking, planning and coming to grips in every way that this is now a human endemic infection and it’s never going to go away,” said Dr. Farrar. What could a future with COVID-19 look like? To answer that, I turned to Ali Mokdad, the chief strategy officer for population health at the University of Washington. An epidemiologist and statistician, he began the business of projections for his hospital system at the start of the pandemic: How many beds would it need to care for infected patients? With a 15-person team, he did the math.
Now, with a 60-person team and 7,700 global collaborators, he is releasing projections of the pandemic’s spread four months out for every country in the world, as well as sharing his pandemic models with the White House COVID-19 task force and others.
From his unique vantage point, Dr. Mokdad can literally map how our desire to prematurely claim victory, rather than accept the virus’s continuance, has led us to throw off restrictions, with deadly effect. He just revised his projected body count for the United States upward, to at least 828,000 total pandemic deaths by Feb. 1, 2022. Masks, which so many Americans abandoned when it seemed the end of the pandemic was in sight, could still make a difference: If 95 percent of Americans wore a mask, his model projects roughly 56,000 fewer deaths by Feb. 1. In the more distant future, Dr. Mokdad does not see “independence from a deadly virus,” to quote our president. “We would expect that the transmission will never go to zero,” Dr. Mokdad told me. “The virus is going to be with us for a long time” — meaning that deaths, and efforts to prevent them, could continue for years. Serious people are now trying to plan for what living with SARS-CoV-2 will look like, a potentially bleak exercise but one also brimming with scientific promise.
An escape variant — one so infectious that it escapes our best mRNA vaccine defenses — is not a certainty, said the experts with whom I spoke. But it is not far-fetched, either, in part because of our slow pace at vaccinating the world. That worst-case scenario could “change the whole landscape,” said Dr. Eric Topol, a professor of molecular medicine at Scripps Research, putting us “back to square one, with masks and distancing our only defense.” But it can be avoided, he and others said. Embracing the COVID-forever possibility is our best path forward, said Dr. Farrar of Wellcome. That mind-set is not only a crucial hedge against complacency, in which we settle for the good-enough defenses we have now. It could drive us to capitalise on the extraordinary scientific progress of the past year. In years to come, perhaps we could have the ultimate moonshot coronavirus vaccine, one that blocks transmission of all coronaviruses (a massive challenge because of their genetic differences).
The vaccine could be a single dose stored at a modest temperature, be “cheap as chips,” said Dr. Farrar, and be available to everyone in the world. We could have unlimited oxygen and protective gear in every hospital. With the right investment, says Dr. Farrar, we could even roll out a whole new time frame: release a genomic sequence on Day 1 of identifying it, develop a responsive vaccine within seven days and begin shots in arms within a month. On Sept. 3, the Biden administration released a pandemic preparedness plan that, though somewhat less aggressive, calls for slashing the timeline for creating and scaling up a vaccine from under a year to under 100 days. As we come to terms with COVID forever, what might our daily lives look like? Will all-day masking in schools and offices continue indefinitely? Will we have to pare back our holiday party guest lists for years to come? Will home testing before any social gathering become de rigueur? Will vending machines in every subway station carry cheap KN95 masks? Given the viral U-turns of the past 20 months, some experts I spoke with seemed wary of detailed predictions. “Every morning, I scrape five inches of mud off my crystal ball,” Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me. “Any effort to predict a future course beyond 30 days relies on pixie dust for its basis.” But others, including Dr. Mokdad, envision flu-like seasonal surges of COVID-19, accompanied in some years by heavy death tolls. Those could lead us to mask up seasonally, get an annual vaccine as we head into the winter months and make ongoing improvements to ventilation in critical public spaces like transportation hubs.
In that scenario, our lives would not return to a pre-pandemic normal. Instead, the biggest shift in our new normal could be a growing societal embrace of protective measures, rather than a continued war over school mask wearing or workplace vaccine mandates. “People are not stupid,” said Dr. Jeffrey Duchin, the chief of the communicable disease, epidemiology and immunisation section for public health in Seattle and King County. “They will come around to accept reality.” To him, the clashes over seatbelt wearing, and its ultimate acceptance, offer a useful comparison.
But it is important to note how far our definition of reality has shifted in the four short months since Biden’s hopeful Fourth of July speech. “No one is trying to eradicate COVID from the planet,” said Dr. Dara Kass, an associate professor of emergency medicine at the Columbia University Medical Center. “If that was a goal, that’s not the goal right now.” Instead, she said, “we’re trying to remove it from being a guiding force in our lives.” To do that, we have to face facts: COVID may well be with us forever.
Eban is an investigative journalist and the author of “Bottle of Lies: The Inside Story of the Generic Drug Boom.”
The New York Times