After 18 months of being stuck in our homes—if we were lucky enough to do so—and being surrounded by death and suffering, we are all ready to move past this pandemic. The vaccines offered hope for this in the spring—it seemed that by summer the virus would be at low levels and people could safely gather again. Then the Delta variant, combined with lackluster vaccination levels and a disastrous CDC guidance that told vaccinated people they could remove their masks indoors and dispense with social distancing, led to major setbacks. These factors combined to create a perfect storm of rising infections, hospitalizations, and deaths. As a result, despite having plentiful supplies of vaccines, as of early September, the United States is seeing more than 1,000 deaths a day.
As we try to navigate this latest surge, when some of us are protected and others remain completely vulnerable, a talking point has begun to circulate among journalists and public health experts: that we need to learn to live with the virus. According to this view, the virus will eventually become endemic—it will still exist, but as rates of immunity in the population increase as a result of prior infection and vaccination, it will cause only cold-like symptoms in those who do get infected. We will learn to live normal lives again with that small risk. But while it is helpful to have a sense of how the pandemic will play out, such a prognostication may be a little hasty. Widespread immunity and less severe symptoms may be inevitable, but we don’t know how many people will die or be left with long-term symptoms—that will be determined by our nation’s ongoing response to the pandemic, or lack thereof.
Conservative politicians like Florida Governor Ron DeSantis, the academics associated with the controversial Great Barrington Declaration—which called for the virus to circulate with no real mitigation other than the focused protection of vulnerable populations—and some journalists argue that learning to live with the virus means accepting the risks as they are today. They claim that vaccination protects individuals sufficiently from death and hospitalization and that anyone who wants a vaccine has gotten one; vaccinated people can therefore return to normal life, and unvaccinated people can deal with the risks.
But while it is true that vaccines reduce an individual’s risks significantly, we cannot exit this pandemic individually. The risk of long Covid is 50 percent lower for vaccinated people than for unvaccinated people, but if we fail to mitigate the current high rates of community spread, breakthrough infections will be more common and more people—even vaccinated people—will face long-term complications.
This past summer, we saw the consequences of a premature return to normal life. Both unvaccinated people, who remain at much greater risk of hospitalization and death, and vaccinated people contributed to the spread of the virus as the use of masks disappeared overnight in many places. Pediatric cases of Covid skyrocketed because most children aren’t vaccinated yet. Hospitals became overwhelmed, mostly with unvaccinated patients. In the South, where vaccination rates are lower, non-Covid patients find themselves without a hospital bed, whether they are vaccinated or not. Of course, this puts immunocompromised people (for whom vaccines are less effective) at risk as well. Ignoring the virus is untenable.
A lot of discussions about the pandemic focus on returning to normalcy, proposing to relax restrictions and preempt the implementation of new measures. Instead, the goal should be to keep infections at a low level. This means we must accept that Covid will be a dangerous part of our lives for the near future and make plans based on that fact.
Learning to live with the virus is not an individual state of mind—it calls for a robust policy response. This will require two steps: reducing the rate of transmission and making sure we can contain outbreaks as they occur. To control transmission, we need to return to the measures we used early in the pandemic, which include mandating masks and issuing a stay-at-home guidance. But this time we need to pay people to stay at home for one or two months, which is especially urgent as enhanced unemployment benefits expire. Only seven states and a few cities have mandated masks, despite the fact that the CDC changed its guidance and now recommends that vaccinated people wear masks indoors. Vaccinations need to be ramped up with a thorough campaign that funds community outreach operations, publicly addresses concerns, and mandates vaccine sick leave.
Once community transmission is lower, we will need to make significant investments to keep it that way. Just as the Great Depression demanded the creation of temporary federal agencies, a Pandemic Response Agency should be created to manage funding and personnel for test-and-trace operations, quarantine housing, free masks, and ventilation upgrades to schools and other buildings. It must also ensure that the funds are actually being used. The American Rescue Plan made funds available to schools, but billions have yet to be spent. The ARP also provided funds to improve test-and-trace operations for vulnerable populations and to cover testing for the uninsured. Yet there is still insufficient capacity to properly test and trace new infections. For now, testing is mainly a way for people to check their own status, not part of a robust infection control strategy.
Many of our schools require ventilation upgrades, and some have no HVAC systems at all. Our public health departments face staff shortages and funding cuts. A dedicated federal agency could procure tests and masks and provide them directly to people, even in states whose leadership is opposed or unhelpful. It could also coordinate upgrades to schools’ ventilation systems and rebuild public health departments.
Despite initially trying to project a measure of optimism, the White House seemingly cannot ignore the Delta variant any longer. It has announced measures including reducing the cost of rapid tests, sending free tests to food banks and health clinics, and mandating an OSHA standard that requires employers of 100 or more workers to vaccinate or test weekly. But these measures are still insufficient. Rapid tests will still be too expensive for daily use for many Americans, and the OSHA standard leaves out measures like ventilation and masking to protect employees. A more ambitious response may seem politically unfeasible, but times like this demand the impossible.