November 11

America Has Lost the Plot on COVID We’re avoiding the hardest questions about living with the coronavirus long term. ........ We know how this ends: The coronavirus becomes endemic, and we live with it forever. ........ How do we manage the transition to endemicity? When are restrictions lifted? And what long-term measures do we keep, if any, when we reach endemicity? ......

The answers were simpler when we thought we could vaccinate our way to herd immunity.

....... The Delta variant and waning immunity against transmission mean herd immunity may well be impossible even if every single American gets a shot. ....... The path ahead is not just unclear; it’s nonexistent. We are meandering around the woods because we don’t know where to go. ......... Even when we reach endemicity—when nearly everyone has baseline immunity from either infection or vaccination—the U.S. could be facing tens of millions of infections from the coronavirus every year, thanks to waning immunity and viral evolution. (For context, the flu, which is also endemic, sickens roughly 10 to 40 million Americans a year.) ......... COVID-19 policies differ wildly by state, county, university, workplace, and school district. And because of polarization, they have also settled into the most illogical pattern possible: The least vaccinated communities have some of the laxest restrictions, while highly vaccinated communities—which is to say those most protected from COVID-19—tend to have some of the most aggressive measures aimed at driving down cases. ........ We don’t know how much immunity may continue to wane, how long the effects of a booster last, the exact incidence of long COVID in the vaccinated, or if a new variant will upend even the best-laid plans. .......... One plausible goal is to focus on minimizing COVID-19’s impact on hospitals. A collapsed health-care system means more people will die, not just of COVID-19 but from other treatable diseases and injuries. ........... By the time hospitalizations start to rise, a bigger increase may already be baked in with people already infected but not yet sick enough to see a doctor. ......... COVID shots for kids 5 to 11 were authorized last week, and data for those ages 2 to 4 are expected before the end of the year. ........ Vaccinated parents, living with vaccinated children, who have vaccinated grandparents, can worry that much less about the virus’s worst impacts, and start behaving less cautiously. ..........

The risk of hospitalization for an unvaccinated person over 80 is 25 times that for an unvaccinated person under 18.

...... two communities with 90 versus 99 percent of the elderly vaccinated actually have a tenfold difference in the number of people at risk for hospitalization. ......... Even when the coronavirus is endemic, it will still make people sick and it will still cause deaths and hospitalizations. That means our fight against COVID-19 is not over, and we might consider strategies sustainable over the long term. Better ventilation, for example, can make indoor spaces safer against all respiratory viruses, not just COVID-19. And even without mask mandates, people who feel at risk can still voluntarily mask up. In the longer term, Çevik says, we also need less focus on policies that work by “reducing small risks among many” and more on policies targeted at the people most affected by COVID-19. During the pandemic, the virus has disproportionately sickened people who are poor, who are less likely to be able to work from home, and who are less likely to have space to isolate from their family at home. When COVID-19 becomes endemic, it will likely, as many diseases are, continue to be correlated with poverty.

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