A realistic Covid-19 endgame requires accepting some risk. The question is how much.
A realistic Covid-19 endgame requires accepting some risk. The question is how much. More than a year and a half into the Covid-19 pandemic, America still doesn’t agree on what it’s trying to accomplish. Is the goal to completely eradicate Covid-19? Is it to prevent hospitals from getting overwhelmed? Is it hitting a certain vaccine threshold that mitigates the worst Covid-19 outcomes but doesn’t prevent all infections? Or is it something else entirely? At the root of this confusion is a big question the US, including policymakers, experts, and the general public, has never been able to answer: How many Covid-19 deaths are too many? The lack of a clear end goal has hindered America’s anti-pandemic efforts from the start. At first, the goal of restrictions was to “flatten the curve”: to keep the number of cases low enough that hospitals could treat those that did arise. But that consensus crumbled against the reality of the coronavirus — leaving the country with patchwork restrictions and no clear idea of what it meant to “beat” Covid-19, let alone a strategy to achieve a victory. The vaccines were supposed to be a way out. But between breakthrough infections, the risks of long Covid, and new variants, it’s becoming clear the vaccines didn’t get rid of the need to answer the underlying question of what the Covid-19 endgame is. America is now stuck between those two extremes: The country wants to reduce the risk of Covid-19, but it also wants to limit the remnants of social distancing and other Covid-related restrictions on day-to-day life. “We’re not trying to go for zero Covid,” Ashish Jha, dean of the Brown University School of Public Health, told me. “The question becomes: When do, in most communities, people feel comfortable going about their daily business and not worrying, excessively, about doing things that are important and meaningful to them?” Will Americans accept the deaths of tens of thousands of people, as they do with the flu, if it means life returning to normal? Can the public tolerate an even higher death toll — akin to the drug overdose crisis, which killed an estimated 94,000 people in 2020 — if that’s what it takes to truly end social distancing and other precautions? Does it make a difference if the vast majority of deaths are among those who are willingly unvaccinated, who, in effect, accepted a greater risk from the coronavirus? Are further reductions in deaths worth postponing a return to “normal” — or changing what “normal” means — if continued precautions are mild, like prolonged masking or widespread testing? There are no easy answers here. Even among the experts I’ve spoken to over the past few weeks, there’s wide disagreement on how much risk is tolerable, when milder precautions like masking are warranted, and at what point harsher measures, like lockdowns and school closures, are needed. There’s not even agreement on what the endgame is; some say that, from a policy standpoint, the goal should be to keep caseloads manageable for hospitals, while others call for doing much more to drive down Covid-19. One big problem identified by experts: “I don’t think we’re having those conversations enough,” Saskia Popescu, an infectious disease epidemiologist at George Mason University, told me. Instead of the public and officials openly discussing how much risk is acceptable, the public dialogue often feels like two extremes — the very risk-averse and those downplaying any risk of the coronavirus whatsoever — talking past each other. But the path to an endgame should begin with a frank discussion about just how much risk is tolerable as the coronavirus goes from pandemic to endemic. We’re looking for a balancing act, not a total end to Covid-19 If there is one point of agreement among most experts, it’s that Covid-19 is here to stay. “Until very recently, I was hopeful that there was a possibility of getting to a point where we had no more Covid,” Eleanor Murray, an epidemiologist at Boston University, told me. Now she believes that “it is infeasible, in the short term, to aim for an eradication goal.” Particularly with the rise of the delta variant, a consensus has formed that the coronavirus likely can’t be eliminated. Like the flu, a rapidly shapeshifting coronavirus will continue to stick around in some version for years to come, with new variants leading to new spikes in infections. Especially as it becomes unlikely that 100 percent of the population will get vaccinated, and as it becomes clear that the vaccines provide great but not perfect protection, the virus is probably always going to be with us in some form, both in America and abroad. That doesn’t mean the US has to accept hundreds of thousands of deaths annually in the coming years. While the vaccines have struggled at least somewhat in preventing any kind of infection (including asymptomatic infection), they have held up in preventing severe illness, hospitalization, and death — reducing the risk of each by roughly 90 percent, compared to no vaccine.
