Americans are still living with a 2020 attitude to COVID-19 risk. It’s time for that to change

As the pandemic has evolved and most Americans have sought vaccines for protection, and as those who chose to forgo vaccination became infected (often more than once), the risk that COVID-19 poses to most Americans has decreased. . It is estimated that more than 90% of Americans have some degree of immunity to COVID-19 through vaccination or previous infection.

Along with this wall of immunity, approaches adopted when we had limited resources to prevent spread no longer offer benefits that always justify the costs of social disruption, diminished classroom experiences and economic barriers.

But we’ve been slow to adapt our strategies to evolving notions of risk. The CDC is soon expected to update its policy, moving away from national recommendations and instead linking it to measures of local prevalence, its guidelines for the protective measures people should take. This standard per community may not be sufficient. We turned restrictions on, but not turned them off because circumstances changed. In many cases, that’s because we still rely on the same metrics we used at the start of the pandemic. These concepts for measuring risk have remained largely established ever since, even as people were given protection against the virus.

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At the beginning of the pandemic, we had a shared awareness of the threat and a shared willingness to sacrifice a lot to deal with it. As the pandemic has evolved and the burden has increased, that social pact has frayed. Now we need to move from collective action to tactics taken individually by people who weigh their own individual risk against their degree of caution. This means that we have to accept more regional and local variation in measures taken at the state level. The role of government will be to ensure that people have the tools they need to make those choices.

Steps that were critical in 2020 to reduce mortality and pressures on the healthcare system when we were overwhelmed are no longer justifiable. But which anchors that change? Even when actions were adjusted based on risk, in many cases it came too slowly. Without intentional signposts, it’s hard to gauge why one attitude has to give way to another and how to make those decisions.

We will never go back to many of the tragic steps we had to take in the spring of 2020 when we were overwhelmed by the first wave of the virus. Use the 45 days to slow the spread of President Donald Trump to try to reduce that devastating first wave. When we think about those extreme measures, today it’s hard to remember how bad it was then because we haven’t anchored the debate in a consistent degree of danger and recovery.

New York City’s health care system had all but collapsed. We used hospital ships and triage tents set up in Central Park to try to control a devastating cascade of disease and death. The White House correctly ruled that if other American cities fell, the nation would be overwhelmed. At the time, a White House official told me that in such a circumstance, the federal government would be tapped and another city would not be able to give the “New York treatment.” It was a reference to the extraordinary support New York was getting. The comment stuck with me.

Read more: The Omicron wave is receding, but the pandemic is far from over

Remember, the CDC failed to run a diagnostic test that could tell us where COVID-19 was spreading and where it hadn’t yet arrived, so we couldn’t focus our steps on the cities where the virus was already epidemic. We didn’t know where COVID-19 was, or where it wasn’t. We misjudged the magnitude of the seeding going on in cities like New York and Seattle. People still claimed that COVID-19 was no worse than the flu, with a death rate of 0.1 percent. By July 2020, when that first wave had subsided, 0.25 percent of New York City’s entire population had died from COVID-19, but only one-fifth of the city’s residents had been infected.

The risk of COVID-19’s ongoing march was a catastrophic prospect. Our tools to limit its spread did not exist. And our vulnerability seemed limitless. We had no immunity. We had no effective drugs. We didn’t know how to properly care for the patients admitted to our ICUs. We had to slow down the spread and gain some time to get our response in place. At the peak of the epidemic in the winter of 2020, more than 6,000 people in the US died each week in nursing homes alone.

That was 2020.

Now, in 2022, we need to put those 2020 thoughts about risk behind us. What was rated as “moderate” prevalence at this time last year, when we were largely unvaccinated, may be the new “low” when our vulnerability has decreased. Especially as we are faced with a more transmissible but less severe strain like Omicron.

Since then, more Americans have gained immunity through vaccination and successive waves of infection. By some estimates, nearly 70% of Americans have been infected at least once. About 87% of adults have had at least one dose of vaccine. We have a growing stock of therapies that can treat the sick and significantly reduce the risk of hospitalization or death. The US will soon produce nearly half a billion “at-home” COVID tests each month. We have also seen dramatic progress in our care for the sick.

Still, many of the other structures have remained in place even as the Omicron wave began to subside. Until recently, many children in schools still wore a mouth cap, without an agreed standard for when that will stop. When Omicron reached its peak, some schools went back to distance learning. Offices are closed in many major cities. Some states and companies are still mandating vaccines, in an effort to force fewer vaccines at the cost of mounting bitterness, even though many of the unvaccinated are likely infected, some more than once.

Read more: Why the number of COVID-19 cases no longer means what they used to be

Public health trust has been tarnished because we’ve been too slow to adapt the steps we take to changing perceptions of risk. Some people take their own steps to reduce their risk and voluntarily choose to avoid gatherings, wear masks, and take other precautions. Many people are extremely vulnerable to COVID-19 because of their age or health conditions, and those who continue to worry must have access to resources and support to stay safe. There is understandable concern among parents who are torn between fear of the virus and steps to keep children, especially toddlers, safe. But for those more confident in diminishing risks, we can only ask so much of the public for so long. There is an accumulated effect of the disturbances. People are exhausted. People’s livelihoods and mental health have been damaged by the reduced lives we have had to compromise with. Many children have not had a normal school day for two years. The constant disruptions take a cumulative toll. We never agreed that the costs outweigh the benefits. The problem is, we can’t measure these compromises, and no framework for deciding when to turn things on and, just as importantly, turn them off.

Take the pandemic and endemic debate. There is no clear nomenclature for what it will mean if the virus becomes a persistent but manageable risk that does not dominate our lives. Public health leaders have different definitions of what it means when the pandemic gives way to an endemic state, in which COVID-19 is part of the predictable repertoire of circulating pathogens. The easiest way to define that transition is when constant waves of excessive infection no longer plague the country, and COVID-19 settles into a more predictable pattern that follows the seasons. Some, including me, think 2022 will be the year we make this transition. Others still rate the risk so high that another unexpected variant pops up and shatters that prediction.

Regardless, it remains an ongoing and ongoing risk and requires us to be more vigilant for respiratory illnesses, especially in winter when these pathogens are most susceptible to circulating. We need to protect environments where vulnerable people gather and create incentives for people to stay up to date on vaccines. We need to improve air quality and filtration in indoor environments. We need to ensure broad access to testing and create new cultural norms around staying home from work or school when you’re not feeling well. We need to widely distribute home diagnostic tests so that consumers always have a small supply on hand. Masks could be used on a voluntary basis and become a tool for certain situations and for short periods of time, to deal with epidemic peaks. We must also continue to innovate and invest in therapies that can treat the sick and ensure their wide distribution.

But as long as we’re stuck in a 2020 doctrine for measuring prevalence and how it correlates with risk, we won’t be able to adapt public health measures to the ebb and flow of the virus, or find a common touchstone. for managing risks in our lives.

COVID-19 will remain a terrifying virus for the foreseeable future, but one that we must learn to live with. Federal health officials have guided us through one of the most difficult periods in our nation’s modern history, helping to preserve life, even as we lost more than 900,000 of our fellow citizens.

We have gradually found a way to coexist with this virus. Now we need a glide path to what becomes normal and a new math to guide how we adapt to COVID-19, even if we never fully beat it.

This post Americans are still living with a 2020 attitude to COVID-19 risk. It’s time for that to change

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