As millions of Americans cast off their masks and a summer of close-to-normalcy approaches, I spoke with New York editor-at-large David Wallace-Wells about the current and future state of the pandemic in the U.S.
Ben: COVID cases are plummeting across America. Death numbers are ticking down day after day, albeit slowly. And after being accused of being overly conservative with its mask guidance, the CDC said to hell with it on Thursday, and advised that vaccinated people can go mask-less in most indoor settings, as well as outdoors. That move, perhaps more than anything, makes it feel like the pandemic as we know it is really on the way out — even as it rages in other parts of the world, particularly India. Is there anything not to like about current COVID trends in the U.S.?
David: The trends are good, especially with warm weather coming. The levels aren’t great — less than half of Americans have been fully vaccinated. (About 45 percent of adults.) That’s a lot of vulnerable people left out there.
The trajectory of cases and deaths is very encouraging — we just hit levels we hadn’t seen since last April, and that progress has been especially good news given that it’s happened while we’ve seen the arrival and growth of all these “variants of concern.” For the time being, at least, it seems that the vaccination program is outracing the variants. But to get all the way back to a true pre-pandemic normal — not just a low level of infection and dying that we sort of collectively decide is no big deal — is going to take considerably more vaccine uptake than we have today. And that uptake is slowing now, not accelerating.
I do think the summer is going to be a great relief, especially for those people who’ve been vaccinated. But there are more holdouts than I’d like. In the fall, I worry those people will be vulnerable again, and that those who have been vaccinated will regard them with a kind of pandemic schadenfreude — i.e., that they don’t deserve our sympathy, that their getting ill or even dying “serves them right.”
Ben: You wrote back in February that “the second year of the American pandemic is beginning to look less like a page-turning, book-slammed-shut bang and more like a long and indefinite whimpering into the future — in which many are protected but the disease, undefeated, still circulates, perhaps forever.” Have you changed your view between now and then about COVID’s future tenacity? One of the big, still-looming questions is whether any current or future “variants of concern” could break through the vaccines we have.
David: It’s probably best to think of these things not in binary terms. The variants of concern do seem to reduce the efficacy of vaccines — though to what extent they do, and especially to what extent they manage to produce severe disease in people who’ve been vaccinated, remains an open question. As I understand it, our best evidence suggests the effect is really on the margins, meaning that even against the scariest variants the vaccines we have comfortably meet the thresholds set by the FDA for efficacy before clinical trials began. In other words, even when compromised somewhat, the vaccines still very much “work.” But if a vaccine’s efficacy is reduced from 95 percent to 85 percent it makes it much harder to get enough population immunity to snuff the disease out completely, which brings us to the scenario I sketched out in February: that rather than truly disappearing, the disease just sort of recedes, infecting some number of people and probably killing some of them, too, but far, far fewer than in any of the scary waves we’ve seen to this point. Presumably, at that point, we’ll choose to functionally declare the pandemic “over,” even if technically it isn’t.
To be clear: I’m not suggesting that we’re going to see this summer — or even this fall or winter — levels of infection or dying like we saw last summer or fall or winter. But we’re almost certainly not going to get those figures all the way to zero, and there is always the risk of more variants popping up, perhaps even scarier than the ones we’ve encountered so far. I think some of the new messaging we’ve gotten about best practices follows this logic: For much of the pandemic, the CDC was essentially advising that no risk level was acceptable. Its recent moves suggest a more broadminded approach to COVID risk, in which some tiny fraction of infection risk is worth taking for a return to “normalcy.”
Ben: So we might not squash this version of COVID entirely. But what’s the chatter out there in science-land about whether the virus will become a recurring, yearly phenomenon, like the flu? And is it thought that the rate of vaccination among Americans over the next few months will actually play a role in whether we see the virus again in future years?
David: In general, I think people are reluctant to make hard and fast predictions, but barring the arrival of a dramatic new variant that wipes out most or all of existing immunity, from infection of vaccination, I think the likely endgame is COVID-19 as an endemic disease, circulating in much the same way that the common cold or flu does today. It will probably be seasonal, and it will likely have a nonzero impact on our public health, including likely killing some Americans every year — but in numbers so much smaller than what we saw this past year that it amounts almost to a different scale of disease threat. With total vaccine uptake, we could probably get to that point very soon; without it, we may have another in-between sort of year, when the disease isn’t nearly as worrying as it has been over the past 15 months but also hasn’t become as much of an afterthought as the common cold or flu is today.
But of course, this is not just an American pandemic, and the longer it takes the rest of the world to be vaccinated the more chances there will be for more worrying variants to arise. Presumably, even if a new variant does emerge, we will be much better prepared to protect the most vulnerable — the very old — without necessarily upending the entire life of the country. Though of course a lot depends on the particular characteristics of the variant. But in the big picture, my view is: We’re not going to reach the threshold of true herd immunity, but in terms of what that means in the day-to-day lives of vaccinated Americans … not much. For them, things will start to seem much more normal, and much more safe, very soon.