public health

America Can Get Back to Normal and Get Better at Fighting COVID

Get vaxxed. Photo: Al Seib/Los Angeles Times via Getty Images

Last week, the Democratic Party had its “mask off” moment. With voter support for COVID-19 mandates declining in tandem with case counts, the Democratic governors of New Jersey, New York, California, Connecticut, Delaware, and Oregon moved to relax their states’ public-health regulations. Federal regulators are now poised to follow suit. On Wednesday, the Centers for Disease Control and Prevention said it would soon issue new guidance that will “give people a break from things like mask wearing when these metrics are better.”

These developments have intensified blue America’s (already acrimonious) debate over how policy-makers should balance the competing goods of restoring normalcy and minimizing COVID deaths. The “vaxxed and relaxed” contend that the costs of stringent quarantine rules for asymptomatic schoolchildren, indoor mask requirements, and limited public services now outweigh their benefits. The Omicron variant is among the most contagious viruses in human history. Even the exceptionally robust and intrusive “COVID zero” policies of Hong Kong and China have proved incapable of preempting its spread. Blue states’ poorly enforced mandates are simply no match for the bug. Meanwhile, vaccines have exponentially lowered the risk that COVID poses to all who are willing to avail themselves of a free treatment available at nearly every drugstore in the country. And as Omicron ebbs, the risk to blue states’ hospital systems is relenting. This is not March 2020. As 70 percent of Americans recently said in a Monmouth University poll, “It’s time we accept that Covid is here to stay and we just need to get on with our lives.”

Those who favor maintaining non-pharmaceutical interventions, or NPIs, note that COVID is still killing close to 3,000 Americans every day. Masks and quarantine rules may not be sufficient to deter Omicron’s spread. But they help. And although the vaccines are effective at preventing severe illness, plenty of vaccinated individuals have perished from COVID, while millions of immunocompromised Americans enjoy only limited protection from their shots. The belief that it is worthwhile to accept minor infringements on one’s personal comfort for the sake of protecting the most vulnerable is — or should be — fundamental to the progressive ethos. Surely, it is not too much to ask Americans to continue wearing a facial covering while shopping so the immunocompromised may participate in public life without facing a greater risk of mortal illness than they do already.

Personally, I have quibbles with both sides’ arguments. In my view, some proponents of a “return to normal” understate the value of slowing Omicron’s spread. For example, Matt Yglesias has argued that the case for NPIs was much stronger before the advent of the vaccines than it is today, writing, “‘Don’t do X for some defined period of time after which X will become dramatically safer’ is a very different piece of advice than ‘don’t do X indefinitely.’” This is surely true. At the same time, it isn’t the case that, after the vaccines became widely available, the value of slowing COVID’s spread fell to zero. We now have breakthrough anti-viral medications that substantially reduce COVID’s lethality, but they are difficult to access because of limited supply. If we could sustain public buy-in for pandemic restrictions a little longer while ramping up anti-viral production, we could be in a position to normalize at lower cost in the near future.

On the other hand, I think COVID hawks can understate the costs of pandemic restrictions. Many progressives have expressed incredulity about complaints from the pro-normalization contingent, insisting that everything is already back to normal. But Social Security offices around the country remain closed, making it more difficult for their vulnerable constituents to secure benefits. Children who merely have close contact with a person infected with COVID can be expelled from a week of school or child care in some jurisdictions, disrupting their educations and their parents’ work schedules. And there is some evidence that constant masking in schools may impair child development by inhibiting the acquisition of face-reading skills.

Some pro-mandate rhetoric also strikes me as overheated. The Atlantic’s Ed Yong recently defended the notion that America’s lackluster efforts to protect the immunocompromised can be understood as a form of eugenics, writing, “When a society acts as if the deaths of vulnerable people are unavoidable, and does little to lessen their risks, it is still implicitly assigning lower value to certain lives.” I think American society is shamefully callous in its treatment of all manner of vulnerable groups including those most at-risk from COVID. But proponents of eugenics sought to improve society by encouraging the “fit” to reproduce while removing the “unfit” from the future gene pool. What made eugenic policies distinctive was not that they reflected an indifference to the fate of the vulnerable (something that could be said of a high percentage of all laws in the early 20th century) but that their primary purpose was to remove the genetically disabled and/or “racially inferior” from the human community. It is silly to suggest that parents who want schools to lift mask mandates are motivated primarily by a desire to cleave the unfit from America’s gene pool.

In any case, political reality looks poised to render much of this debate moot. While there is still significant public support for mask and vaccine mandates — in some surveys, majority support, depending on how the proposals are phrased — blue-state governors who have liberalized public-health regulations have seen little backlash thus far. As the change of seasons lowers case counts, the political momentum behind restoring normalcy is likely to grow stronger.

And yet just because policy-makers are slouching toward a “return to normal” does not mean they can’t do more to protect those most at risk. There are public-health measures that benefit the vulnerable at a cost to the convenience of Americans who are neither unvaccinated nor immunocompromised. But there are also plenty of policies that would reduce COVID deaths without disrupting normal life. The most tragic aspect of American policy during the Omicron wave might be that we’ve failed to do the (relatively) painless stuff.

If our concern is minimizing COVID deaths, few objectives are more important than triple-vaccinating the elderly. As The Atlantic’s Sarah Zhang writes, the biggest determinant of an individual’s vulnerability to severe illness from COVID is age. In fact, the salience of that variable dwarfs even that of cancer or immunosuppression. A person who is immunosuppressed is, in the aggregate, two to four times more likely to die from COVID than a person who is not. A person over 65, by contrast, is at least 65 times more likely to die of COVID than a person in their 20s. Roughly 93 percent of this year’s COVID deaths were suffered by people age 50 or older. And a huge percentage of those deaths are attributable to undervaccination.

Graphic: The Atlantic

During the Omicron wave, America has hit 80 percent of its pre-vaccine peak in daily deaths; in more heavily vaccinated countries, that figure has ranged from 20 to 30 percent. In England, 92 percent of those over 65 are vaccinated and boosted; in the U.S., that rate is 65 percent. As Zhang notes, the Centers for Medicare & Medicaid Services could nudge that rate up by incentivizing health-care providers, Medicare Advantage insurers, and nursing homes to maximize vaccine distribution by incorporating vaccination rates into Medicare’s “quality” ratings.

The undervaccinated elderly are scarcely the only at-risk population. This week, The Atlantic and the New York Times published excellent features on the plight of America’s immunocompromised. Roughly 7 million Americans take immunosuppressive drugs to combat cancers or autoimmune disorders or to prevent their bodies from rejecting transplanted organs or cells. The vast majority of this population enjoys some protection from vaccination. But that protection is more limited than that which the typical vaccinated American enjoys. For the most unfortunate, meanwhile, the vaccines themselves can be dangerous or ineffective. Many of the immunocompromised individuals who spoke with the Times and The Atlantic strongly support the continuation of indoor mask mandates at stores that provide basic necessities such as grocers and pharmacies. This strikes me as a reasonable request. At the very least, those inclined to mock or stigmatize those who appear excessively COVID cautious in public would do well to read these pieces and contemplate the plight of their subjects.

But many of the things the immunocompromised want impose no significant burden on normal life. They demand greater access to anti-viral medications, better ventilation systems in public buildings and businesses, and the continuation of remote-work options introduced during the pandemic. Investing in ramped-up anti-viral production would redound to the benefit of everyone vulnerable to a future COVID infection — which is to say, everyone. And raising ventilation standards would make all Americans less vulnerable to future flus, colds, and other airborne illnesses. Incentivizing companies to provide remote-work options to employees who can perform their work at home would benefit a wide swath of the labor force while mitigating traffic problems in many urban centers. Separately, economic policies that promote tight labor markets simultaneously encourage employers to find ways of accommodating disabled workers’ needs and give laborers of all kinds more leverage in their workplaces.

Happily, the Biden administration is pushing to make progress on some of these fronts. The White House told Congress on Tuesday that it is seeking $30 billion in new spending to combat COVID — including an $18 billion investment in anti-virals and vaccines — as part of the impending government-funding package. Republicans who insist that their hostility toward mandates bespeaks no contempt for the immunocompromised should be eager to support the president’s proposal.

It is still worth fighting for mask mandates at providers of essential goods and services and vaccine mandates at a broader sphere of public accommodations. But if those battles are lost, the war against COVID can — and must — go on.

The Fight Against COVID Isn’t Over Yet