We've swung between fear and denial for too long
and need to talk about this disease from a different perspective
By Steven Phillips
President Joe Biden’s recent bout of COVID drew
immediate comparisons with President Donald
Trump’s experience. Biden had mild symptoms and
worked at his desk, while Trump developed a
severe respiratory condition requiring helicopter evacuation and three days
of urgent treatment at
Walter Reed Army Medical Center. The experiences
of these two men reflect changes in COVID risk
that actually impact all of us.
Although the administration designed procedures
to protect Biden, his aides viewed his infection as
a near inevitability. CNN reported that aides “saw
the illness as a sign that even the most protected
person can come down with COVID and be just fine.”
For similar reasons, Americans are becoming
increasingly burned-out on precaution. Many are
skeptical of COVID prevention measures altogether.
Still others think that when it comes to mental health,
educational and other opportunity costs, “returning
to normal” is less damaging to individuals and society
than stringent precautions - those beyond vaccination,
using Paxlovid appropriately and selectively practicing
social distancing and mask-wearing.
However, there’s little practical understanding or
consensus regarding what returning to normal
means for us—individually or for society at large.
It’s worth reflecting on the dominant pandemic
narratives that have played out to date, and to note
that to thrive in our current environment we must
construct a new narrative that both more closely
reflects observable facts and helps us to live with
Humans know so much more now about the
coronavirus that causes COVID and how it plays
out in those infected. How we think about COVID
needs to reflect this new knowledge.
As a medical epidemiologist, and member of the
COVID Collaborative, I have been following this
research and the evolving recommendations from
the Centers for Disease Control and Prevention,
experts and the media. That experience suggests
that now society should help to protect people who
are most vulnerable (the elderly, immunodeficient
or those with specific conditions) to help them avoid
exposure; the rest of the population, in my opinion,
should go about business as usual. With this caveat:
where the welfare of people who could get seriously
ill intersects with those who likely won’t, we must
look out for the needs of the former. Balancing
freedom to live without restrictions with the freedom
from being needlessly exposed to disease should
be the through line of our national narrative, policies
Here’s why: early on, two dominant narratives
emerged. One called the virus no more dramatic
than the flu, and that people urging us to be
cautious sought to undermine our politics, security
and economic prosperity. The other championed
the idea that the virus could attack and kill anyone
and potentially lurked in every breath. Most people
fell into one of these groups, absorbing the
consequences of these beliefs and behaviors in
their own group and shunning the other.
The central question in constructing a new COVID narrative is whether we
can say that the virus no
longer poses a major public health threat. What
does it mean that the disease is still around but
is not causing significant disruption in our daily
lives? When and how does a virus migrate from
being “pandemic” to “endemic”? There is no clear
epidemiologic definition of “endemic” relative to
“pandemic.” Some think that this milestone has
already passed; others think it’s achievable in the
near term; and still more believe it’s in the indefinite
About 850,000 Americans are being infected daily,
nearly 2 percent of the entire U.S. population
every week. These are likely to be your relatives,
friends, neighbors, public figures and even yourself.
This is on top of the 82 percent of the country
estimated to have been infected at least once as of mid-July.
Despite this firestorm of spread, classical herd
immunity leading to eradication is unlikely (in
contrast to its achievement with smallpox, for
example, where both natural infection and
vaccination eliminated virus transmission).
SARS-COV-2 produces only a steadily waning natural
and vaccine-induced immunity and does not
eliminate transmission. But it does maintain high
levels of population immunity that protects against
serious illness from widespread sporadic and
epidemic waves of infection and re-infection.
Yet, while about 22 percent of eligible Americans
are unvaccinated, almost all of this group are
vaccine skeptics, who are unwilling or uncertain
about getting vaccinated. Expanding new
vaccinations alone is unlikely to be a major
successful control strategy.
At no time during the pandemic has there ever
been a more dramatic disconnect between infections
and serious disease. Given a high background of
incidental asymptomatic cases, this translates to
current hospitalization and death rates for COVID
being at or near the lowest levels of the pandemic.
Still, death rates remain stubbornly high for older
people; this year about 77 percent of all COVID
deaths have occurred in those age 65 and above.
Vulnerable people will need to continuously and
vigilantly try to prevent infection and have access
to early treatment to keep them out of the hospital.
Protecting them, for example, with masks or reliable
testing, is the shared responsibility of both society
and the affected people themselves. For most others,
except when they cross paths with vulnerable people,
life can go on pretty much unaffected.
As philosophers of science have noted, challenging
narratives isn’t something that comes readily to the
human mind. Through the many tortuous turns of
the pandemic, the “follow the science” mantra has
become as contentious as the tenets of any other
belief system. While there have been many incremental
tweaks in expert and resulting media guidance, the
bifurcation of camps around “fear the virus” and “full
speed ahead” continues.
The status quo, abundance-of-caution, stay-scared
narrative is still reverberating through media and
expert commentary. The list of ominous headlines
is lengthy: the specter of new variants, increased virulence, rising
wastewater virus levels, maskless
passengers, a new surge of cases, unvaccinated
preschoolers, superspreader events, waning booster
immunity, vaccine escape, likely ongoing reinfection,
and long COVID.
These are not invented concerns, but they should
not be invoked as a barrier to a new normalcy.
Unlike in football, the end of the pandemic will not
be signaled by a sharp whistle clearing the playing
field and audible to all. It will instead look exactly
like our current percolating and—almost
imperceptible—daily shift to a new way of living.
When do we stop running from a virus that is not
going to disappear and will likely become a ubiquitous
state of nature? Given the history of pandemics, we
know that this change will inevitably occur. The
uncertainty is how much individual and societal
damage we can avoid in the interim.
When we do resume unencumbered lives, it will not
be because we have pandemic burnout. It will be
because we have embraced a new narrative to support
our risk-tolerant behavior and adopted better strategies
to protect the vulnerable.
Civilization has been knit together since prehistory by
shared narratives. As the historian and philosopher
Yuval Noah Harari observed, “Homo Sapiens is a
storytelling animal that thinks in stories rather than
in numbers or graphs, and believes that the universe
itself works like a story.”
This is an opinion and analysis article, and the views
expressed by the author or authors are not necessarily
those of Scientific American.