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How to Live With Covid
The emergency is over. It’s time to pivot to preparedness.
The Omicron variant, like its predecessors, transformed the COVID-19 virus. Unlike its predecessors, however, it also transformed the way the country thinks about COVID-19. The pandemic is not over, but the emergency is. Someone needs to come up with a national plan to pivot to a post-emergency regime focused on preparedness instead of containment.
Fortunately, someone has: the Biden Administration. Unfortunately, you haven’t heard about it, because no one is talking about it—including, mystifyingly, President Biden. That needs to change, and soon, if Biden hopes to lift his sagging presidency.
None of this is to say that the pandemic has run its course. As of early February, COVID was killing over 2,000 Americans a day. In hard-hit areas, understaffed hospitals were strained. There was no reason to think Omicron would be the last variant. We were not out of the woods, although the Omicron wave looks—fingers crossed—as if it will subside this month.
Nonetheless, human-virus relations have entered a new stage, that of coexistence. Everyone realizes that the virus, with its repertoire of mutations, is here to stay. Panels and articles on the new normal are cropping up. Governors are adjusting their approach. Protocols that seemed at least vaguely justifiable a few months ago now seem ridiculous. Does anyone think it serves any purpose to wear a mask in a restaurant until you’re seated, then take it off when beverages are served? To tell vaccinated college students they shouldn’t leave the county or eat outdoors at a restaurant? To bar travel from entire countries in hopes of keeping out variants that are already here or will arrive from somewhere else?
Fortunately, many Americans grasp that the human-virus relationship has turned a corner, and that the 2020-2021 way of thinking is obsolete. But how should we retune our mindset?
A useful suggestion comes from Alex Tabarrok, an economist at George Mason University who has been saying smart things about the pandemic since it began. “When vaccines were coming, it made a lot of sense to put off a lot of other good things in life—to do what economists call intertemporal substitution,” he said in a recent interview. “Once vaccines are available and widespread, you can’t intertemporally substitute anymore because there’s no more cavalry coming. This is it. Before vaccines, costly actions can delay your getting COVID until after you’re vaccinated, which is highly valuable. But the corollary is that once you move to the permanent scenario and are vaccinated, costly actions that mostly delay when you get COVID have much less value.”
Here’s a way to help think about this. Suppose we could sustainably reduce the annual COVID death toll to about 150,000, which was the level of last summer, before the Delta wave. Your odds of dying of COVID-19 would be about 3.5 times the odds of dying in a traffic accident or a fall (each category claims about 40,000 lives a year, according to the CDC), and a bit less than your odds of dying in all kinds of accidents (which kill about 200,000).
I’m not saying that 150,000 is a number we should aim for; we can, should, and eventually will do much better. Still, as we saw last summer, it is a level which most Americans feel is compatible with a mostly normal lifestyle. For vaccinated people, the risk level would be far lower, and no greater than other risks we accept in everyday life, such as driving around. Even at Omicron’s currently high prevalence, COVID-19 is no emergency for the vaccinated and healthy.
That being the case, Tabarrok proposes a rule of thumb: “Whatever we do, we should be thinking about, ‘Do we make this permanent or not?’” If measures are not candidates for permanence, “We might as well stop them now or soon.”
Specifically, what might that rule of thumb imply? Lockdowns and border closures would end. Ditto for social distancing. Masking would be optional except among the vulnerable. Workplaces would reopen. Schools would stay open. At least for the vaccinated, COVID testing would be deployed only to diagnose symptoms and avoid particularly risky situations, not as a way to screen the population or decide about joining friends for dinner. Self-isolation for people with COVID could be encouraged but not required, except for special cases like health-care and eldercare workers.
On the other side of the equation, we would double down on cost-effective measures we can live with indefinitely. Invest to speed vaccine development and deployment. Accelerate work on universal vaccines that work against multiple variants. Implement monitoring and surveillance for new variants and pathogens. Stockpile equipment, tests, and therapeutics. Build more hospital surge capacity. Encourage vaccination, and support employers and organizations who choose to mandate it.
Thoughtful institutions are already pointing the way to the post-emergency era. In January, in the teeth of the Omicron wave, the University of Denver brought all but about 1,000 of its 13,500 students back for in-person classes. At the same time, it reduced the student positivity rate from 20 percent at the start of January to under 5 percent a few weeks later. When I asked Sarah Watamura, the university’s COVID response coordinator, how it was done, she cited mandatory vaccination, regular testing, a separate dorm where positive students could isolate together, and an emphasis on communication and transparency.
Today, the university is thinking about the longer term and “shifting resources from controlling transmission to the greatest extent possible to something that’s focused on supporting individuals who are more vulnerable,” Watamura told me. “We’ve learned we can pivot really quickly if we need to.” And, she emphasized, the university has learned “that a lockdown, pulling people out of their social environment, serves one aspect of well-being but compromises others.” A recent study finds that university shutdowns “had a detrimental impact on the mental health of a large proportion of academic staff and students,” including problems like anxiety, boredom, and lack of motivation. No one wants to repeat that.
The country needs to follow institutions like University of Denver toward resilience: preparedness to handle whatever surprises the virus may spring. We don’t have to wonder what a national preparedness strategy might look like, because in September the administration proposed one. It contains a host of sensible, sustainable measures, which you can read about here, here, and here.
In the world of public health, there is little disagreement on the measures required for resilience and preparedness: real-time monitoring and early warning of new infectious agents; more and faster vaccine development; stockpiling equipment and expanding supply chains and health-system surge capacity; improving public-health infrastructure; and more. The administration plan includes most of those features, at a proposed cost of $65 billion over seven to ten years.
Yet President Biden hasn’t seemed to notice it. Paging through hundreds of White House statements and press releases since the plan’s release, I found only one mention of it, and that was the fact sheet distributed by the White House science adviser when the program was announced.
Congress didn’t pay much attention, either; the House’s version of the gigantic “Build Back Better” bill found space for all of $3 billion for pandemic preparedness, a sum which barely qualifies as chicken feed. Encouragingly, on Jan. 25, Sens. Patty Murray (D-Wash.) and Richard Burr (R-N.C.) announced what they called a discussion draft of a bipartisan preparedness bill. It has many of the same features as the Biden plan (again, there isn’t much disagreement among the experts). So far... crickets.
Meanwhile, the political world is still waging culture wars and legal battles over sideshows like masking, partying like it’s 2020. “Even after a pandemic, we can’t get the will to spend more on pandemic preparation? That’s bizarre to me,” Tabarrok said. “We’re still not investing enough in having vaccine capacity ready to go and developing new vaccines for new variants quickly. That just seems like such an obvious thing to do, and yet we’re not doing it. Let’s do the things we can all agree on. We’re just stuck on all these cultural issues.”
Building capacity to prevent and manage pandemic shocks is essential to putting the emergency phase behind us. Putting the emergency phase behind us is essential to righting Joe Biden’s listing presidency. Mr. President, complete the syllogism. Pandemic preparedness should be front and center in the national conversation. On March 1, in your State of the Union speech, put it there.
Jonathan Rauch is a columnist at Persuasion and the author of The Constitution of Knowledge: A Defense of Truth.