Living with Covid

 From the NYT opinion column By Katherine Eban, an investigative journalist; a contributing editor at Vanity Fair, where she covers Covid-19; and the author of “Bottle of Lies: The Inside Story of the Generic Drug Boom.”

How Will We Live if Covid Is Here to Stay?

Even as cases decline again and vaccination numbers rise, a once-unthinkable idea is breaking through any assumptions that we would vanquish Covid-19. Dr. Anthony Fauci laid it on the line at a White House press briefing this month: “It is going to be very difficult — at least in the foreseeable future and maybe ever — to truly eliminate this highly transmissible virus.”

That SARS-CoV-2 could be with us forever is a dark thought. But pulling that mental lever may be just what we need to organize effectively for the very long haul, dramatically improve our pandemic response and embed safeguards into our everyday lives. 

Rather than debate how to end the pandemic, we need to debate how to live with it. “We have to start thinking, planning and coming to grips in every way that this is now a human endemic infection and it’s never going to go away,” said Dr. Farrar.

From his unique vantage point, Dr. Mokdad can literally map how our desire to prematurely claim victory, rather than accept the virus’s continuance, has led us to throw off restrictions, with deadly effect. He just revised his projected body count for the United States upward, to at least 828,000 total pandemic deaths by Feb. 1, 2022. Masks, which so many Americans abandoned when it seemed the end of the pandemic was in sight, could still make a difference: If 95 percent of Americans wore a mask, his model projects roughly 56,000 fewer deaths by Feb. 1.

In the more distant future, Dr. Mokdad does not see “independence from a deadly virus,” to quote our president. “We would expect that the transmission will never go to zero,” Dr. Mokdad told me. “The virus is going to be with us for a long time” — meaning that deaths, and efforts to prevent them, could continue for years.

Serious people are now trying to plan for what living with SARS-CoV-2 will look like, a potentially bleak exercise but one also brimming with scientific promise.

An escape variant — one so infectious that it escapes our best mRNA vaccine defenses — is not a certainty, said the experts with whom I spoke. But it is not far-fetched, either, in part because of our slow pace at vaccinating the world. That worst-case scenario could “change the whole landscape,” said Dr. Eric Topol, a professor of molecular medicine at Scripps Research, putting us “back to square one, with masks and distancing our only defense.” But it can be avoided, he and others said.

In years to come, perhaps we could have the ultimate moonshot coronavirus vaccine, one that blocks transmission of all coronaviruses (a massive challenge because of their genetic differences).

The vaccine could be a single dose stored at a modest temperature, be “cheap as chips,” said Dr. Farrar, and be available to everyone in the world. We could have unlimited oxygen and protective gear in every hospital. With the right investment, says Dr. Farrar, we could even roll out a whole new time frame: release a genomic sequence on Day 1 of identifying it, develop a responsive vaccine within seven days and begin shots in arms within a month.

On Sept. 3, the Biden administration released a pandemic preparedness plan that, though somewhat less aggressive, calls for slashing the timeline for creating and scaling up a vaccine from under a year to under 100 days.

As we come to terms with Covid forever, what might our daily lives look like? Will all-day masking in schools and offices continue indefinitely? Will we have to pare back our holiday party guest lists for years to come? Will home testing before any social gathering become de rigueur? Will vending machines in every subway station carry cheap KN95 masks?

But others, including Dr. Mokdad, envision flulike seasonal surges of Covid-19, accompanied in some years by heavy death tolls. Those could lead us to mask up seasonally, get an annual vaccine as we head into the winter months and make ongoing improvements to ventilation in critical public spaces like transportation hubs.

In that scenario, our lives would not return to a prepandemic normal. Instead, the biggest shift in our new normal could be a growing societal embrace of protective measures, rather than a continued war over school mask wearing or workplace vaccine mandates. “People are not stupid,” said Dr. Jeffrey Duchin, the chief of the communicable disease, epidemiology and immunization section for public health in Seattle and King County. “They will come around to accept reality.” To him, the clashes over seatbelt wearing, and its ultimate acceptance, offer a useful comparison.