We’re in the Wait-and-Watch Era of COVID
Things look calm right now. They may even stay that waybut we wont know for sure for a good long while. By all official countsat least, the ones still being talliedthe global situation on COVID appears to have essentially flatlined . More than a year has passed since the world last saw daily confirmed deaths tick above 10,000; nearly a year and a half has elapsed since the population was pummeled by a new Greek-lettered variant of concern. The globes most recent winters have been the pandemics least lethal to dateand the World Health Organization is mulling lifting its COVID emergency declaration sometime later this year, as the final pandemic protections in the United States prepare to disappear. On the heels of the least-terrible winter since the pandemics onset , this spring in the U.S. is also going ... kind of all right. I am feeling less worried than I have been in a while, Shweta Bansal, an infectious-disease modeler at Georgetown University, told me. That sense of phew , though, Bansal said, feels tenuous. The coronaviruss evolution is not yet predictable; its effects are nowhere near benign . This might be the longest stretch of quasi-normalcy that humanity has had since 2020s start, but experts cant yet tell whether were at the beginning of post-pandemic stability or in the middle of a temporary reprieve. For now, were in a holding pattern, a sort of extended coda or denouement. Which means that our lived experience and scientific reality might not match up for a good while yet. Read: The next stage of COVID is starting now There is, to be fair, reason to suspect that some current trends will stick. The gargantuan waves of seasons past were the rough product of three factors: low population immunity, genetic changes that allowed SARS-CoV-2 to skirt what immunity did exist, and upswings in behaviors that brought people and the virus into frequent contact. Now, though, just about everyone has had some exposure to SARS-CoV-2s spike protein, whether by infection or injection. And most Americans have long since dispensed with masking and distancing, maintaining their exposure at a consistently high plateau. That leaves the viruss shape-shifting as the only major wild card, says Emily Martin, an infectious-disease epidemiologist at the University of Michigan. SARS-CoV-2 could, for instance, make another evolutionary leap large enough to re-create the Omicron wave of early 2022but a long time has passed since the virus managed such a feat. Tentatively, carefully, experts are hopeful that were at last in a period that could be kind of indicative of what the new normal really is, says Virginia Pitzer, an infectious-disease epidemiologist at Yale. Top American officials are already gambling on that guess. At a conference convened in late March by the Massachusetts Medical Society, Ashish Jha, the outgoing coordinator of the White House COVID-19 Response Team, noted that the relative tameness of this past winter was a major deciding factor in the Biden administrations decision to let the U.S. public-health emergency lapse. The crisis-caliber measures that were essential at the height of the pandemic, Jha said, were no longer critical at this moment to keep the nations health-care system afloat. Americans could rely instead primarily on shots and antivirals to keep themselves healthyIf you are up to date on your vaccines and you get treated with Paxlovid, if you get an infection, you just dont die of this virus, he said. (That math, of course, doesnt hold up as well for certain vulnerable groups, including the elderly and the immunocompromised.) The pharmaceuticals-only strategy asks much less of people: Going forward, most Americans will need to dose up on their COVID vaccines only once a year in the fall, a la seasonal flu shots . Making sweeping assessments at this particular juncture, though, is tough. Experts expect SARS-CoV-2 cases to take a downturn as winter transitions into springas many other respiratory viruses do. And a half-ish year of relative quietude is, well, just a half-ish year of relative quietude too little data for scientists to definitively declare the virus seasonal, or even necessarily stable in its annual patterns. One of the most telling intervals is yet to come: the Northern Hemispheres summer, says Alyssa Bilinski, a health-policy researcher at Brown University. In previous years, waves of cases have erupted pretty consistently during the warmer months, especially in the American South, as people flock indoors to beat the heat. SARS-CoV-2 might not end up being recognizably seasonal at all. So far, the virus has circulated more or less year-round, with erratic bumps in the winter and, to a lesser extent, the summer. There is a consistency there that is very enticing, Bansal told me. But many of the worst surges weve weathered were driven by a lack of immunity, which is less of an issue now. So I like to be extremely careful about the seasonality argument, she said. In future years, the virus may break from its summer-winter shuffle. How SARS-CoV-2 will continue to interact with other respiratory viruses, such as RSV and flu, also remains to be seen. After an extended hiatus, driven largely by pandemic mitigations, those pathogens came roaring back this past autumn making it more difficult, perhaps, for the coronavirus to find unoccupied hosts. Experts cant yet tell whether future winters will favor the coronavirus or its competitors. Either way, scientists wont know until theyve collected several more years of evidenceI would want at least a handful, like four or five, Bansal said. Amassing those numbers is only getting tougher, though, as data streams dry up, Martin told me. Virus-surveillance systems are being dismantled; soon, hospitals and laboratories will no longer be required to share their COVID data with federal officials . Even independent trackers have sunsetted their regular updates. Especially abysmal are estimates of total infections, now that so many people are using only at-home tests, if theyre testing at alland metrics such as hospitalization and death dont fully reflect where and when the virus is moving, and which new variants may be on the rise. Shifts in long-term approaches to virus control could also upend this period of calm. As tests, treatments, and vaccines become privatized, as people lose Medicaid coverage , as community-outreach programs fight to stay afloat, the virus will find the countrys vulnerable pockets again. Those issues arent just about the coming months: COVID-vaccination rates among children remain worryingly low a trend that could affect the viruss transmission patterns for decades. And should the uptake of annual COVID shots continue on its current trajectoryworse, even, than Americas less-than-optimal flu vaccination ratesor dip even further down, rates of severe disease may begin another upward climb. Experts also remain concerned about the ambiguities around long COVID, whose risks remain ill-defined. Read: Long COVID is being erasedagain We could get lucky. Maybe 2023 is the start of a bona fide post-pandemic era; maybe the past few months are genuinely offering a teaser trailer of decades to come. But even if thats the case, its not a full comfort. COVID remains a leading cause of death in the United States , where the virus continues to kill about 200 to 250 people each day, many of them among the populations most vulnerable and disenfranchised. Its true that things are better than they were a couple of years ago. But in some ways, thats a deeply unfair comparison to make. Deaths would have been higher when immunity was low; vaccines, tests, and treatments were scarce; and the virus was far less understood. I would hope our standard for saying that weve succeeded and that we dont need to do more is not Are we doing better than some of the highest-mortality years in history? Bilinski told me. Perhaps the better question is why were settling for the status quoa period of possible stability that may be less a relief and more a burden weve permanently stuck ourselves with.