Last month, the Food and Drug Administration approved an updated Covid vaccine that specifically targets the dominant BA.5 subvariant. A few days later, the Advisory Committee on Immunization Practices (ACIP) reviewed and recommended these vaccines as boosters (from Pfizer-BioNTech for people ages 12 years and older, and from Moderna for people ages 18 years and older). Federal health officials have expressed optimism that this booster could provide extended protection, transitioning us to an annual Covid vaccine updated for current variants, similar to, and administered alongside, yearly flu shots.
Although the U.S. has 4.25% of the world’s population, it has now borne approximately 16% of worldwide deaths from Covid-19.
But whether many will receive the updated vaccine remains in doubt, in no small part because it arrives at a time when much of the U.S. has decided it is simply done with the pandemic.
Few schools will maintain mask mandates or surveillance testing this fall. The Centers for Disease Control and Prevention has shortened the isolation period for Covid illness to five days, even though many studies suggest high rates of infectiousness beyond this window. The U.S. vaccination rate currently sits below the average for high-income countries. Successful administration rates have declined with each successive available booster. As school resumes, a minority of younger children have received Covid vaccines. And government sponsorship of Covid vaccines will fall off this autumn, a move that will decrease access, particularly among those without a regular source of care and without adequate insurance coverage.
With the current high cost of over-the-counter tests, the uncertain status of future Covid testing supply, the absence of test-to-return policies, the widespread removal of masking and distancing guidelines, the high transmissibility and the immune escape of more recent strains, conditions are ripe for ongoing surges in transmission.
Our “done-ness” — a combination of mental fatigue, frustration, denial, apathy, unearned optimism and callousness across individuals, organizations and policymakers — has little to do with clear metrics of success: The pandemic is marching along quite robustly. Although the U.S. has 4.25% of the world’s population, it has now borne approximately 16% of worldwide deaths from Covid-19. It is the primary cause of the sharp drop in U.S. life expectancy over the past two years. This summer, we reached a bleak plateau of around 40,000 hospitalizations each day and 500 daily Covid deaths, with more than 30,000 deaths between June and August.
Alongside the severe outcomes of acute illness, we’re seeing a steady emergence of disturbing data on the prolonged disability that can occur even if (and this is key) the initial illness is only mild. Thus, wildly rampant mild disease is difficult to celebrate. And metrics earlier believed to herald the end of the pandemic phase of Covid, such as its predictability, are not yet in sight.
Pandemics are curbed by caring and by persistent urgency. The lack of these may cost us as a nation in many ways.
First, dismissing the pandemic is callous dismissal of those most affected. Every time we peel back protections against Covid and other infectious diseases, we leave people performing essential in-person work along with racial and ethnic minority populations, the elderly, and those who are disabled, immunocompromised or poor to bear the largest burden of disease and death, while having the least amount of sick leave, access to health care and therapies, and financial reserve to buffer a period of illness.
Inequities, already drastically widened by the pandemic, will widen further. And heaping the burdens of the virus on groups that have been socially and economically marginalized has grave long-term consequences for the whole population.
“Viruses just keep busting the myth that we’re discrete beings, that we’re not connected to each other,” sociologist and journalist Steven Thrasher told me in a phone call earlier this summer. “They keep reminding us that we’re not alone in this. Therefore we can’t act for our self-interest. We have to act in an interdependent way.”
Pandemics are curbed by caring, and by persistent urgency. The lack of these may cost us as a nation in many ways. The existence of long Covid also defies the national desire to dismiss Covid. Ignoring it has been feasible thus far because knowledge gaps, the recency of the disease and its protean manifestations have made it underdiagnosed, understudied and untreated. As Covid cases run rampant, long Covid — which affects a steady, significant percentage of those who are infected — will be increasingly visible: Already, prolonged post-Covid symptoms are currently keeping 2 to 4 million people out of work. Without appreciation of the gravity of this situation, we will remain in a scientific void that abandons some to despair and others to quackery. Further, maintaining vigilance about managing Covid and its aftermath will determine our future with respect to other infectious diseases and future epidemics and pandemics. One spillover effect of the misinformation that proliferated around Covid vaccines was to reduce influenza vaccine uptake in some populations (ahead of an upcoming flu season that promises to be severe). Meanwhile, the emergence of polio in the U.S. this year was made possible by pockets of low vaccination rates, and disruptions in usual care and supply chain problems have led to a worldwide reduction in routine childhood vaccination rates. Regaining ground on all vaccines must occur alongside efforts to increase booster uptake, an additional challenge to a depleted public health and health care workforce, especially without the force of public and political will. Our nation is facing dual realities: One, that we have prematurely declared the pandemic is over; and two, having done so threatens to exacerbate the ongoing suffering of the pandemic and other health threats. In a country now numb to infection health risks and the sheer devastation of the pandemic, we must yet find a way to maintain a collective sensibility about measures that will blunt the impact of ongoing threats to our health, including the structural investments that relate to all epidemics and pandemics and are the foundational work of public health. Whether we are heading toward the next surge or the beginning of a true post-Covid-pandemic era, we cannot afford to be this “done.”
Esther Choo
Dr. Esther Choo is an emergency physician and researcher who studies health disparities, substance use disorders, and gender bias. She obtained her M.D. from Yale University, did her clinical training at Yale-New Haven Hospital and Boston Medical Center, and completed a health services research fellowship at Oregon Health & Sciences University. She has published over 65 research manuscripts on substance use disorders, health disparities, gender bias, and emergency care.She serves on the executive board of FeminEM.org and Women Physicians For Humanity, and started the #DoctorsSpeakOut project capturing the opinions of physicians about the Senate health care bill. She also created the #thatsbias hashtag to advance discussions of gender bias in medicine, and #codehate to raise awareness about racism in the healthcare setting. 
