--- title: It's Time to Rethink Your COVID-19 Risk Tolerance description: As we enter the next stage of the COVID-19 pandemic, we need to change how we think about who is vulnerable and how we behave canonical: https://time.com/6159152/rethink-covid-19-risk-tolerance/ author: Steven Phillips article:opinion: true article:content_tier: free article:published_time: 2022-03-22T18:06:10.000Z article:modified_time: 2026-08-04T07:51:42.801Z article:section: Ideas og:title: It's Time to Rethink Your COVID-19 Risk Tolerance og:description: As we enter the next stage of the COVID-19 pandemic, we need to change how we think about who is vulnerable and how we behave og:url: https://time.com/6159152/rethink-covid-19-risk-tolerance/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt4ea56b9a32524192/698a301a86f68eaffc6f1076/GettyImages-1365460079.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 og:image:width: 1024 og:image:height: 576 og:image:alt: A free COVID-19 testing site in Hawthorne. og:type: article twitter:card: summary_large_image twitter:title: It's Time to Rethink Your COVID-19 Risk Tolerance twitter:description: As we enter the next stage of the COVID-19 pandemic, we need to change how we think about who is vulnerable and how we behave twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt4ea56b9a32524192/698a301a86f68eaffc6f1076/GettyImages-1365460079.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 ---  # It's Time to Rethink Your COVID-19 Risk Tolerance > Sponsored content. 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The miracle workers behind the COVID-19 vaccines are the TIME Heroes of the Year not only because they gave the world a defense against a pathogen, but also because the manner of that astonishing achievement guards more than our health: they channeled their ambitions to the common good, talked to one another and trusted in facts._ by [Steven Phillips](https://time.com/author/steven-phillips/) ## Steven Phillips Mar 22, 2022 6:06 PM UTC  A free COVID-19 testing site was hosted by Reliant"nHealth Services at the Betty Ainsworth Sports Center, parking lot, in Hawthorne on Tuesday, January 18, 2022. A free COVID-19 testing site was hosted by Reliant"nHealth Services at the Betty Ainsworth Sports Center, parking lot, in Hawthorne on Tuesday, January 18, 2022. Brittany Murray-MediaNews Group/Long Beach Press-Telegram by [Steven Phillips](https://time.com/author/steven-phillips/) ## Steven Phillips Mar 22, 2022 6:06 PM UTC The U.S. is taking a crash course in learning to “live with the virus.” Policymakers and health experts agree that we have migrated to a less-disruptive [COVID-19 endemic phase](https://time.com/6141679/omicron-end-covid-19/). This has produced [extensive commentary](https://www.covidroadmap.org/) on what living with the virus, and achieving the “new normal” might look like—liberating some while confusing others. Many people have spent two years avoiding and fearing the virus and are now being advised that it’s safe to unmask and to [resume a normal social life](https://time.com/6148424/covid-19-rethink-risk/). For them, this has not ushered in a comfortable sense of natural transition, but instead has caused a national emotional whiplash. Psychologists call this avoidance conflict. CDC’s new look-up [map tool](https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html) for COVID-19 community risk-level attempts to balance key goals of preventing hospital overload and flattening the curve of serious disease. The agency’s previous map based on level of transmission reflected most counties as high-intensity bright red. The [new map](https://www.npr.org/sections/health-shots/2022/03/10/1085797307/cdcs-new-covid-metrics-can-leave-individuals-struggling-to-understand-their-risk) is mostly a reassuring low-risk green. Critics of this new approach say that the agency “seems to have [moved the goalposts](https://www.npr.org/sections/health-shots/2022/03/10/1085797307/cdcs-new-covid-metrics-can-leave-individuals-struggling-to-understand-their-risk) to justify the political imperative to let people get back to their normal lives.” What both the critics and supporters of the CDC’s new tool have missed is that—whether red or green—the tool _doesn’t_ change our prior fundamental relationship to the virus which we have had since the beginning of the pandemic. We are all still advised to warily avoid it until it becomes “safe enough.” This old paradigm will not lead us to a “new normal”. With the new CDC guidance our [old paradigm dilemmas](http://www.apple.com/) remain endless. When do I mask? Do I send my child to school with the sniffles? Can I return to work after cancer chemotherapy? Do I need a [fourth shot](https://time.com/6157560/fourth-covid-19-vaccine-dose/)? When do I use at home rapid tests? Should our family fly to our usual summer vacation spot? In this era of cautious fraught optimism, few have grasped the stark reality that for the country to successfully navigate to a sustainable endemic phase, most of us must transition from avoiding to accepting transmission and infections. Let’s sit with that for a second. This should be the center-point of our endemic-phase policies and practices. This is the seismic shift that will ultimately enable us to live in a sustainable new normal. Here are five guideposts that should help us get there: ### 1) Accept that we can’t outrun Omicron Omicron is an extraordinarily communicable variant. It is ubiquitous and will eventually infect nearly all susceptible people, whether they try to avoid infection or not. The Institute of Health Metrics and Evaluation estimates that about three-fourths of the country already has [“functional immunity” to Omicron](https://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run), and expects this to continue to “grow through the tail-end of the Omicron wave.” As with many respiratory viruses like the flu, colds and pneumonia, we should expect to see a seasonal pattern with more case (positive test) surges. Further outbreaks of[ high caseloads](https://time.com/6129225/omicron-covid-19-case-counts/) should not set off alarms to deviate from a steadfast endemic-phase new paradigm, as long as the vulnerable population—which suffers the brunt of the disease burden—is protected from infection. We have accepted coexistence with many other communicable pathogens with similar characteristics in the past, without undue mental trauma or physical disruption. Now it’s COVID-19’s turn. ### 2) Identify “vulnerable” and “non-vulnerable” risk sub-groups The public has been conditioned by dire whole population numbers (all test-positive cases, hospitalizations, and deaths). This drives risk perceptions, and actions for much of COVID-19 policy. Throughout the pandemic this has resulted in a [grossly inaccurate](https://www.nature.com/articles/s41598-021-95134-z) and distorted view of individual risk and has led to excessive mass avoidance behaviors and bad policy. This flawed lens must now be replaced. To enable the “new normal,” Americans can be separated into two discrete risk-based sub-populations: those that if infected have a similar or lower risk of hospitalization and death than that from influenza (called the “non-vulnerables”) and those that have a far higher comparative risk of these outcomes (called the “vulnerables.”) Risk is actually a continuum from very low to very high, but this simplifying binary categorization is intended to offer clear public understanding. The determination of vulnerability is based on three overwhelmingly dominant factors that drive severe outcomes from Omicron infection: age, immunological susceptibility, and underlying conditions. Poverty and ethnic/racial factors also confer risk, but indirectly through social and health-equity disparities. Age is the single greatest predictor of infection outcome. A recent [CDC study](https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html) revealed that compared to people under 30 years of age, those over 65 year olds who are infected are 5-10 times more likely to be hospitalized and 65-340 times more likely to die. The absolute numbers are staggering. Over age 65s comprise 13 percent of the population and in January produced [80 percent](https://www.webmd.com/lung/news/20220209/omicron-death-rate-higher-than-during-delta-surge) of total deaths from Omicron. Those over 75 are 6 percent of the population and produced about half of the daily average 2600 deaths during the [January surge](https://www.washingtonpost.com/health/2022/02/08/omicron-deaths-covid/). Individual and population susceptibility is reduced through either infection or full vaccination. Either are about [80-90 percent protective](https://www.nejm.org/doi/full/10.1056/NEJMoa2115481) against serious disease and death, with effectiveness significantly waning with age and over time. The level of susceptibility is an ever-changing dynamic equilibrium between waxing and waning forces. It should increase slowly in coming months as Omicron declines. With the expected increase in transmission and further booster uptake later in the year, we should again expect higher population immunity. The CDC has listed over [twenty underlying medical conditions](https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/underlying-evidence-table.html) with conclusive evidence of higher risk for severe COVID-19 outcomes: obesity, advanced diabetes, mental disorders have the [highest association](https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html) with death. Additionally there are the estimated ten million immunocompromised Americans, who have autoimmune disease, cancer, chemotherapy regimens or other reasons for immunosuppression. In this new paradigm about 20-25 percent of the American population has a current risk of serious illness from Omicron significantly greater than that of the seasonal flu. These vulnerable people are anyone over 65, and increasing exponentially with advanced age, immunological susceptibility, and significant comorbidities. The immunocompromised of any age are also included. This group must avoid infection, which is their key prevention metric. The remaining 75-80 percent of Americans are “non-vulnerable” as defined by having a similar or lower chance of serious outcomes from Omicron than from the seasonal flu. This group does not need to avoid infection. Their important metric is serious disease and deaths, not cases. ### 3) Prioritize protection of the high-risk vulnerable population This binary scheme now produces much simpler, targeted and effective disease-mitigating framework: the non-vulnerable new normal can be similar to the old normal when interacting with other non-vulnerables. However, when non-vulnerables directly intersect with the welfare of the “vulnerable” population, specific accommodations should be required. In practice this means universal masking on public transport, vaccination, boosting and masking for health care workers and in congregate facilities, such as nursing homes. As a country we have precedents for balancing “freedom to” with “freedom from”—for example in establishing smoke-free public spaces. For those in the vulnerable group, there is unfortunately no dramatic new normal. This is not a societal but a viral imposition. COVID-19 and its variants have taken an unimaginable and inequitable toll in the vulnerable population. Vaccines and boosters have slowed but have [not stemmed](https://betterhealthwhileaging.net/coronavirus-vaccine-in-aging-what-to-know/) this tide. Society will need to intensively work through protective public accommodations, and each vulnerable individual and household will need a viable plan. ### 4) Plan for the most likely scenario Many are rightfully apprehensive about important “known unknowns” relating to COVID-19 infection. This includes the emergence of new variants, the dangers of [Long Covid](https://time.com/6144427/long-covid-treatments-health-care-wait/), the lack of an approved vaccine for infants and young children, and other possible adverse developments. These are all legitimate concerns, however the positive risk-benefit calculus for most individuals and society favors the resumption of our normal lives. Strategic decisions in war are usually focused on “most likely case” assumptions while also preparing for a “worst case.” As new information develops we must maintain the capacity to pivot quickly if things change for the worse. ### 5) Unite the country through minimizing restrictions This “new normal” can perhaps take us from the rancor of partisan politics and ideology to focusing on what works for the country in saving and restoring lives. The primary issue becomes protecting the vulnerable, not masking and other interventions. Obligatory protections should focus only on the areas of intersection with the vulnerable. And hopefully many or even most Americans, no matter their political outlook, can agree on this priority. Pulling together as a society is likely to be most effective when it is the collective embodiment of individual expression. This would not only produce public health dividends, but also boost the economy and help restore America’s full productivity and dynamism at a particularly challenging time in our history. Adopting these guideposts will accelerate our progress to the new normal. It will take time, tenacity, and societal consensus to reach our goal. But the pandemic off-ramp is clearly in view. ## Transcript Kind: captions Language: en I think vaccines are misunderstood, and maybe it's because it seems like magic. That simplicity and the mystery of it is something that ends up creating a lot of skepticism. People are fooled by the speed. Everything that we knew when it was time to design a vaccine for COVID-19, we knew for so long, but the public had just become aware of it. If this would happen two years ago, we would not be ready. Saying that it happened overnight, it took two, three decades, at least. 2021 was the year when so many praised the miracle of vaccine development. In science, there is hardly ever a simple, quick fix. But this was truly a moment of the right fix - a brand new kind of vaccine technology - at exactly the right time. I started out in math, and I moved to biology. And after medical school, I saw one of the first cases of HIV in Tennessee back in 1982. And so the first part of my career was trying to understand the immunology of vaccine-enhanced disease and trying to make vaccines safer. I got interested in science when I was 16 years old. I was hooked on the idea that you could go to work and discover something that no one else in the world knows on any given day. It seems at 16, I thought that maybe I will be a scientist. I was always working with mRNA, I mean for 30 years at least. And I never wanted to develop a vaccine. I wanted to develop it for therapy. When I first came to Penn from the NIH, pure luck hit where I met Kati Karikó over a Xerox machine. And she told me she worked on RNA, and she could help us with our vaccine. Every experiment doesn't work, every hypothesis isn't good. It was a continuous flow of negative feedback. But we saw the potential of the RNA and neither of us would give up. Although mRNA can teach our cells to fight infection, it took doctors Karikó and Weissman 16 years to figure out how to use it safely in a vaccine. First when I made this RNA, actually I did not tell Drew Weissman, my colleague, because I thought that maybe I mixed up something. So I repeated the experiment and we could see that there was no inflammation in human cells. We're both scientists. We're not baseball players who cheer when we hit a homerun. We knew that it had great potential. But what we thought about is what are we going to do with it? Meanwhile, doctors Corbett and Graham spent years unlocking the structural secrets of viruses. One of the really important problems in coronaviruses that had not been solved is really simple. What does the coronavirus really look like to the immune system? And to figure that out, you have to be able to take a really high definition picture of the proteins that are on the surface of the coronavirus. And then do some protein engineering to stabilize the structure. At that moment, you realize that you have almost what is a universal strategy for creating a vaccine for coronaviruses. A mysterious respiratory illness with similarities to SARS has healthcare workers around the world on alert. What we said to each other, all's we need is a sequence and we're ready to go. We can make a vaccine in weeks and get it into people very quickly. The fact that we made a vaccine in 10 months, and has the potential to end this pandemic, will certainly stand out. "Do it mama!" (laughter) Most scientists never get to see a product actually used. And to watch the evening news and see the relief on healthcare providers getting immunized, those were special moments. I also get emotional when I got a letter from an elderly home, and they reported that they received the vaccine. There were like 200 elderly in that home. And nobody died. On social media, when children were going back to visiting their grandparents again. Seeing people reunited in that way, it was a very surreal moment. A surreal moment, and definitely worth celebrating, if only briefly before a return to work. These scientists are now trying to apply their game-changing discoveries to other diseases. Influenza, even cancer. 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