At the supermarket, work, schools, restaurants, sports events, and airports we are witnessing a remarkable change. Masks are rarely seen. People are hugging, crowding, traveling. The latest Google COVID Community Mobility Report shows that most forms of activity have returned to near normal relative to the pre-pandemic baseline. But some people are understandably confused and conflicted. Mainstream media and many “experts“ continue to admonish us to avoid exposure. Are we indeed still in the treacherous pandemic phase? Are the throngs being irresponsible? Or are we witnessing a crowd-sourced, rational resetting of risk tolerance based on better information, options, and lived experience?
The current data is not in dispute. But the interpretation, implications and what to do about it is.
What’s clear is that the latest Omicron sub-variants are running rampant across the globe. These are the most communicable human viruses on the planet. Vaccines remain highly effective in preventing serious disease, but are far less effective in stopping infections and transmission. The virus is highly adept at circumventing the immune defenses even of those who were previously infected or are up-to-date on vaccinations, or both. The fact is that infections and reinfections are virtually impossible to avoid or contain. We all know many public figures, relatives, neighbors and friends, including ourselves who have had and recovered from recent COVID-19. That’s likely to remain the case. Given the characteristics of SARS-COV-2, the name of the virus that causes the disease, it is unlikely that future variants — or newer vaccines — will change the prospect of waves of infection and reinfection.
And there are a lot of them. We are currently experiencing over 100,000 reported infections per day. But with most home testing unreported, the actual U.S. infection detection rate is estimated to be around 14 percent. This means that over three-quarter million Americans are being newly infected every day. That’s 1.5 percent of the entire U.S. population every week.
Yet, but for a slight uptick, fatality rates and hospitalizations caused by infection are near their lowest levels of the pandemic, due to the relative mildness of the sub-variants and growing population immunity. A UK study has revealed that severe outcomes from Omicron are far less likely than with the earlier Delta strain, whether people are vaccinated or not. Mortality rates by age cohorts still show the same dramatic upward skew in elders and other vulnerable populations that has been seen since the start of the pandemic.
We must face the blunt reality that a significant minority of Americans will choose not to be vaccinated. Despite great efforts to persuade them otherwise, about 20 percent of American adults are currently unwilling to be vaccinated and a further five percent are uncertain. Thirty-one percent of children aged 12-17, and 64 percent ages 5-11 are unvaccinated. However, antibody analysis has revealed that early in the Omicron surge in February of this year, between 70 and 80 percent of all children over the age of one had been infected. With the current even more communicable sub-variants it is likely that nearly all children have already been infected at least once.
The ultimate protection against serious outcomes from any airborne circulating virus is robust population immunity. The level of population protection at any point is a function of many variables related to vaccine coverage, effectiveness and durability. Similar parameters apply to immunity generated by natural infection. For those who develop symptoms and are high risk, oral antivirals such as Paxlovid can ameliorate the illness and significantly decrease hospitalization and mortality, whether immunized or not.
This is the landscape in which so much of the public is choosing to return to normal, accepting the risk of exposure and infection. Is that good? Or bad?
It’s natural. What we are witnessing is an inevitable phase of societal psychosocial adaptation to living with the virus–an evolutionary arc moving from fear to resignation to acquiescence to normalcy. We will not be able to resume our lives without completing this progression. This is a natural human and societal adaptation, predicated on increased knowledge, experience, and evolution of the virus. Because New York City was seeing an upturn in cases and hospitalizations at the time, Mayor Eric Adams was criticized this summer for discontinuing the color-coded warning system for virus transmission. But changing the settings on the alarm is not upending the system.
The public is becoming increasingly “immune” to the daily barrage of uncertainties and warnings from “experts” and the media. In the main this reflects wisdom-of-crowds common sense and rational risk adaptation and not a blind disregard of evolving science and facts. It involves a complex revision of our individual risk calculus.
The reality is that current high levels of population immunity will be maintained, and greatly dampen the effects of today’s and likely future variants. This will occur both actively–through ongoing vaccination and boosters–and passively, through relentless cycles of mostly asymptomatic or mild but rarely severe infections.
With access to vaccines and antivirals, most people with COVID-19 now face a relative mortality risk comparable to influenza. This is good news.
It is not news that applies to the elderly, immunodeficient, or people with specific comorbidities. The vulnerable have a far more serious risk profile that calls for vigilant exposure protection strategies. They must be protected.
But current science supports a much more relaxed policy and risk-tolerant environment, free of most mandates and shaming. We can expect to see progressively less testing, quarantine and isolation as people and institutions recognize that the disruptive downsides of identifying cases in many circumstances far exceeds the benefit of containment measures. This is especially true when ongoing significant community transmission is inevitable and most infections are asymptomatic or mild. This was the rationale for the recent CDC order eliminating the testing requirement for international air passengers entrance into the U.S. We can expect more relaxation of similar mandates.
Information, societal trends and cultural norms are undercutting the opinion of experts and the media vanguard. This represents neither pandemic fatigue nor a willful disregard of facts. It’s a natural, messy transition phase supported by increasing knowledge, lived experience and better tools. We have been longing for light at the end of the tunnel since early 2020. If we squint hard enough we can now see it.
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