COVID: When will it be “over”?

When will COVID be over? It feels like a question we have been asking since March 2020. At that time, I thought it was April 2020. It wasn’t. From a policy standpoint, the pandemic is clearly not over yet. Not everyone is vaccinated. There is a desperate need for more vaccines globally. There are large pockets of unvaccinated individuals in the U.S., and we are still seeing significant hospitalizations in some areas. However: let’s think about households where all the adults are fully vaccinated and where the unvaccinated kids are healthy. We’ve done what we can to protect ourselves, and we know the vaccines are very effective. And yet every decision is somehow still agonizing. Playdates. Should I go to that friend’s wedding? Can I have a baby shower? The other day, someone asked me if they should keep their 2-year-old out of school until the youngest child in the class turned 2 and was required to wear a mask. The anxiety and frustration boils down to the question: When will it be over? This is the wrong question. Or, rather, framing the question like that will lead you to a frustrating answer. Because if what you mean by “over” is “back to the before times,” the answer is, quite simply, never. At the most basic level, this is because the SARS-CoV-2 virus will be with us in some form (as an epidemic virus, not a pandemic) forever. It will circulate like other coronaviruses, and the idea of complete elimination is not realistic. We will live the rest of our lives with some risk of getting COVID-19. If you are waiting for a moment when someone declares the world COVID-19-free, you shouldn’t expect it to come in your lifetime. Beyond this, I expect the pandemic will leave behind a heightened sensitivity to all illness risk. It will change our behavior. I think many people will wear masks indefinitely in the winter, especially on public transit and airplanes. The social acceptability of sending kids to school “a little” sick will be less. I think we will all be more sensitive to exposing older family members to illness. This is partly because of increased fear, but partly because we realized the possibility of having (for example) a more limited flu season. You may like it or not, but I’m expecting some schools to encourage mask use during flu outbreaks (at least until Moderna comes out with a yearly COVID-flu-RSV protection shot). We are not going to arrive at a point where there is no COVID. The 2019 world in which you’d never heard of COVID-19 and never thought about it will not happen again. I’m not saying this to scare you or make you sad. I say it because if you are waiting for that moment to decide it is over, it makes sense to adjust your framing. Let’s ask instead: When can I stop obsessing about calculating COVID numbers around every choice I make? The answer here is: When you decide to. And it will be a conscious decision. The real pandemic “endgame” at a decision level is to start thinking about COVID the way we think about the flu or other contagious illnesses. There may be some broad adaptations of our behavior to the existence of the risk, but there will also be a point at which COVID is not a part of our everyday calculations about playdates and weddings and birthday parties. And when we get to this point, it will feel more like the “before times,” even if it looks a little different. Arriving at this endgame requires deciding at what point you feel the COVID-19 risk for your family belongs in this bucket. It means deciding when you feel it is in the space of the other risks you take. In a sense, there may be some relief in saying that, hey, this is in your control. But at the same time, making that shift will be cognitively challenging. We’ve spent the past 18 months with COVID-19 at the front of our mind, as the most salient risk. It is involved in every decision. That cannot be true forever, and it shouldn’t be once people are vaccinated. But choosing to relegate it to a more conventional risk bucket is going to require actual mental effort, especially at first. The timing of when this could happen will differ across families and circumstances. For some people, it’s now. Vaccinated adults are at very low risk for serious illness. If your household is all vaccinated, the risk of serious illness is extremely low, and even breakthrough infections are not that common (see discussion here). And if you do get a breakthrough infection, the vast, vast majority of the time it will be mild or asymptomatic. What if you have unvaccinated children? For some households in this category, you may still feel protected if all the adults are vaccinated. From the standpoint of serious illness, kids remain extremely low-risk. Recent data from the U.K. actually suggests that unvaccinated kids are at lower risk for serious illness than vaccinated adults. The fact is, in my house, the highest-risk people are me and my husband, both fully vaccinated, not our kids. If we feel we are protected (which in our case, we do), it is not unreasonable to think of the kids as protected also. For other parents, especially with children who are immune-compromised or have pre-existing conditions, they won’t feel protected until vaccines for children are available (possibly as soon as October...). I suspect many people in general are waiting on children’s vaccines. If you have immune-compromised adults in your household, maybe you are waiting for a booster. Feeling protected is not the same as feeling that no one will ever get COVID. I am purposely not linking this to case rates. There will continue to be mild and asymptomatic cases of COVID forever. Vaccines for kids are something I want to take advantage of, but they will not eliminate the risk that kids get COVID. You can feel protected while still accepting the possibility that you will get COVID or your kids will. One way I see it: when policymakers and the media discuss the low risks of COVID to vaccinated people, they still focus tremendously on numbers, trying to help people understand the low risk with numbers like 1 in 5,000 or 1 in 10,000. We know from psychology that small probabilities like this are hard for people to really understand and think through. Moving forward is going to require accepting that the risk is “small but not zero” but not obsessing about whether it is 1 in 5,000 or 1 in 10,000. In the end, the message here is that there is no world of “no COVID” and if you are waiting for some external sign that the pandemic is over, you will be waiting forever. Eventually it will move to our everyday risks; our behavior will adapt to its existence, but it will not be top-of-mind all the time. Driving might provide a good parallel. It has risks, and you take steps (i.e. wearing a seatbelt, putting your kids in car seats) to mitigate those risks. But you also do not calculate the risk when you decide about every car trip. The end here will be that going to a bachelorette party still has some COVID risks, and you mitigate them by being more careful about not going if you’re sick, and maybe wearing a mask on the plane there. But you do not calculate the COVID risk when you decide to go, and you do not wonder if the jello shots are a COVID vector. But, but, but … Let me address a few of the questions I know I will get. What about protecting other people? There are those who think we should maintain a more serious lockdown until we can get closer to no COVID cases. I disagree with doing so because I think the non-COVID costs (e.g. mental health, other physical health, economic hardship) are extremely high, and the protection afforded by vaccines is excellent. However: there are clearly actions we should take to protect others. This includes getting vaccinated, staying home when sick, and getting tested, especially after significant travel or group activities. In areas with higher case rates, wearing a mask inside also likely provides some protection for others. You can do those things, as part of your normal life, without obsessing about them. I live in a state with high COVID rates. “Feeling protected” is explicitly about your thinking on the disease risk for you and your family. You could feel protected by being vaccinated people with low-risk children even if COVID rates are higher. I wrote the above without an idea of a case rate “cutoff.” But the “new normal” is going to make us more thoughtful about illness risks in general; I think we’ll react to flu outbreaks more seriously, for example. If your area is having a COVID outbreak, it may be appropriate — now and indefinitely — to take more precautions (more mask wearing, maybe more testing before seeing older relatives). I can’t move on because of school quarantine rules. Indeed. You may be ready to move on from a disease-risk standpoint with kids but also be worried about missed school. This is a tough nut. It is another reason vaccines for kids will be valuable for many parents, or that we should loosen quarantine rules. What about long COVID? Long COVID is still poorly understood, and we do know that some small share of kids have persistent symptoms, which are generally mild. This is a topic about which we need to know more. The Bottom Line I titled this post “When will it be over?” It’s a hard question. The answer is both “never” and, in some ways, “when you decide.” This next phase is going to be challenging in a different way than the last one was. Recognizing that may be the first step in facing it.

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