President Biden’s rebound case of COVID-19 has highlighted the continued threat to public health posed by the rapidly spreading BA.5 variant. COVID infections are becoming more common, with cases rising in most states just as population immunity wanes. Many infected people are struck down with severe flu-like symptoms for several days. Hospitals are once again filling up with COVID admissions, increasing by more than 41,000 every day. Therefore, public health experts issue warnings that BA.5 portends the continued evolution of more severe variants and the need for caution and behavioral changes.
But although COVID is on the rise again, there seems to be little public concern about it. Simultaneously, politicians are acting as if COVID is over by refusing to appropriate additional funds to support public health improvements, purchase vaccines and treatments, accelerate research and development of vaccines and treatments, or trigger advance purchases of necessary next-generation drugs, tests or vaccines. It seems most Americans have decided that “everyone is going to get COVID” and have resigned themselves to the inevitable. Life is therefore largely back to what it was in 2019: no masks and no restrictions.
How should the federal government handle the disconnect between a public health emergency and a population that seems hardened?
The only sensible approach is to accept the attitude of the audience and work with – or around – it. If the public doesn’t listen, the advice of public health experts – however urgent, persistent and vocal – will not be effective. This means policymakers must pivot, instituting passive measures to mitigate transmission and tailor interventions to public acceptance.
Public health officials must accept that SARS-CoV-2 is now endemic and will constantly evolve. On this point, the American public is right. The language of “defeating the virus” or “overcoming COVID” is misleading and alienates the public. The next steps require accepting that COVID will be with us forever, and “normal life” requires living with the virus.
COVID also appears to have caused Americans to recalibrate their risk tolerance – considerably. In exchange for fewer restrictions on masking, travel and socializing, Americans now seem willing to accept 150,000 to 200,000 COVID deaths per year – around 400 per day – or three times bad flu seasons. That would make COVID the fourth leading cause of death in the United States. They also seem to rule out or minimize the risks of a long COVID. Public acceptance of increased risk necessitates increased thresholds for issuing public health recommendations and restrictions.
Accepting the public position also means waiving closures of schools, offices, bars and restaurants, and all other public places, even when high levels of transmission are occurring or likely. That’s what endemic means – to live with the virus.
But that doesn’t mean doing nothing. Public health policymakers must adopt the air bag model for COVID – safety measures that work in the background without individuals needing to take the initiative to achieve substantial benefits.
One thing that can be done is to improve indoor air quality. COVID is an airborne disease and improving indoor air quality can reduce transmission and keep people healthy. It is essential to compel schools, public buildings and other indoor places to upgrade HVAC systems or use germicidal UV light. Air quality must also be improved in planes, trains, buses and other means of transport. The action is happening all over the country, but very slowly.
The public health system also needs to be upgraded with real-time data collection infrastructure, sewage and home testing kits expanded to include detection of multiple pathogens, and the addition of a framework of community health workers targeting vulnerable populations.
Likewise, due to the high contagiousness of BA.5 – and possibly other later variants – there must be paid medical and family leave for all workers. One of the most damaging economic effects of BA.5 is the absence of workers resulting in flight cancellations, supply chain disruptions and other economic strains, such as store and office closures. because everyone has contracted COVID. It’s often the result of infected workers passing on COVID to co-workers. Paid medical leave will help reduce the transmission of COVID and other respiratory viruses.
Vaccines also need to be changed, prioritizing their manufacture of one dose per year with long durability and wide immunological scope. Research should also focus on drugs that can be sprayed into the nose or mouth to prevent SARS-CoV-2 from latching onto cells and causing infection. It might be effective for just a few hours, but it would make social events safer.
COVID has exposed the public’s limit to adapting their lives to an emergency. And Biden proves that COVID is raging and that new transmissible and virulent variants will continue to emerge. An ideal response would be for people to mask up in areas with high case numbers. But asking that would be like deja vu – repeating the same mistakes and incurring the same mortality and economic pain. Instead, we need to institute measures beyond that, so as not to burden Americans. It’s time to correct the course.
Dr. Ezekiel J. Emanuel is Vice Provost for Global Initiatives and Co-Director of the Healthcare Transformation Institute Perelman School of Medicine and The Wharton School at the University of Pennsylvania.