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With the United States in the midst of a surge of coronavirus cases driven by the Delta variant and scientists concerned that colder weather may bring yet another spike in infections in the fall, it can be easy to lose sight of the reality that, eventually, the pandemic will end.
The end of the pandemic does not mean that COVID-19 will go away entirely, however. Most scientists have come to believe that the idea of a “COVID zero” future is unrealistic. Only one infectious disease among humans, smallpox, has ever been fully eradicated, and that didn’t happen until nearly 200 years after the first smallpox vaccine was invented.
All other diseases become endemic, a term that describes a state in which the threat gradually decreases until the disease becomes a regular part of life, like the flu — which kills up to 60,000 people a year. In this scenario, there would still be a baseline of COVID-19 infections at any given time and occasional larger outbreaks, but immunity from vaccines and infections would lower overall risk enough that large-scale mitigation measures like masking and lockdowns won’t be seen as necessary.
Why there’s debate
Experts agree that the U.S. will ultimately have to learn to live with COVID, but reaching that future creates its own set of complicated questions. One of the most difficult tasks, many argue, is deciding what level of risk would be considered acceptable as part of day-to-day life. Reaching a consensus on how many cases, hospitalizations and deaths society is willing to tolerate in exchange for a return to normalcy could prove to be incredibly difficult in light of the intense divisions that have prevailed throughout the pandemic.
Some scientists believe that certain low-difficulty strategies like masking, preference for outdoor gatherings and testing will become more regular features of day-to-day life, at least when cases start to rise. Many also predict that COVID booster shots will become a part of standard medical care. Despite these strategies, the key to reaching the endemic phase of the pandemic will be accepting that, on a long enough time scale, everyone is likely to contract COVID. Some say the goal should be to ensure that those infections are mild through vaccinations and protecting the vulnerable.
These predictions are typically couched with reminders of the many variables that could affect what things look like, most notably with the virus itself. The Delta variant has shown how it can change to become more dangerous, and scientists say it’s possible, although fairly unlikely, that a much more virulent or vaccine-resistant variant could flip the script. It’s also plausible that the virus could become less deadly through a combination of earned immunity and mutation to less harmful strains.
Before the U.S. can reach the endemic stage of COVID, of course, the acute period of the pandemic must come to an end. Public health experts see some indications that the surge of infections driven by Delta may have peaked, but there are also concerns that cases may rise during the cold weather months in states that have avoided the Delta wave.
Everyone should assume they will contract COVID eventually
“With a strain as infectious as Delta going around, the right way to bet is that we’re all going to be exposed to COVID one of these days. We should just plan on getting vaccinated first — and getting a booster shot once our immunity has started to wane — so we most likely don’t even notice, as in fact most of the vaccinated probably haven’t, even when they’ve gotten infected.” — Noah Millman, The Week
For most people, catching COVID won’t be a big deal
“Today, reports of reinfections and vaccine breakthroughs tend to come as a scary surprise. But they will increasingly feel normal as the acute phase of the pandemic draws to a close.” — Katherine S. Xue, New Yorker
Americans must decide how many virus deaths are too many
“Instead of the public and officials openly discussing how much risk is acceptable, the public dialogue often feels like two extremes — the very risk-averse and those downplaying any risk of the coronavirus whatsoever — talking past each other. But the path to an endgame should begin with a frank discussion about just how much risk is tolerable as the coronavirus goes from pandemic to endemic.” — German Lopez, Vox
COVID can’t be allowed to stifle the economy in the long term
“Let’s hope the political class has learned some lessons from the last 18 months — namely, that Covid will always be with us, and that we have to live with it without shutting down the economy.” — Editorial, Wall Street Journal
The transition to the endemic stage may be frustratingly slow
“The light at the end of the tunnel for me is that the long-term picture still doesn’t look so bad, it’s just that it’s not this kind of ‘get to this magical threshold of vaccine coverage and it’s all over.’ It’s a slower progression with a less clear-cut end.” — Jennie Lavine, epidemiologist, to STAT
Living with COVID will mean accepting that some people still face elevated risk
“As much as the campaign to vaccinate might want to exercise zero-tolerance policies against resisters, in the absence of a law mandating universal compliance, we can’t reach that goal. Realism requires us to accept — though not salute — dead-enders who have burrowed deeply into their tunnels. Some people will never surrender their lost causes.” — Jack Shafer, Politico
Life will look very different in different parts of the country
“I suspect we’re headed for a two-tiered society (or maybe a many-tiered society) built not just on the risk the coronavirus poses to the local population, but on the sensitivity to that risk. … So there may be no one endgame here, only constant management of the risks we face and are willing to bear.” — Ezra Klein, New York Times
Some virus mitigation strategies will remain part of everyday life
“We can’t eliminate all viral threats, but we can build a culture of care that can help protect us from many diseases. In the same way we walk through a forest with an eye to the ground for poison ivy, so too should we walk through our days: aware of the risk of, for example, a public transit commute and adopting mitigative strategies.” — William Haseltine, Washington Post
We will have to be willing to change strategies as the virus changes
“As long as the virus is evolving, we have to evolve with it.” — Vineet Arora, University of Chicago professor of medicine, to Time
There’s no way to truly know what the future of COVID will look like
“No one knows. I repeat: no one knows. No one can know. Which means even though we might be approaching an awkward start-stop, yes-no, relax-panic, ‘is it really over?’ phase, we are stuck flying blind. …. Even though planning doesn’t always make perfect, considering the range of ‘maybes’ is the only way to prepare.” — Kent Sepkowitz, CNN
It’s dangerous to assume the virus will simply fade into the background
“People assert, with enviable confidence, that all infectious diseases become milder over time, but many examples — such as smallpox, polio, measles and cholera — contradict this wishful thinking. … Others state confidently that humans will adapt to the virus, but I doubt that, when saying this, they are aware that this is survival of the fittest, a scenario involving a great deal of death.” — Aoife McLysaght, Irish Times
We will have to unlearn many of the lessons from the early stages of the pandemic
“The transition to endemic COVID-19 is also a psychological one. … That means unlearning a year of messaging that said COVID-19 was not just a flu. If the confusion around the CDC dropping mask recommendations for the vaccinated earlier this summer is any indication, this transition to endemicity might be psychologically rocky.” — Sarah Zhang, The Atlantic
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Photo illustration: Yahoo News; photos: Daniel Slim/AFP via Getty Images, Getty Images
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