Why the worst of the Covid-19 pandemic may be over — for some – Vox.com

Covid-19 case counts are falling in the United States and many parts of the country are starting to relax.

Cities like Washington, DC, and New York are lifting vaccine mandates for many public indoor spaces. National public health officials are easing up, too. The Centers for Disease Control and Prevention now advises that communities with low levels of transmission can forgo universal masking.

As spring draws near, is it finally time to feel hopeful? Is it possible the worst of the pandemic is behind us?

The US public seems to think so. A March 1 poll from the Kaiser Family Foundation found that majorities across the political spectrum think the darkest days of Covid-19 are over.

Kaiser Family Foundation

However, we’ve been fooled before. Over the past two years, wishful thinking has proved naïve time and time again. Initial hopes that the vaccines would be a ticket to freedom were dashed by waning immunity and the emergence of more contagious variants. How much further the virus will evolve from here is impossible to predict.

Many of us just don’t know what to think about the future. How will we know when things are really getting better? Is there still the chance that things will get worse?

In our search for clarity, we turned to eight experts in public health, virology, infectious disease ecology, medical anthropology, and medical history with a simple question: Is the worst of the pandemic over, and if not, how will we know when it is?

We heard a lot of measured optimism, but also uncertainty. While the pandemic situation might be easing in the United States and other countries, much of the world still remains unvaccinated and highly vulnerable. And the unpredictability of both viral evolution and human behavior means we need a healthy dose of humility as we move into the future, the experts told us. Brighter days are likely ahead, but the unknowns continue to cloud a clear view of the future.

Is the worst behind us? For many in the US: Probably.

Overall, most of the experts said, with some reservations, that in the US and much of Europe, the most destructive waves of Covid-19 are in the rearview mirror.

“I am hopeful that the worst of the pandemic is now behind us,” said Dr. Megan Ranney, an epidemiologist and physician at Brown University’s School of Public Health.

Her optimism stems from a variety of factors, chief among them the widespread immunity in the US, whether acquired through vaccination or infection.

In addition to immunity, there are new, effective Covid-19 treatments available — like monoclonal antibodies and antiviral drugs — which can help infected people avoid hospitalizations and death. Also, the broader availability of high-quality masks and air filters — and a better understanding of ventilation, social distancing, and other mitigation strategies — puts us in a better position to reduce transmission than we were earlier in the pandemic.

And even though immunity wanes over time, “protection against the most severe disease and death will remain for quite a long time,” Dr. A. Marm Kilpatrick, an infectious disease researcher at the University of California Santa Cruz, writes in an email, citing CDC data. So people may continue to get infected with SARS-CoV-2, but the worst outcomes might be largely behind us.

But … variants are still a major concern

Everyone we spoke with — even the optimists — said the threat of new variants is still very real. Just as the infectiousness of delta and omicron caught researchers by surprise, new variants may evolve and cause us to reset our expectations for the future.

“I just don’t like to underestimate the virus,” Dr. Kari Debbink, a virologist and immunologist at Johns Hopkins, said.

There’s been some hopeful speculation that perhaps, in the future, the virus will evolve to become less deadly. However, that’s not a rule: “It is not an iron law of virology that newer variants are necessarily weaker or less virulent than a prior variant,” said Dr. Nirav Shah, Maine’s chief epidemiologist and president of the Association of State and Territorial Health Officials. “It can absolutely go the opposite direction.”

Variants are more likely to emerge in parts of the world where vaccination rates are lowest; the more infections that occur, the more chances the virus has to replicate and change. That’s why it’s so important to vaccinate as many people as possible against the virus.

Channi Anand/AP

But momentum might be stalling. Shah said that while raising vaccination rates in India and sub-Saharan Africa would reduce the risk that a new variant of concern would emerge, the appetite for vaccines in these regions varies. There are also supply chain hurdles and personnel shortages hampering the effort to reach the most remote and most vulnerable people.

The best we can do to prepare for new variants is to be on the lookout for them.

The most concrete way to identify variants of concern is through genomic surveillance, regularly scanning virus samples from infected people for mutations. But the US still has a patchwork system for finding variants, according to Dr. Shweta Bansal, an infectious disease ecologist at Georgetown University. As a consequence, new variants arising in the US may not be found right away.

However, other trends can signal that a concerning new variant is taking hold. If scores of previously vaccinated or infected people start to get sick, it could suggest a variant has developed that can evade the immune response. Scientists will be closely monitoring changes in case numbers, hospitalizations, or excess deaths in the US or in other countries.

Human behavior is an important wild card

Public responses to policy are another important determinant in the future of the pandemic. We’ve “learned a ton in terms of behavior, and how people tend to kind of react to policies of controlling viruses,” said Bansal.

But it’s unclear that the institutions responsible for crafting policy and messaging are equipped to overcome social divisions that have hampered widespread preventive efforts. “We’re obviously not having a great discussion about civic values and responsibility, and I thought we would by this point,” said Dr. Sarah Cobey, a University of Chicago infectious disease researcher and modeler.

On the other hand, the Covid-19 pandemic created dozens of natural social science experiments as states and cities deployed different tactics. That’s given researchers real-world feedback on what kinds of messages and policies motivate people to use preventive measures like social distancing and mask-wearing, pointing the way toward more effective public health strategies.

We’re not really taking advantage of transmission lulls to improve preparedness

With transmission now receding throughout the US, policymakers are now taking off-ramps from intense preventive measures, loosening mask requirements, vaccination mandates, and restrictions on gatherings. “But we’ve seen that movie before,” said Bansal, and “the virus has a way of roaring back.”

“We really should be taking advantage of this hiatus” to build up our preparedness capacity, she said.

Others agreed that the best way to avoid another disastrous transmission surge is to get ready for it — but they’re not convinced we’re doing that effectively: “I’m fearful that the country wants to be done with Covid-19 — and thus, many of the things that we need to do to prepare for the next wave are not being done,” said Shah. He would like to see broader use of wastewater testing as an early warning system, and assurance that our rapid test and PPE supply chains are robust and responsive to transmission surges.

Ranney agreed that improving preparedness was critical to ensuring the worst is behind us, and that ensuring good systems for early outbreak detection are key. Improving global and local vaccination rates, developing and scaling up access to Covid-19 treatments, and getting community buy-in around preventive measures are also important, she said.

Allen J. Schaben / Los Angeles Times via Getty Images

We always have to ask: The worst may be over, but for whom?

When we asked experts “is the worst over?” some responded with a question of their own: “For whom?”

Even as the peak of the pandemic crisis fades into the rearview mirror for some, others — generally those already marginalized by poor access to healthcare and other vulnerabilities — will still be living with its worst effects.

“The pandemic being mostly over for me might not mean that it’s over for somebody else,” said Debbink. She worries that declaring the worst is over “kind of allows people to disregard those who are still at great risk.” That includes immunocompromised people and those living in parts of the world with limited vaccine access. “There are millions and millions of people that don’t even have access to a vaccine yet,” she said — and the worst might still be to come for them.

Plus, she said, we don’t really know the long-term toll that long Covid symptoms will continue to take on people. “With each person that gets infected, you still have this huge group of people that may suffer long-term impacts,” she said. For them, the worst might not be over, but just beginning. “At this point, we have no idea if long Covid symptoms are going to be permanent.”

The global view is particularly sobering. The US has high levels of infections and vaccinations, but “are probably yet to see their most damaging waves, or would require ongoing harsh restrictions” to delay surges of transmission, Dr. Adam Kucharski, an infectious disease epidemiologist at the London School of Hygiene & Tropical Medicine, wrote in an email.

The SARS-CoV-2 virus will likely cause human disease well into the future, and in that sense, it may yet do more damage than it has already done. But because those effects will be distributed over a longer period of time, we may not perceive them to be as severe as the waves of hospitalization and death we have experienced over the past two years. “I think we’re going to be living with it for a very, very long time — so in that sense, the worst isn’t behind us,” Cobey said.

We may never get a definite answer for when this is all over

The worst of the pandemic is probably behind us in the US. But the virus is still infecting, hospitalizing, and killing people. How much longer that will continue has to do with variables that are hard to predict right now: the duration of immunity over the course of years, and risks even further afield, like the chances of a new variant emerging from wildlife like deer.

Because sanguine pandemic predictions have so often been proved terribly wrong, few of our experts were willing to forecast sunny skies without qualification. “Historically, though, we know that all pandemics eventually end, and this one will as well,” said Dr. J. Alexander Navarro, assistant director of the Center for the History of Medicine at the University of Michigan. “That day is likely sooner rather than later, but we will have to see what the future has in store for us.”

And we may not even recognize the end of the pandemic as we pass it. Instead, it may require some historical distance before we can look back and find a point that may have been an exit. “There will not be a particular day or week or month when we wake up and say ‘I’m sure glad that’s over,’” said Dr. Maureen Miller, a medical anthropologist at Columbia University. “Even the pandemic end date, like everything else Covid-19, will likely be the subject of heated debate.”