The Corner

Health Care

Normalcy Now

An usher holds a sign reminding spectators of mask mandates during an NBA playoff game at Staples Center in Los Angeles, Calif., June 6, 2021. (Kirby Lee-USA TODAY Sports)

On Thursday President Biden unveiled yet another plan to “beat the pandemic,” following up on his campaign pledge to “shut down the virus.” It’s time to retire this eliminationist thinking. Over the last several months, the COVID endgame has become increasingly clear: The virus gradually reaches an endemic state in which most of us are exposed. That’s it. No intervention — not lockdown, not masking, not “test and trace,” and not even the vaccine — has been able to stop COVID’s long march.

Whatever influence the interventions may have on viral spread, it is clearly not enough to prevent major waves of infection from washing over the country, region by region, on a largely seasonal basis. We have 18 months’ worth of proof. That’s why I’m uninterested in debating the quality of that Bangladeshi mask study or poring over infection trends in states with different indoor capacity rules or arguing whether self-quarantines should be ten days or 14 days. Why fight over interventions that are marginal at best? They do not change COVID’s basic pattern, which is a series of seasonal waves that will continue until infection has become sufficiently widespread.

So although we have no choice about the endpoint, we do have a choice about how we get there. We can keep on masking and distancing and quarantining and tut-tutting at people who congregate in large groups, or we can return to normal life as the virus completes its pandemic phase. I vote for normal life.

Accepting the inevitable is difficult for many people, perhaps because COVID has earned such a frightful reputation. But pharmaceuticals have rendered the virus much less dangerous than it was in 2020. Vaccines taken prior to infection prevent most severe cases, and infusions of monoclonal antibodies, received soon after infection, appear to be quite effective as well.

Even some people who understand the low risk associated with a typical COVID case are still reluctant to accept that their own infection is forthcoming. The restrictions themselves deserve some blame here. When a mere positive test requires quarantine and awkward calls to friends and colleagues, it’s understandable that people will take extraordinary measures to avoid it. In that sense, the restrictions are self-reinforcing. Infection is even seen as shameful in some circles, as if it is some kind of personal failing. It’s time to put that all behind us.

The public-health establishment does not agree, of course. They have volunteered no specific endpoint for the restrictions, and it’s fair to assume that none is imminent. “If endemicity is the future, then masks, distancing, and other precautions merely delay exposure to the virus — and to what end?” Ed Yong asked in a piece for The Atlantic last month. The answer, the public-health advocates told him, is “to buy time.”

That answer is not persuasive. First of all, how much time is actually available to purchase? As noted above, no intervention has prevented major surges from coming and going at seasonally predictable points in various parts of the country. At best these interventions may have shortened waves, but they did not prevent them. That’s why the most plausible reason to buy time — to prevent hospital overruns — is still unconvincing. Hospitals have been stressed for sure, but the early fear that untreated patients would be dying outside of overflowing ERs never came to pass. With the pharmaceutical treatments available now, it’s hard to believe it ever will.

Other reasons given to Yong for buying time are even less convincing. One is “to keep schools open,” but it is the restrictions themselves that threaten to close schools. Here again the mitigation strategies seem self-reinforcing: We have to quarantine students and close schools at the first sign of an outbreak, because otherwise infections might spread, and then we’d have to . . . quarantine students and close schools. Once we acknowledge that infection is inevitable, schools are in fact one of the most obvious places to restore normal operations. If we cannot accept that the lowest-risk demographic group (students) will be exposed to the virus, then we are not ready to accept reality at all.

Other justifications for buying time include studying breakthrough infections, further encouraging the vaccine stragglers, and giving hospital workers a break. These are useful goals, but few people outside of public health will believe they are of such importance that they justify preventing a return to normal life. This is one reason that elected leaders should never transfer decision-making authority to public-health advocates. Such advocates have important contributions to make, but they cannot be expected to balance competing interests in the same way that the people’s representatives do.

The public-health establishment will always be inclined to ask for more time for its own priorities. Sometimes — like now — we have to say no. If we are not able to acknowledge the inevitable and recover our freedoms in this moment, I fear we never will.

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