The COVID-19 emergency must end
Post-COVID-19 loss of key sense is a special agony
Christmas of 2021: According to President Joe Biden and Dr. Anthony Fauci, together the two most prominent voices on public health in America right now, that’s when we can hope for a return to normalcy, the beginning of life after the emergency.
Even that not-exactly-optimistic prediction comes with hedges and caveats.
Next Christmas won’t necessarily be the end of pandemic restrictions, according to Biden — just a time when “significantly fewer people having to be socially distanced, having to wear a mask.”
Likewise, Fauci has described his hope as “a degree of normality” by the end of 2021, with the possibility of widespread masking persisting into the following year.
I am not vested with Biden’s authority or Fauci’s expertise, but I can read trend lines and vaccine studies, and at this moment both their takes look way too pessimistic. A major setback is always possible, but right now, the conditions for the end of the emergency seem likely to arrive sometime in the summer, not at Christmastime. Those conditions don’t require the coronavirus to disappear entirely. They just require its dangers to diminish to the point where the reasons for suspending ordinary life no longer obtain, and the emergency measures taken against COVID-19 no longer justify their cost.
The looming arrival of herd immunity is part of this story.
In a report over the weekend, two of my colleagues estimated that a combination of infections and vaccinations could deliver us into the herd-immunity range by July. If we speed up vaccination, the date might arrive even sooner. Alternatively, if social distancing declines rapidly in the interim or a more infectious variant spreads, then we’ll get a last spike of cases and more people will die — but more infections also means more immunity, so even in that grim scenario herd immunity could actually arrive sooner still.
A variant that is more infectious and much more vaccine or immunity-resistant could alter this timeline. But the leading candidate for that role, the South African variant, appears at least somewhat vulnerable to the vaccines that we already have. And even in South Africa itself, it only appears to have caused a temporary spike in cases, followed by a swift decline.
The other part of the optimistic story is vaccine availability.
By sometime in the summer, if not sooner, everyone in the U.S. who wants a vaccine should be able to get one. This will create new challenges as public health authorities try to woo vaccine skeptics.
But even if the uptake rate isn’t as high as it needs to be and it takes longer than hoped to fully clear the herd-immunity threshold, the simple availability of vaccines will change the moral calculus around the disease. What has been up till now a collective-action problem, justifying restrictions and closures and mask mandates, will become more of a matter of individual responsibility, where people who don’t get a vaccine are primarily putting themselves rather than society at risk.
At that point, with herd immunity close and vaccines generally available, the arguments marshaled by COVID skeptics and
lockdown critics, which have been mostly wrong or misguided up till now, will begin to make more sense.
It’s not much worse than the flu, skeptics have argued. Well, no, COVID isn’t remotely like normal influenza. But under conditions of mass vaccination, with vaccines that reduce the risk of death and severe illness even among the small share of vaccinated people who get sick, the coronavirus will actually look a lot more like the flu.
We can protect seniors and other vulnerable people while otherwise continuing with normal life, skeptics have argued. Well, no, we can’t, because the elderly and vulnerable are a huge population that can’t be easily segregated from the rest of society (and the segregation we’ve pursued has been quite cruel enough). But once you can vaccinate the elderly and others who are vulnerable, the disease can still circulate among younger and healthier people without it being a constant mass-fatality threat.
The damage to the economy and mental health from closures and restrictions outweighs the threat of the disease itself, skeptics have insisted. Well, maybe in certain cases, like elementary school closures — but in general a disease that has killed at least 500,000 Americans more than justified a robust attempt to stop its spread. However: Once the old and vulnerable are genuinely protected, the death toll drops, and vaccines are generally available, the toll that emergency measures take on just about everyone — business owners, college kids, churches, parents, school-age children, the lonely and the old — really will become worse than whatever coronavirus threat remains.
But because some threat will probably endure — perhaps through the winter, perhaps indefinitely — there may be pres
sure on anxious governments to keep the emergency measures in place or lift them ver-r-r-r-y slowly, and similar pressure on public health officials to overstate the continuing risks.
For instance, the fact that a vaccine might not be approved for kids until 2022 could become a reason for schools to extend virtual learning for yet another semester — even though teachers can be vaccinated and the coronavirus does not appear to be more dangerous for children than the flu.
Or again, the fear that a deadlier or vaccine-evading variant might come along could become a reason to maintain restrictions on restaurants, church services or private gatherings through the fall or winter — even though the possibility of a new variant could easily be with us every year, for decades, and we might as well start adapting now.
Or the fear of long-haul, chronic-seeming COVID — which is a genuinely frightening part of this disease — could be cited as a reason restrictions need to remain in place until the virus is entirely eradicated. But other illnesses can have chronic consequences, too, and yet life continues around them: We don’t close schools for the Epstein-Barr virus, despite its link to chronic fatigue syndrome, or expect New England state parks to shut down all spring and summer because of the risk that Lyme disease turns chronic.
To be clear, I can imagine scenarios for 2021’s fall or winter involving a particularly deadly variant or one that’s more dangerous to kids, where reimposing emergency measures might be necessary. And if we end up maintaining mask mandates a little longer than needed, and there’s more mask-wearing in the winter months and on public transportation going forward,
then that’s hardly the greatest burden in the world.
But the danger of the overcautious, wait-for-Christmas public rhetoric from Biden and Fauci is that it provides cover and encouragement for fearful officials to extend the whole suite of emergency measures for many unnecessary months.
No doubt both men have strategic reasons for their approach. Biden presumably hopes to underpromise and overdeliver, while Fauci clearly has a theory of his own role that involves steering public expectations rather than just saying flatly what he thinks.
But after a year of misery, death and sacrifice, the public has a right to know in advance when the emergency should reasonably be over. People who are struggling or despairing right now need a sense of hope, of light at the end of winter’s tunnel. People who are unsure whether to be vaccinated deserve to be told that it can actually change all of our lives, and quickly. And officials struggling to balance risk aversion and the reopening imperative need to be given a permission structure that encourages them to choose normalcy, and soon.
Just under a year ago, Donald Trump was justifiably pilloried when he suggested, without evidence, that the worst of the pandemic might be over by Easter.
But today the situation is radically different. And Joe Biden would be doing our struggling, freezing country a great service if he suggested, with evidence, that with continued effort and reasonably good fortune, the era of emergency might be over by the Fourth of July.
NICE, France — The doctor slid a miniature camera into the patient’s right nostril, making her whole nose glow red with its bright miniature light.
“Tickles a bit, eh?” he asked as he rummaged around her nasal passages, the discomfort causing tears to well in her eyes and roll down her cheeks.
The patient, Gabriella Forgione, wasn’t complaining. The 25-year-old pharmacy worker was happy to be prodded and poked at the hospital in Nice, in southern France, to advance her increasingly pressing quest to recover her sense of smell. Along with her sense of taste, it suddenly vanished when she fell ill with COVID-19 in November, and neither has returned.
Being deprived of the pleasures of food and the scents of things that she loves are proving tough on her body and mind. Shorn of odors both good and bad, Forgione is losing weight andself-confidence.
“Sometimes I ask myself, ‘Do I stink?’ ” she confessed. “Normally, I wear perfume and like for things to smell nice. Not being able to smell bothers megreatly.”
A year into the coronavirus pandemic, doctors and researchers are still striving to better understand and treat the accompanying epidemic of COVID-19-related anosmia — loss of smell — draining much of the joy of life from an increasing number of sensorially frustrated longer-term sufferers like Forgione.
Even specialist doctors say there is much about the condition they still don’t know, and they are learning as they go along in their
diagnoses and treatments. Impairment and alteration of smell have become so common with COVID19 that some researchers suggest that simple odor tests could be used to track coronavirus infections in countries with few laboratories.
For most people, the olfactory problems are temporary, often improving on their own in weeks. But a small minority are complaining of persistent dysfunction long after other COVID-19 symptoms have disappeared. Some have reported continued total or partial loss of smell six months after infection.
Thelongest, some doctors say, are now approaching a full year.
Researchers working on the vexing disability say they are optimistic that most will
eventually recover but fear some will not. Some doctors are concerned that growing numbers of smell-deprived patients, many of them young, could be more prone to depression andother difficulties andweighonstrained health systems.
“They are losing color in their lives,” said Dr. Thomas Hummel, who heads the smell and taste outpatients clinic at University Hospital in Dresden, Germany.
“These people will survive and they’ll be successful in their lives, in their professions,” Hummel added. “But their lives will be much poorer.”
At the Face and Neck University Institute in Nice, Dr. Clair Vandersteen wafted tube after tube of odors under Forgione’s nose after he had rooted around in her
nostrils with his camera.
“Do you perceive any smell? Nothing? Zero? OK,” he asked, as she repeatedly andapologetically responded with negatives.
Only the last tube provoked an unequivocal reaction.
“Urgh! Oh, that stinks,” Forgione yelped. “Fish!”
Test complete, Vandersteen delivered his diagnosis.
“You need an enormous amount of an odor to be able to smell something,” he told her. “You haven’t completely lost your sense of smell but nor is it good.”
He sent her away with homework: six months of olfactory rehab. Twice daily, choose two or three scented things, like a sprig of lavender or jars of fragrances, and smell them for two to three minutes, he ordered.
“If you smell something, great. If not, no problem. Try again, concentrating hard on picturing the lavender, a beautiful purple bloom,” he said. “Youhaveto persevere.”
Losing the sense of smell can be more than a mere inconvenience. Smoke from a spreading fire, a gas leak, or the stink of rotten food canall pass dangerously unnoticed. Fumes from a used diaper, dog’s dirt onashoeorsweaty armpits can be embarrassingly ignored.
And as poets have long known, scents and emotions are often like lovers entwined. Evan Cesa used to relish meal times. Now they’re a chore. Afishdinner in September that suddenly seemed flavorless first flagged to the 18-year-old sports student that COVID19 had attacked his senses.
Foodstuffs became mere textures, with only residual hints of sweet and saltiness.
Five months later, breakfasting on chocolate cookies before classes, Cesa still chewed without joy, as though swallowing cardboard.
“Eating no longer has any purpose for me,” he said. “It is just a waste of time.”
Cesa longs to have his senses restored, to celebrate the taste of pasta in carbonara sauce, his favorite dish, and a run through the fragrant wondersof the great outdoors.
“One might think that it is not important to be able to smell nature, trees, forests,” he said. “But when you lose the sense of smell, you realize how truly lucky we are to be able to smell these things.”