San Francisco Chronicle - (Sunday)
Pandemic’s in a lull but not over yet, experts say
His comment was off the cuff — and the White House spent the rest of the week walking it back. But when President Biden said last Sunday on CBS’s “60 Minutes” that the COVID-19 pandemic was “over,” his words fell on American ears all too eager to believe he was right.
It’s true that the long summer coronavirus surge is winding down, with case numbers, hospitalizations and deaths falling sharply. Weddings and reunions, maskless shoppers at the supermarket and throngs of people crowding into music festivals reinforce the sense that the worst is past and life is getting back to normal.
But nearly three years after COVID emerged and quickly swept across the globe, it’s still premature to claim victory, health experts warn.
Arguing whether the pandemic has ended is largely a matter of semantics, these experts say, and there’s little doubt that COVID remains a stubborn and wily threat — no matter how badly the public wants it to be gone.
“It’s a social mirage, that the pandemic is over, or can be called over in some meaningful way,” said Martha Lincoln, a medical anthropologist at San Francisco State University. “We’re not really out of the woods yet.”
Even as the United States has accumulated an impressive arsenal of tools — including lifesaving drugs and vaccines — to fight the coronavirus, it’s unclear whether the barrier of protection provided by them will be enough to prevent yet another winter surge in a few months, or more waves of illness in 2023. The coronavirus has yet to settle into a stable, seasonal pattern. New variants could pose fresh perils for years to come.
The end of the pandemic may indeed be near. But that’s the kind of judgment call that can only be made in hindsight. And the current situation is hardly ideal, many health experts note: There are too many people still dying, and too much still unknown about the effects of long COVID and other lingering impacts of infection. What many people are struggling with now is a sort of pandemic doldrums — a moment in time when COVID is no longer a threat that overshadows all other life priorities but still can’t be ignored. “We’re in this middle ground, which is difficult,” said Dr. Susan Philip, the San Francisco health officer. “We’re not at the full end, but we’re not in the throes of having to be worried and be mindful every day about what the virus is doing.”
People should remain if not vigilant then at least thoughtful about limiting their exposure to the virus, said Dr. Nicholas Moss, the Alameda County health officer.
“We’re always happier to be in a place where there’s less virus circulating, and we’re in that place today,” Moss said. “More and more people are focused on other things in their lives. They’ve got to pay their rent and deal with their family and they have a vacation to plan — you have to be realistic.”
The Bay Area is indeed enjoying a COVID lull. The region is easing out of a five-month surge that may have produced more infections than at any other time in the pandemic, though it’s impossible to know for sure because many cases are now diagnosed through home testing and never reported to the state or counties.
As of Friday, the state was reporting on average about 5,000 cases a day, down 28% from the previous week and less than a fifth of reported cases at the peak of the summer wave in July. The Bay Area was reporting roughly 700 cases a day, down 31% from the previous week and less than a sixth of its peak.
Deaths are beginning to drop too, statewide and for the region. The Bay Area is recording about three deaths a day, down from 16 three weeks ago; statewide, about 30 deaths are reported a day currently, down from nearly 50 in mid-August. The local data reflects national trends in declining cases and deaths.
The metrics look good at the moment, “but we’re still in a place where it’s about trade-offs,” said Dr. Sara Cody, the Santa Clara County health officer. Like many officials, Cody said she’s especially wary of the potential for another surge this winter if new variants emerge just as more people move indoors for social activities.
“The last two winters have not been kind to us, from a COVID perspective,” she said. “Maybe this winter will be different, but probably not.”
Still, the country is better positioned now than ever before to tamp down infections and save lives, and the crisis mentality that defined the first part of the pandemic has largely, and appropriately, faded, many experts say.
Good news has prevailed on the pandemic front for several weeks, even aside from falling case counts and deaths. Though variants remain a constant concern for health experts, none so far appears poised to replace BA.5 or BA.4.6, the strains currently dominating in the U.S. And federal authorities recently approved new vaccines that more closely match BA.5 and its siblings, suggesting Americans who get it could be better protected against infection and severe illness in the coming months.
In California, which had among the most aggressive responses to the pandemic, officials have been steadily rolling back mandates around masking, vaccination and testing. On Friday, the state further relaxed recommendations for face coverings to more closely match federal guidance and stopped requiring masks in certain congregate settings like homeless shelters and jails. BART plans to drop its mask mandate on Oct. 1.
Most health experts say lifting these restrictions makes sense, and partly reflects that public health agencies — like the residents they serve — have other priorities to address besides COVID.
“We basically need to continue to respond to COVID while we respond to other things, whether it’s monkeypox or a case of polio or drug overdoses,” said Dr. Art Reingold, a UC Berkeley epidemiologist. “We need to walk and chew gum a the same time, and pay attention to multiple different problems.”
Reingold said he’s less bothered than some of his colleagues by Biden declaring the pandemic over — partly because so much of the public has already moved to that mindset anyway. “By one interpretation, it is a perfectly reasonable statement,” Reingold said. “But it’s clear why it irritates people and causes them to get concerned.”
The primary worry is that the president’s message could have political and policy ramifications on a federal level, and potentially globally. Leaders with the World Health Organization pushed back on Biden’s comment, even suggesting it was dangerous for him to make such a call.
In the U.S., suggesting the pandemic has ended could complicate efforts to maintain funding for everything from free COVID tests and treatment to development of next-generation vaccines. Many health experts also worry that Biden’s declaration fuels pervasive public desire to move on and forget about COVID at a critical time, when people should be queuing for the new booster shots and still trying to avoid getting sick.
“People are just so sick of it, so fed up with COVID. They’re saying, ‘I want my life back. I want normality,’” said Dr. Eric Topol, executive vice president of Scripps Research in La Jolla (San Diego County). “But you don’t want to meet them there when it’s not accurate. You don’t want to say they’re right — which is kind of what’s happening right now — when it’s wrong.”
Many health experts continue to advise people to wear face coverings in crowded indoor situations where there’s no obvious downside, such as on public transit or in grocery stories. But it’s probably OK at this point to forgo the mask if it’s going to be awkward, uncomfortable or simply impossible to wear.
Even Dr. Robert Wachter, chief of medicine at UCSF, who has famously kept the public apprised of his COVID comfort level via Twitter, said he’s ready to drop his mask and dine again indoors. “People are a little bit more willing to take those risks, to me, quite appropriately,” Wachter said in an interview.
“I worry about long COVID,” he added. “The case numbers are higher than I would like, the death numbers are higher than we would want. And that should lead to continued investment and continued work on strategies to get those numbers lowers. Do we need to call it a pandemic to do that? I think that is an open question.”