Thread by @dwallacewells

“Probably we were always going to have to decide ourselves when the pandemic was over.” But the arrival of very effective therapeutics means the time for doing that may finally be upon us. A long thread (1/x). nymag.com/intelligencer/…

“Once it became impossible to eliminate the disease entirely, sometime in the spring of 2020, it also became a lot harder to imagine that the course of the disease itself would tell us in any obvious way when to drop our masks and social inhibitions and get on with our lives.”

“‘Science’ wasn’t going to do the job either, with the disease continuing to circulate, causing some amount of severe illness, and passing eventually into a confusing state of endemicity.”

“Staring down that possibility, recently, it wasn’t clear whether we should be judging the state of the disease on case numbers or hospitalizations or deaths or vaccination rates or school closures and quarantines or some other metric.”

“‘America has lost the plot on COVID,’ Sarah Zhang wrote memorably in the Atlantic. Though perhaps the point could’ve been put more sharply: America must make its own plot now — without an obvious one to follow or an intuitive statistical trigger for going back ‘normalcy.’”

“Cases and hospitalizations are falling (but not anywhere close to zero) as vaccinations creep higher (but not yet close to 100 percent). The Delta wave is waning, but the possibility of a winter peak is looming.”

“A few weeks ago, newly minted Trevor Bedford modeled an endemic future in which between 40,000 and 100,000 die every year—enough that it would be tricky to ever call the pandemic truly ‘over,’ but not enough to really justify most of the precautions we’ve taken to this point.”

“It was hard to think about those numbers — on the high end, a third as lethal as COVID was last year, and on the low end, still more lethal than the flu — and believe there was any intuitive exit in sight.”

“But two developments over the last week may shift our collective perspective enough to bring the COVID-19 endgame finally into view: the beginning of vaccination for children between the ages of 5 and 11, and the announcement by Pfizer…”

“…that a trial for a therapeutic drug called PF-07321332 was so successful it was halted midway, with data already revealing an 89 percent reduction in severe illness among those taking the pill.”

“One of these developments is far more epidemiologically significant than the other: In the world of novel therapeutics, the Pfizer drug is a monster breakthrough, capable of reducing the population-level severity of the disease as much as tenfold.”

“Taken together, the two bits of news draw a sort of escape hatch from pandemic anxiety — indeed, they may show the way out of the ongoing, post-vaccine zombie stage of the pandemic that has been dragging on since the summer.”

“In many ways it has proven the most confusing period of our last couple of years.”

“Yes, the country was underperforming on vaccination, and yes, the protections offered by those shots were, while significant, not perfect.”

“But given the prevalence of vaccine protection and the degree to which the disease had spread through the population itself over the last 18 months, it was also reasonable to think, this summer, that, as a whole, the threat was at least subsiding.”

“And yet, even as some of us turned away or tuned out the numbers, they weren’t actually looking much better, with 2,000 Americans dying every day during a period in late September.”

“Elsewhere in the world, the patterns have been similarly divergent and contradictory.”

“On November 2, the Lancet speculated that in Spain, where case numbers were falling, widespread vaccination may have delivered the country to herd immunity. But in Portugal, where vaccination rates are considerably higher, new cases were almost twice as high.”

“In late summer, the U.K. was an encouraging case study—higher vaccination rates there, it seemed, meant that while case numbers spiked, serious illnesses stayed almost flat, a near-total decoupling of disease spread, on the one hand, and hospitalization and death, on the other.”

“But then cases started rising again, and this time, as Bill Hanage has pointed out, hospitalizations and deaths are not staying low but bumping up along with them (in often unpredictable patterns to boot).”

“Now, in many well-vaccinated countries across Europe, cases are rising again — in some places with severe illness rising, too, and in some places, not.”

“Now, in many well-vaccinated countries across Europe, cases are rising again — in some places with severe illness rising, too, and in some places, not.”

“But the arrival of childhood vaccines and really effective post-infection treatment could change all that, clearing quite a bit of that fog, and pointing the way to a fairly intuitive path to at least a ‘next chapter’ for the pandemic.”

“We still need to decide to move on, more or less, because national risk of severe disease hasn’t been brought to zero.”

“But on top of the vaccine effect itself, the new therapies do promise a quite dramatic reduction of that risk, bringing the vulnerability of almost everyone to COVID into the range of far more familiar, quotidian diseases.”

“Another long-neglected tool could help further: focusing very vigorously, from here, on the vulnerability of the old; indeed, treating COVID-19 as the disease of the very old it has always been.”

“First, worrying less about case numbers per se and much more about limiting the risk to those likely to become very sick.”

“That could be achieved, in part, by focusing our vaccination efforts not on the population at large but on ‘boosting’ the elderly; in fact, we should perhaps stop calling the shots boosters and instead conceive of them as an ongoing prophylactic treatment protocol.”

“We could still distribute masks and rapid tests via the AARP, but now with guidance that seniors use the test not to screen others before socializing or interacting but as self-tests meant to quickly trigger the use of therapeutics like Pfizer’s if a test came back positive.”

“With the arrival of quasi-miraculous therapeutics, these protocols seem a bit less necessary than they might’ve even a week ago, but they can still help—both in protecting people with enduring vulnerability and in encouraging the rest of us, finally, to relax a bit, too.” (X/x)