Covid-19 cases count falling in the United States and many parts of the country are beginning to relax.
Cities like Washington, DC and New York is lifting vaccine mandates for many public indoor spaces. National public health officials are also easing. It informs the Centers for Disease Control and Prevention now communities with low transmission levels can give up universal masking.
As spring approaches, is it finally time to feel hopeful? Is it possible that the worst pandemic is behind us?
The American public seems to think so. A vote on March 1 from Kaiser Family Foundation found that majorities across the political spectrum believe that the darkest days of Covid-19 are over.
However, we have been fooled before. Over the last two years, wishful thinking has proven to be naive time and time again. The first hopes that the vaccines would be a ticket to freedom were shattered by declining immunity and the emergence of more infectious variants. How much longer will the virus develop from here is impossible to predict.
Many of us just do not know what to think about the future. How do we know when things will really get better? Is there still a chance that things will get worse?
In our quest for clarity, we approached 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 do we know when it is?
We heard very measured optimism, but also uncertainty. While the pandemic may be easing in the United States and other countries, much of the world is still unvaccinated and very 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, experts told us. Brighter days are probably ahead, but the unknown continues to shoot a clear picture of the future.
Is it the worst behind us? Too many in the US: Probably.
Overall, most of the experts said, with some caveats, that in the US and large parts of Europe, the most devastating waves of Covid-19 are in hindsight.
“I’m 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, most notably the widespread immunity in the United States, whether acquired through vaccination or infection.
In addition to immunity, there are new, effective Covid-19 treatments available – such as monoclonal antibodies and antiviral drugs – that can help infected people avoid hospitalization and death. Also the wider availability of high quality masks and air filters – and a better understanding of ventilation, social distanceand other mitigation strategies – puts us in a better position to reduce transmission than we were before in the pandemic.
And even though immunity diminishes over time, “protection against the most serious illness and death will remain for quite some time,” writes Dr. A. Marm Kilpatrick, an infectious disease researcher at the University of California Santa Cruz, in an email, cites CDC data. So people can keep getting infected with SARS-CoV-2, but the worst results can pretty much be behind us.
But … variants are still a big problem
Everyone we spoke to – even the optimists – said that the threat of new varieties is still very real. Just as the contagion of delta and omicron surprised researchers, new varieties can evolve and cause us to reset our expectations for the future.
“I just do not like to underestimate the virus,” Dr. Kari Debbinka virologist and immunologist at Johns Hopkins, said.
There has been some hopeful speculation that the virus might be in the future will develop into less lethal. However, it is not a rule: “It is not an iron law for virology that newer variants are necessarily weaker or less virulent than an earlier variant,” said Dr. Nirav Shah, Maine’s chief epidemiologist and president of the Association of State and Territorial Health Officials. “It can definitely go the opposite direction.”
Variants are more likely to appear in parts of the world where vaccination rates are lowest; the more infections that occur, the more chances the virus has of replicating and changing. That is why it is so important to vaccinate as many people as possible against the virus.
But momentum may be stalling. Shah said that while raising vaccination rates in sub-Saharan Africa and sub-Saharan Africa would reduce the risk of a new variant of concern emerging, appetite for vaccines in these regions varies. There is also supply chain obstacles and lack of staff hampering efforts to reach the most remote and vulnerable people.
The best thing we can do to prepare for new varieties is to be on the lookout for them.
The most concrete way to identify variants of concern is through genomic monitoring, regular scanning of virus samples from infected humans for mutations. But the US still has a patchwork system to find variants, according to Dr. Shweta Bansal, an infectious disease ecologist at Georgetown University. As a consequence, new variants occurring in the United States may not be available immediately.
However, other trends may signal that a worrying new variant is emerging. If dozens of previously vaccinated or infected people start to get sick, it may indicate that a variant has been developed that can avoid the immune response. Researchers will closely monitor changes in case numbers, hospitalizations or excess deaths in the United States or in other countries.
Human behavior is an important wild card
Public reactions to politics are another important determinant of the future of the pandemic. We have “learned a wealth of behaviors and how people tend to respond to policies to control viruses,” Bansal said.
But it is unclear that the institutions responsible for formulating policies and messages are equipped to overcome social divides that have hampered widespread prevention efforts. “We obviously do not have a big discussion about civic values and responsibilities, and I thought we would at this point,” he said. Dr. Sarah Cobeyan infectious disease researcher and model builder at the University of Chicago.
On the other hand, the Covid-19 pandemic created dozens of natural social science experiments as states and cities implemented different tactics. It has provided real-world feedback on the kinds of messages and policies that motivate people to use preventative measures such as social distancing and mask wearing, pointing the way to more effective public health strategies.
We do not really utilize transmission modes to improve emergency preparedness
With transmission now declining across the United States, politicians are now taking departures from intense preventive measures, loosening mask requirements, vaccination mandates and restrictions on assemblies. “But we’ve seen that movie before,” Bansal said, and “the virus has a way of roaring back.”
“We should really take advantage of this hiatus” to build our contingency capacity, she said.
Others agreed that the best way to avoid another catastrophic increase in transmission is to get ready for it – but they are not convinced that we are doing it effectively: “I’m afraid the country will be done with Covid -19 – and therefore many of the things we have to do to prepare for the next wave are not done, “said Shah. He wanted a broader use of wastewater testing as an early warning system and assurance that our rapid testing and PPE supply chains are robust and responsive to transmission increases.
Ranney agreed that an improvement in preparedness was essential to ensure that the worst is behind us and that it is key to ensure good systems for early detection of outbreaks. It is also important to improve global and local vaccination rates, develop and scale up access to Covid-19 treatments and get the community buy-in around preventative measures, she said.
We always have to ask: The worst may be over, but for whom?
When we asked experts, “is the worst over?” some answered with their own question: “For whom?”
Although the peak of the pandemic crisis disappears in hindsight for some, others – generally those already marginalized by poor access to health care and other vulnerabilities – will still live with the worst consequences.
“The pandemic that is mostly over for me may not mean it is over for someone else,” Debbink said. She worries that declaring the worst is over “in a way allows people to ignore those who are still at high risk.” It includes immunocompromised people and those living in parts of the world with limited access to vaccines. “There are millions and millions of people who do not even have access to a vaccine yet,” she said – and the worst may still be coming for them.
Plus, she said, we do not really know the long-term toll lang Covid symptoms will continue to take on people. “With every person who gets infected, you still have this huge group of people who like long-term consequences,” she said. For them, the worst may not be over, but just beginning. “At this time, we have no idea whether long-term Covid symptoms will be permanent.”
The global view is particularly sober. The United States has high levels of infections and vaccinations, but “is probably yet to see their most damaging waves, or will require ongoing severe restrictions” to delay transmission increases, Dr. Adam Kucharskian infectious disease epidemiologist at the London School of Hygiene & Tropical Medicine, wrote in an email.
The SARS-CoV-2 virus is likely to cause human disease well into the future, and in that sense it can still do more harm than it has already done. However, because these effects will be spread over a longer period of time, we may not perceive them as being as severe as the waves of hospitalization and death we have experienced over the past two years. “I think we’re going to live with it for a very, very long time – so in that sense, the worst is not behind us,” Cobey said.
We may never get a clear answer as to when it’s all over
The worst of the pandemic is probably behind us in the United States. But the virus still infects, infects and kills people. How much longer it will continue has to do with variables that are difficult to predict right now: the duration of immunity over the years and risks even further away, such as the chances of a new variant emerges from wildlife like deer.
Because sensory pandemic predictions have so often proved to be terribly wrong, few of our experts were willing to predict sunny skies without preconditions. “Historically, though, we know that all pandemics will eventually end, and this one will, too,” he said Dr. J. Alexander Navarro, Assistant Director of the Center for Medical History at the University of Michigan. “That day is probably sooner than later, but we will have to see what the future holds for us.”
And we can not even recognize the end of the pandemic when 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 where we wake up and say ‘I’m sure it’s over,'” he said. Dr. Maureen Miller, a medical anthropologist at Columbia University. “Even the end date of the pandemic, like all other Covid-19s, is likely to be the subject of heated debate.”