A Bona-Fide Covid Bump

Dhruv Khullar / The New Yorker
A Bona-Fide Covid Bump A healthcare worker and a patient. (photo: ABC News)

The coronavirus has long since lapsed as a primary concern for most Americans. Can we make progress on a problem when so few seem to care?

Call it the first wave of the endemic, a bona-fide covid bump. The statistics may be hard to parse—the United States stopped systematically collecting data on coronavirus cases months ago—but, almost certainly, growing numbers of Americans are coming down with covid. In recent weeks, Jill Biden went into isolation after testing positive, and John McEnroe missed calling much of the U.S. Open on account of an infection. The virus is increasingly turning up in wastewater, especially in the Northeast, and since late June covid hospitalizations nationwide have nearly tripled.

In historical terms, though, the rise is more ripple than wave—a viral burst softened by three years of infections and vaccines, and by bodies that remember what they’ve seen. Despite the increase in cases, covid hospitalizations still stand at roughly an eighth of their pandemic peak, and coronavirus deaths are a fifth of what they were this time last year. In the spring, the country’s excess-death count—a measure of how many Americans are dying relative to past averages—fell to pre-pandemic levels, a sign that the emergency truly is over. That doesn’t mean the threat has passed.

The virus keeps evolving—replicating billions of times in millions of people each day—and scientists are tracking the ascent of two Omicron descendants in particular. EG.5, informally known as Eris, has become the dominant variant in the U.S., accounting for more than twenty per cent of infections. Although the variant has outcompeted its rivals and likely driven the recent uptick in infections, it doesn’t appear to inflict more punishing illness than previous strains, and treatments such as Paxlovid are effective against it. A second variant, BA.2.86, nicknamed Pirola, has been detected in a handful of states and in at least ten other countries. It carries a barrage of mutations on its spike protein—an “evolutionary jump similar in size” to that of the original Omicron variant, according to one virologist—raising concerns about its potential to evade our defenses. But early evidence suggests that the variant isn’t especially transmissible and that our antibodies confer a reasonable level of protection against it.

In all likelihood, then, the current crop of variants won’t upend our equilibrium. Still, the unceasing evolution of the virus—and the certain emergence of future pandemic pathogens—warrants ongoing vigilance. Considering the costs of a pandemic, it’s hard to imagine that we could overinvest in preparing for new infectious threats, related to this virus or others: in the U.S. alone, covid’s economic toll could reach fourteen trillion dollars by the end of the year—a sum approaching the G.D.P. of China. And yet the public and political will to confront contagion seems to have evaporated and, at times, transmuted into hostility to the very idea that we should do so. More than half the states have recently taken steps to restrict the authority of public-health officials, and opposition to well-established immunization requirements for childhood diseases has surged. The coronavirus has long since lapsed as a primary concern for most Americans, and only seventeen per cent took last year’s covid boosters, including less than half of those over the age of sixty-five. Can we make progress on a problem when so few seem to care?

Last week, the Food and Drug Administration authorized new covid boosters. They target a version of Omicron that was dominant in June, but they also manage to generate antibodies that neutralize the strains now in circulation. Like prior boosters, they are expected to provide several months of protection against serious illness and may provide a short-lived defense against infection. The Centers for Disease Control and Prevention has recommended that all Americans get boosted, even as some experts argue that the benefits of another shot are uncertain in young and healthy individuals who’ve already been immunized and infected. (The United Kingdom currently recommends boosters only for older people, those with chronic conditions, and other select groups.) Amid the debate, it’s easy to lose sight of a plain truth: for populations at high risk, the shot will save lives.

Health officials have started to position covid boosters not as a novelty—something to be dissected and debated—but as a routine occurrence, akin to the annual flu shot. This is, in effect, an effort to make public health boring again. That may well be the right tack, but it feels insufficient. For one thing, only about half of Americans get the flu vaccine. For another, there’s reason to believe we can do better than chase the latest variant with boosters that provide fleeting defense against disease and do little to block transmission. Some scientists are trying to develop vaccines that offer enduring protection not just against the variant du jour but against a range of coronaviruses, or that reduce the chances of contracting the virus by dramatically raising antibody levels in the nose and mouth. It’s also possible that future vaccines will be delivered via skin patches and nasal sprays—a palatable alternative to injections for the needle-shy. Project NextGen, a five-billion-dollar Biden Administration initiative modelled on Operation Warp Speed, is intended to accelerate advances in vaccine technology, and last month the program dispatched its first round of funding. But whether and when such vaccines will become available—and how many people will take them—is anyone’s guess.

Politics may be the art of the possible, but it is also a practice in prioritization. Central to the challenges of endemic covid are flagging public interest and, in some corners, revisionist punditry. Meanwhile, because of pandemic fatigue, many Americans are now loath to accept inconvenience, let alone make sacrifices, in order to reduce the risks of infection. We can’t give up on education, communication, and persuasion—the essential tools of public health—but, for the time being, spending our limited political and financial capital on biomedical advances may be the surest path forward.

The swift arrival of covid vaccines saved countless lives during the pandemic—a feat possible only because of the decades of research and development that preceded it. A rapid response to an emergency depends on the investments we make before it arrives; a smooth return to normal life requires sustaining them after it passes.

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