Top of mind for most of us today is the question, “When does the COVID-19 pandemic end?” I think the really relevant question is “When does normalcy return?” When can we breathe a collective sigh of relief?
There is no precise epidemiological definition for living normally with COVID-19 — it’s not measurable by case counts or number of deaths. Living with COVID-19 means that we as a society cope with the virus using countermeasures to allow a return to “normative” behavior. Does Gov. Jay Inslee’s announcement to lift the statewide mask mandate requirement on March 12 answer this question? Does normalcy mean attending a sports event without a mask? Or is it feeling that if I do get COVID-19, it’s no big deal? Normalcy is each of us knowing that the effectiveness of available tools no longer pales in comparison to the risk of infection and its consequences.
We apply this approach to all other respiratory illnesses. For example, during influenza season, we get a flu shot, which is usually 50% to 60% effective. We still go to work, and our kids attend school. We tolerate Influenza A with a large number of cases as well as 30,000 deaths a year, but between the vaccine and oral antivirals, most of us are kept out of the hospital, and our lives aren’t upended.
How close are we to this approach with COVID-19? When we can start making individual decisions that allow us collectively to open up our society fully? Our current vaccines are good, but the rapid pace of variant change and waning immunity with both the mRNA vaccines don’t really instill the level of confidence we had a year ago before the emerging variants. But we do have new tools — new potent oral antivirals and improved one-shot monoclonal antibodies — that in my opinion shift the equation to one similar to influenza. These tools are highly effective in preventing complications from COVID-19. Paxlovid, an oral antiviral pill, has been shown to prevent hospitalization in close to 90% of persons if given within three days of onset of COVID-19 symptoms. Similar data exist with a one-dose IV treatment or one shot of monoclonal antibodies. Programs to “test and treat” with Paxlovid and these monoclonals are being proposed and discussed for use at pharmacies and urgent care facilities.
Once programs to administer these new tools are established, reaching behavioral normalcy will for many be achieved. It will take work to implement and socialize the widespread use of these tools, largely because access is generally an issue for new medications and because people perceive risk differently. But what will occur is that we’ll have more options and can make decisions based on a personal risk assessment.
Normal will vary by person and by event, and we as a community need to both recognize and be tolerant of these issues. Mask wearing continues to be an effective tool in reducing the risk for acquiring COVID-19 and other viruses such as influenza. You still may find yourself asking if it’s OK to go to a movie theater and sit shoulder to shoulder with a stranger. Or eat indoors at your neighborhood family-style restaurant with a large crowd? How about a concert hall with its vast ceilings, and yet 2,000 people present?
For me, I will for the next few weeks continue to be cautious about attending indoor events. Yet I did attend and thoroughly enjoy a theater performance last week at Seattle Rep in which all attendees were required to be vaccinated, and I was wearing a well-fitted N95 mask. Yes, I do know about breakthrough asymptomatic cases of omicron, but I made this calculation and decided that I wanted normalcy.
The economic devastation and behavioral impacts of the COVID-19 outbreak have frightened all of us. Every economy in the world has suffered — and every person has in some behavioral way altered their life. Still, while antivirals are a major tool in helping us cope with COVID-19, they are not the scientific end-all for reaching pre-COVID-19 living or the “Before Times.”
Science has the ability to up the game and improve our vaccines so they prevent COVID-19 infection altogether. So, no breakthroughs, no sickness, no hospitalizations, no complications, no anything. In experiments with animal models and in some of our monoclonal antibody prevention studies in humans, there is evidence that very high levels of antibodies to the virus can prevent it from infecting us in the first place. We stop it from invasion, so to speak. These data indicate to me that if we increase our post-vaccination boosting immunity to levels that would prevent acquisition, then we might truly reduce the widespread dissemination of the virus globally. I don’t mean elimination of the virus, but a meaningful reduction in case counts in our communities. Our current vaccines do this infrequently, especially with the omicron variant.
We have the scientific ability, and I think the societal need, to push for the next generation of vaccines. I’m quite certain we can — and should — achieve this goal. The results could very well lead to the reemergence of a confident public, lives made fuller and richer by all the things and people that nourish our communities.