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Experts grapple with COVID’s trajectory

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From the most respected epidemiologists to public health experts who have navigated past disease panics, from polemicists to political partisans, there are no definitive answers to the central question in our life: As a Drudge Report headline put it recently, “is it ever going to end?”

With children returning to classrooms, in many cases for the first time in 18 months, and as the highly contagious delta variant and spotty vaccination uptake send case numbers and deaths shooting upward, many Americans wonder what exactly has to happen before life can return to something that looks and feels like 2019.

The answers come in a kaleidoscopic cavalcade of scenarios, some suggested with utmost humility, others with mathematical confidence: The pandemic will end because deaths finally drop to about the same level we’re accustomed to seeing from the flu each year. Or it will end when most kids are vaccinated. Or it will end because Americans are finally exhausted by all the restrictions on daily life.

Innumerable predictions over the course of the pandemic have come up lame. Some scientists have sworn off soothsaying. But as they learn more about the coronavirus that bestowed covid-19 on mankind, they build models and make projections and describe the hurdles that remain before people can pull off the masks and go about their lives.

The good news is there is some fuel for optimism.

“I truly, truly think we are in the endgame,” said Monica Gandhi, an infectious-disease specialist and professor of medicine at the University of California at San Francisco. “The cases will start plummeting in mid- to late September and by mid-October, we will be in a manageable place, where the virus is a concern for health professionals, but not really for the general public.”

Gandhi bases her optimism on the fact that all previous epidemics of respiratory viruses have ended through the acquisition of immunity, whether by vaccination or natural infection. Although viruses do keep changing, potentially circumventing people’s defenses, “they mutate quickly, at a cost to themselves,” weakening over time. Gandhi said she believes the delta variant that has hit the United States so hard that this summer will mark the peak of this virus’s strength.

But Gandhi warns she has been wrong before: In February 2020, she said the United States would not tolerate a disease that killed 100 Americans a day; people would come together to do whatever it took to stop that. That didn’t happen.

The bad news is there is too much cause for doubt.

“We’re in a moment of uncertainty, and humans don’t do well with uncertainty,” said Ezekiel Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania. “Telling people it’s going to be two or three more years of this is really hard, but I don’t think anyone can be comfortable with the current state, with a lot of kids ending up in the hospital and a thousand deaths a day. That’s not returning to normal.”

Emanuel, too, notes that his crystal ball has suffered occasional cloudiness: In March 2020, he said the country would get back to normal around November 2021. For that, his friends dubbed him “Mr. Pessimist.” Now, his message is at least as unwelcome: It’s going to be at least spring 2022 and possibly much longer before most people are ready to resume normal activities, because of the spread of the delta variant, continuing resistance to vaccines and widespread anxiety, especially about children who are not yet eligible to get vaccinated.

Despite the disparities in experts’ opinions, there is a consensus bottom line about the biggest question: Pandemics do end, sort of. (Though there are exceptions, such as malaria.) Only smallpox has been effectively eradicated by human intervention. But many pandemics become endemic, meaning they morph into something that is no longer an emergency, but rather an annoyance, an ugly, even painful fact of life that people simply learn to cope with, like the flu or common cold.The question is when and how we get to that point.

Some of the nation’s most prominent epidemiologists and public health experts say we are already there -for different reasons.

“The emergency phase of the disease is over,” said Jay Bhattacharya, a professor of medicine and health economist at Stanford University. “Now, we need to work very hard to undo the sense of emergency. We should be treating covid as one of 200 diseases that affect people.”

The pivotal engine driving a return to normal life for Bhattacharya has been the vaccines, “which really do protect against death,” he said. “It’s a miraculous development, and we should just be celebrating it.” By driving down deaths and hospitalizations, especially for the most vulnerable populations — the elderly and people with preexisting health problems — “we have greatly succeeded, and to me, that’s the endpoint of the epidemic because we really can’t do better than that.”

The virus will continue to mutate and there will continue to be outbreaks, both seasonal and in geographic clusters, but “panicking over case numbers is a recipe for continuing unwarranted panic,” he said.

Bhattacharya is ready to resume most pre-pandemic activities. He recently made his first overseas trip, to England, “and it was wonderful,” he said, “even with a mask.”

Gandhi, too, has concluded that as scary and dangerous as the delta variant has been, “we’re sort of at the peak of the pandemic because the delta variant is causing immunity like crazy. Delta comes in like a hurricane, but it leaves a lot of immunity in its wake.”

Although its rapid spread and severe impact on some people are scary, the delta version has a hidden benefit: It makes future variants less likely to be more lethal, Gandhi said.

Covid isn’t going away – “we’re going to get it,” Gandhi said – but as immunity increases, the virus will cause less harm. (Washington Post)

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