Almost exactly 12 months ago, America’s pandemic curve hit a pivot point. Case counts peaked—and then dipped, and dipped, and dipped, on a slow but sure grade, until, somewhere around the end of May, the numbers flattened and settled, for several brief, wonderful weeks, into their lowest nadir so far.
I refuse to use the term hot vax summer (oops, just did), but its sentiment isn’t exactly wrong. A year ago, the shots were shiny and new, and a great match for the variants du jour; by the start of June, roughly half of the American population had received their first injections, all within the span of a few months—a remarkable “single buildup of immunity,” says Virginia Pitzer, an epidemiologist at Yale. The winter surges had run their course; schools were letting out for the season; the warm weather was begging for outdoor gatherings, especially in the country’s northern parts. A confluence of factors came together in a stretch that, for a time, “really was great,” Katelyn Jetelina, an epidemiologist at the University of Texas Health Science Center at Houston, told me.
It’s now the spring of 2022, and at a glance, the stop-SARS-CoV-2 stars would seem to be aligning once more. Like last time, cases have dropped from a horrific winter peak; like last time, people have built up a decent bit of immunity; like last time, rising temperatures are nudging people outside. Already, one of the pandemic’s best-publicized models is projecting that this summer could look about as stellar as the start of last.
These trends don’t guarantee good times. If anything, national case counts—currently a woeful underestimate of reality—have started to creep upward in the past couple of weeks, as an Omicron subvariant called BA.2 continues its hostile takeover. And no one knows when or where this version of the virus will spit us out of its hypothetical surge. “I have learned to not predict where this is going,” says Theresa Chapple, a Chicago-area epidemiologist.
In crisis, it’s easy to focus our attention on waves—the worst a pandemic can bring. And yet, understanding the troughs—whether high, low, or kind of undecided—is just as essential. The past two years have been full of spastic surges; if the virus eventually settles down into something more subdued, more seasonal, and more sustained, these between-bump stretches may portend what COVID looks like at baseline: its true off-season.
At these times of year, when we can reliably expect there to be far less virus bopping around, our relationship to COVID can be different. But lulls are not automatic. They cannot be vacations. They’re intermissions that we can use to prepare for what the virus serves up next.
Lulls, like waves, are the products of three variables—how fast a virus moves, how hospitable its hosts are to infection, and how often the two parties are forced to collide. Last year’s respite managed to hit a trifecta: a not-too-speedy virus met fresh vaccines while plenty of people were still on high alert. It was enough to stave off COVID’s worst, and tamp transmission down.
This time around, some of the variables are a bit different. The virus, for one, has changed. In the past year, SARS-CoV-2 has only gotten better at its prime operative of infecting us. High transmissibility nudges the natural set point of the pandemic higher: When the virus moves this fast among us, it’s simply harder to keep case levels ultralow. “We have a lot less breathing room than we used to,” says Alyssa Bilinski, a health-policy researcher at Brown University.
The situation arguably looks a bit better on the host side. By some estimates, population immunity in the U.S. could be near its all-time high. At least 140 million Americans—perhaps many more—have been infected with SARS-CoV-2 since the pandemic’s start; some 250 million have dosed up at least once with a vaccine. Swirl those stats together, and it’s reasonable to estimate that more than 90 to 95 percent of the country has now glimpsed the coronavirus’s spike protein in some form or another, many of them quite recently. On top of that, America has added a few tools to its defensive arsenal, including a heftier supply of at-home tests to identify infection early and super-effective oral antivirals to treat it.
But any discussion of immunity has to be tempered with a question: immunity … against what? Although defenses against serious illness stick around pretty stubbornly, people’s safeguards against infection and transmission erode in the months after they’ve been infected or vaccinated—which means that 90 to 95 percent exposed doesn’t translate to 90 to 95 percent immune. Compared with last spring, the map of protection is also much patchier, and the range of immunity much wider. Some people have now banked several infections and vaccinations; others are many months out from their most recent exposure, or haven’t logged any at all. Add to that the trickiness of sustaining immunity in people who are older or immunocompromised, and the mediocrity of America’s booster campaign, and it’s easy to see how the country still has plenty of vulnerable pockets for the virus to exploit.
Then there’s the mess of us—our policies and our individual choices. The patterns of viral spread “depend a lot on what we as a society do, and how we interact,” Yonatan Grad, who studies infectious-disease dynamics at Harvard, told me. A concerted effort to mitigate transmission through masking, for instance, could help counteract the virus’s increased contagiousness, and squish case curves back down nice and low. But the zeal for such measures is all but gone. Even amid the rise of actual waves, “the willingness to take on interventions has gotten smaller,” Yale’s Pitzer told me. During declines and lulls, people have even less motivation to act.
The more the virus is allowed to mosey about, the more chances it will have to mutate and adapt. “Variants are always the wild card,” says Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison. Already, America is watching BA.2—the speedier sister to the viral morph that clobbered the country this winter (now retconned as BA.1)—overtake its sibling and spark outbreaks, especially across the northeast. Perhaps BA.2 will drive only a benign case bump. Maybe a sharp surge will happen, but contract quickly, ushering the country out of spring with even more immunity on its side. Or BA.2’s rise will turn dramatic and prolonged, and sour summer’s start all on its own. Nor is BA.2 the worst-case scenario we could imagine, Sethi told me. Though it’s faster than BA.1, it doesn’t appear to better sidestep the immune shields left behind by infection or vaccines. SARS-CoV-2’s relentless mutational churn could still slingshot something far more problematic our way; already, a slew of recombinant variants and other Omicron subvariants are brewing.
I asked Deshira Wallace, a public-health researcher at the University of North Carolina at Chapel Hill, what would make this summer less than rosy—or possibly, close to cataclysmic. “Continuing as is right now,” she told me. The pandemic is indeed still going, and the U.S. is at a point where excessive mingling could prolong the crisis. Tracking rises in cases, and responding to them early, is crucial for keeping a soft upslope from erupting into a full-on surge. And yet, across the nation, “we’ve been seeing every single form of protection revoked,” Wallace said. Indoor mask mandates have disappeared. Case-tracking surveillance systems have pulled back or gone dark. Community test and vaccination sites have vanished. Even data out of hospitals have begun to falter and fizz. Federal funds to combat the pandemic have dried up too, imperiling stocks of treatments and care for the uninsured, as the nation’s leaders continue to play chicken with what it means for coronavirus cases to stay “low.” And though many of the tools necessary to squelch SARS-CoV-2 exist, their distribution is still not being prioritized to the vulnerable populations who most need them. Spread is now definitively increasing, yet going unmeasured and unchecked.
Americans would have less to worry about if they reversed some of these behavioral trends, Wallace told me. But she’s not counting on it. Which puts the onus on immunity, or sheer luck on the variant side, to countervail, which are gambles as well. Say no new variant appears, but immunity inevitably erodes, and no one masks—what then? Behavior is the variable we hold most sway over, but America’s grip has loosened. Last year, around this time, “there were more protections in place,” Wallace said. “Now it just feels like we’re in chaos.”
Even last summer’s purported reprieve was a bit of an illusion. That lull felt great because it was the pandemic’s kindest so far in the United States. But even at its scarcest, the virus was still causing “about 200 deaths per day, which translates to about 73,000 deaths per year,” Bilinski told me. That’s worse than even what experts tend to consider a very bad flu season, when annual mortality levels hit about 50,000 or 60,000, Harvard’s Grad told me. (Stats closer to 10,000 or 20,000 deaths in a season are on the “low” end.) To chart a clearer future with COVID, even during lulls, the United States will have to grapple with a crucial question, says Shruti Mehta, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health: “What’s the acceptable level of mortality per day?”
There’s a bit of a bind to work through here. With SARS-CoV-2’s dominant variants now as fast-spreading as they are, infections will remain tough to stave off, at least in the near term. The U.S. is growing only less equipped to track cases accurately, given the shift to home tests, which are rarely reported; community-level data collection is also in disastrous flux. So in some respects, the success of future COVID off-seasons might be better defined by hospitalizations or deaths, UT Health’s Jetelina noted, as many other infectious diseases are. It’s the exact shift that the Biden administration and the CDC have been pushing the population toward, and there is at least some logic to it. Thanks in large part to the potency of vaccines, infections have continued to untether from serious illnesses; speedy diagnostics and treatments have made a big dent as well. (Consider, for instance, that COVID hospital admissions have now dipped below last summer’s lows, even though documented cases have not.)
But merely tracking hospitalizations and deaths as a benchmark of progress doesn’t prevent those outcomes; they’ve already come to pass. By the time serious illness is on the rise, it’s too late to halt a surge in transmission that imperils high-risk groups or triggers a rash of long-COVID cases. That makes proactiveness during case lulls key: The virus doesn’t have to be actively battering a country’s shields for them to get a shoring up. It’s tempting to chill during low-case stretches—“ignore the virus for a little while, stick our heads in the sand,” says Andrea Ciaranello, an infectious-disease physician at Massachusetts General Hospital. But it’s wiser, she said, to realize that efforts to build capacity at community, state, and federal levels can’t rest during off-seasons. Lulls do tend to end. It’s best if they don’t catch people off guard when they do.
I asked nearly a dozen experts where they’d focus their resources now, to ameliorate the country’s COVID burden in the months and years ahead. Almost all of them pointed to two measures that would require intense investments now, but pay long-term dividends—all without requiring individuals, Chapple told me, to take repeated, daily actions to stay safe: vaccines, to blunt COVID’s severity; and ventilation, to clean indoor air. Other investments could similarly pay off when cases rise again. More widespread wastewater-surveillance efforts, Ciaranello says, could give public-health officials an early glimpse of the virus. Paid-sick-leave policies could offer workers the flexibility to isolate and seek care. If masking requirements stay in place on buses, trains, subways, and planes, they could more seamlessly move into other indoor public places when needed. “The more we’re willing to do that’s happening in the background, the more headroom we have,” Bilinski told me.
Most essential of all, vaccines, tests, masks, and treatments will need to become and remain available, accessible, and free to all Americans, regardless of location, regardless of insurance. Supply alone is not enough: Leaders would need to identify the communities most in need, and concentrate resources there—an approach, experts told me, that the U.S. would ideally apply both domestically and abroad. A truly good summer would be one in which “we felt like the risk level was more comparable across populations, across individuals,” Mehta told me. America, much less the globe, is nowhere near that benchmark yet.
As grand as last summer might have felt, it was also a time when the U.S. dawdled. Inequities went unaddressed. International aid fell short. Delta gained steam in parts of the American South where vaccination rates were low, and where people were cloistering indoors to beat the heat, then trickled into the east, west, and north. The pandemic simmered; Americans looked away, and let the crisis boil over again. Instead of holding last summer up as our paragon, we would do better to look ahead to the next one, and the next—moving past wanting things as they were, and instead imagining what they could be.