The Pandemic’s Soft Closing
The CDC’s latest COVID guidelines are the closest the nation’s leaders have come to saying the coronavirus crisis is done.
A quick skim of the CDC’s latest COVID guidelines might give the impression that this fall could feel a lot like the ones we had in the Before Times. Millions of Americans will be working in person at offices, and schools and universities will be back in full swing. There will be few or no masking, testing, or vaccination mandates in place. Sniffles or viral exposures won’t be reason enough to keep employees or students at home. And requirements for “six feet” will be mostly relegated to the Tinder profiles of those seeking trysts with the tall.
Americans have been given the all clear to dispense with most of the pandemic-centric behaviors that have defined the past two-plus years—part and parcel of the narrative the Biden administration is building around the “triumphant return to normalcy,” says Joshua Salomon, a health-policy researcher at Stanford. Where mitigation measures once moved in near lockstep with case numbers, hospitalizations, and deaths, they’re now on separate tracks; the focus with COVID is, more explicitly than ever before, on avoiding only severe illness and death. The country seems close to declaring the national public-health emergency done—and short of that proclamation, officials are already “effectively acting as though it’s over,” says Lakshmi Ganapathi, a pediatric-infectious-disease specialist at Boston Children’s Hospital. If there’s such a thing as a “soft closing” of the COVID crisis, this latest juncture might be it.
The shift in guidelines underscores how settled the country is into the current state of affairs. This new relaxation of COVID rules is one of the most substantial to date—but it wasn’t spurred by a change in conditions on the ground. A slew of Omicron subvariants are still burning across most states; COVID deaths have, for months, remained at a stubborn, too-high plateau. The virus won’t budge. Nor will Americans. So the administration is shifting its stance instead. No longer will people be required to quarantine after encountering the infected, even if they haven’t gotten the recommended number of shots; schools and workplaces will no longer need to screen healthy students and employees, and guidance around physical distancing is now a footnote at best.
All of this is happening as the Northern Hemisphere barrels toward fall—a time when students cluster in classrooms, families mingle indoors, and respiratory viruses go hog wild—the monkeypox outbreak balloons, and the health-care system remains strained. The main COVID guardrail left is a request for people to stay up to date on their vaccines, which most in the U.S. are not; most kids under 5 who have opted for the Pfizer vaccine won’t even have had enough time to finish their three-dose primary series by the time the school year starts. In an email, Jasmine Reed, a public-affairs specialist for the CDC, suggested the Pfizer timing mismatch wasn’t a concern, because “a very high proportion of children have some level of protection from previous infection or vaccination”—even though infection alone isn’t as powerfully protective as vaccination. “It’s like they're throwing their hands up in the air,” says Rupali Limaye, a public-health researcher and behavioral scientist at Johns Hopkins University. “People aren’t going to follow the guidance, so let’s just loosen them up.”
For many, many months now, U.S. policy on the virus has emphasized the importance of individual responsibility for keeping the virus at bay; these latest updates simply reinforce that posture. But given their timing and scope, this, more than any other pandemic inflection point, feels like “a wholesale abandonment” of a community-centric mindset, says Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill—one that firmly codifies the “choose your own adventure” approach. Reed, meanwhile, described the updates as an attempt to “streamline” national recommendations so that people could “better understand their personal risk,” adding that the CDC would “emphasize the minimum actions people need to take to protect communities,” with options to add on. (Ashish Jha, the White House’s top COVID adviser, did not respond to multiple requests for comment.)
It is true that, as the CDC epidemiologist Greta Massetti said in a press briefing last week, “the current conditions of this pandemic are very different.” The country has cooked up tests, treatments, and vaccines. By some estimates, roughly three-quarters of the country harbors at least some immunity to recent variants. But those tools and others remain disproportionately available to the socioeconomically privileged. Meanwhile, Planey told me, people who are poor, chronically ill, disabled, immunocompromised, uninsured, racially and ethnically marginalized, or working high-risk jobs are still struggling to access resources, a disparity exacerbated by the ongoing dearth of emergency COVID funds. Know your risk, protect yourself, the infographics read—even though that me before we concept is fundamentally incompatible with tempering an infectious disease. If wide gaps in health remain between the fortunate and the less fortunate, the virus will inevitably exploit them.
The most recent pivots are not likely to spark a wave of behavioral change: Many people already weren’t quarantining after exposures, or routinely being tested by their schools or workplaces, or keeping six feet apart. But shifting guidance could still portend trouble long-term. One of the CDC’s main impetuses for change appears to have been nudging its guidance closer to what the public has felt the status quo should be—a seemingly backward position to adopt. Policies are what normalize behaviors, says Daniel Goldberg, a public-health ethicist at the University of Colorado Anschutz Medical Campus. If that process begins to operate in reverse—“if you always just permit what people are doing to set your policies, guaranteed, you’re going to preserve the status quo.” Now, as recommendations repeatedly describe rather than influence behavior, the country is locked into a “circular feedback loop we can’t seem to get out of,” Ganapathi told me. The policies weaken; people lose interest in following them, spurring officials to slacken even more. That trend in and of itself is perhaps another form of surrender to individualism, in following the choices of single citizens rather than leading the way to a reality that’s better for us all.
No matter how people are acting at this crossroads, this closing won’t work in the way the administration might hope. We can’t, right now, entirely shut the door on the pandemic—certainly not if the overarching goal is to help Americans “move to a point where COVID-19 no longer severely disrupts our daily lives,” as Massetti noted in a press release. Maybe that would be an option “if we were genuinely at a point in this pandemic where cases didn’t matter,” says Jason Salemi, an epidemiologist at the University of South Florida. Relaxed guidance would be genuinely less “disruptive” if more people, both in this country and others, were up to date on their vaccines, or if SARS-CoV-2 was far less capable of sparking severe disease and long COVID didn’t exist. (Reed, of the CDC, told me that the agency’s “emphasis on preventing severe disease will also help prevent cases of post-COVID conditions,” adding that “vaccines are an important tool in preventing and treating post-COVID conditions”—even though immunization can’t completely block long COVID and seems to relieve its symptoms in only a subset of people.) Guaranteed paid sick leave, universal health care, and equitable resource allocation would also reduce the toll of loosening the nation’s disaster playbook.
Layered onto this reality, however, chiller guidelines will only spur further transmission, Planey told me, upending school and workplace schedules, delaying care in medical settings, and seeding more long-term disability. For much of the pandemic, a contingent of people has been working to advance the narrative that “the measures to prevent transmission are the cause of disruption,” Stanford’s Salomon told me; vanishing those mitigations, then, would purport to rid the country of the burdens the past couple years have brought. But unfettered viral spread can wreak widespread havoc as well.
Right now, the country has been walking down an interminable plateau of coronavirus cases and deaths—the latter stubbornly hovering just under 500, a number that the country has, by virtue of its behaviors or lack thereof, implicitly decided is just fine. “It’s much lower than we’ve been, but it’s not a trivial number,” Salemi told me. Held at this rate, the U.S.’s annual COVID death toll could be about 150,000—three times the mortality burden of the worst influenza season of the past decade. And the country has little guarantee that the current mortality average will even hold. Immunity provides a buffer against severe disease. But that protection may be impermanent, especially as the virus continues to shapeshift, abetted by unchecked international spread. Should the autumn bring with it yet another spike in cases, long COVID, hospitalizations, and deaths, the country will need to be flexible and responsive enough to pivot back to more strictness, which the administration is setting Americans up poorly to do.
Acceptance of the present might presage acceptance of a future that’s worse—not just with SARS-CoV-2 but with any other public-health threat. Months on end of weakening guidelines have entrenched “this idea that mitigation can only be dialed in one direction, which is down,” Salomon told me. If and when conditions worsen, the rules may not tighten to accommodate, because the public has not been inured to the idea that they should. “If it’s going to be 600 deaths a day soon,” or perhaps far more, Ganapathi told me, “I won’t be surprised if we find a way to rationalize that too.”