The Key Distinction That Helps Clarify the Path Forward on the Pandemic

We need to focus less on what individuals can do and more on what institutions can do.

Two women sitting at a bar while a bartender pours a drink
Nina Westervelt / Bloomberg / Getty

About the author: Craig Spencer is an emergency-medicine physician and director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center.

As the Omicron surge recedes, millions of the country’s thrice-vaccinated find themselves wondering if now, finally, is their moment to enjoy life and stop worrying as much about COVID.

Yet more than a thousand Americans are still dying every day. Millions of immunocompromised people remain vulnerable, even if they’ve gotten their shots, and children under the age of 5 still can’t get vaccinated at all. And millions more are vaccine-defiant, putting the nation’s hospitals in crisis mode with each wave. The pandemic is in no way over. So shouldn’t everybody—including vaccinated adults—continue to do their part, observing stringent measures to reduce the chance that they’ll get COVID and spread it to someone else?

This question has, in some ways, become a central fight of the pandemic two years in—at least among the remaining percentage of the country that cares at all. But it is one that is easily resolvable if we think more clearly about how to fight the pandemic, and that means sorting mitigation strategies into two camps: what individuals can do and what institutions can do.

What individuals can do to fight the pandemic is simple: Get vaccinated. This remains the most effective way to protect oneself and others. Early on in the pandemic, public-health experts asked everybody—everybody—to do their part and stay home to prevent COVID spread. But now that we have vaccines, that is no longer necessary—if you’re vaccinated (and boosted). Yes, Omicron increased the risk of breakthroughs, but boosted people are still significantly less likely to get infected, thus lowering the risk of them infecting others. The shots also dramatically lower the likelihood of developing long COVID, as well as increase the likelihood, for those who do, that their symptoms ultimately resolve. Perhaps most important, even if recent data suggest that some benefits of a third dose wane slightly over time, boosted adults are still far less likely to require hospitalization and 41 times less likely to die from COVID. This has relieved significant pressure from the health-care system as it has teetered on the brink. (In a population with near-universal vaccine uptake and boosting, COVID would never overwhelm the health-care system, which is an appealing daydream for health-care providers like myself who’ve been on the front lines for every wave.)

So if you’re not vaccinated (and boosted), get vaccinated (and boosted). But if you are thrice shot, you should feel comfortable reengaging. Whether that means dining indoors with friends, getting drinks at a bar, or jumping on a plane for a long-delayed trip abroad, public-health advocates (and their allies in the public) shouldn’t make the boosted feel like they’re doing something scandalous by enjoying themselves. They did their part.

Many may choose to continue masking even as mandates fall across the country. The transition will take time for a lot of people, and they should do what makes them feel most comfortable. Others might want to use rapid testing before a large family gathering. And still everyone should live with the expectation that things can always change again should another variant emerge. But the boosted can do things—enjoy the company of other people, attend cultural events, eat in restaurants—even if we do sometimes take these additional precautions.

In fact, this is exactly how I go about my life now. I work in an emergency room and am constantly exposed to COVID. I test whenever I feel unwell or meet with others, especially those at high risk for COVID’s worst outcomes. I dine and drink with friends indoors. I wear a high-quality mask when one is required and in busy or crowded spaces such as grocery stores. And I change my behaviors in the days before visits to immunocompromised family members to lower the risk. If I ever do test positive, I’ll make sure to isolate in accordance with CDC guidance. I always remember that my actions affect others, and I try to behave responsibly and kindly. But I also know that the future of the pandemic does not depend on vaccinated people like me avoiding getting COVID forever.

So what does it depend on? Here we should look to institutions—both public and private—to do three things: increase vaccinations, reduce spread, and improve treatment options and availability.

On vaccinations, the place where we can have the greatest impact is with the elderly. In the United States, three-quarters of all COVID deaths have been in people ages 65 and older. Yet only 65 percent of this highly vulnerable population has been boosted. As Sarah Zhang recently wrote, that’s a much lower proportion compared with other wealthy countries such as England, where 92 percent of its elderly population has been boosted.

The situation is similarly dire in long-term-care facilities. Nursing homes are responsible for 16 percent of the total COVID death toll to date. But still only 87 percent of nursing-home residents are vaccinated. And only 69 percent have received a booster, despite the extra shot’s astounding impact on protecting this high-risk group. Similarly, only 83 percent of staff working in nursing homes have gotten their shots, and only 35 percent are boosted. That’s higher than the national average, but still too low. A recent Centers for Medicare and Medicaid Services rule, upheld by the Supreme Court, requiring certain health-care facilities—including nursing homes—to ensure that all staff are vaccinated should help, but more incentives and action are needed to get more staff and residents vaccinated and boosted.

Moreover, booster uptake generally in the U.S. has lagged significantly behind that of other countries. Only half of all eligible people here have received a booster. To increase uptake, employers could require them for staff as part of safe return-to-work protocols. And health-care providers could help better educate their patients on the enhanced protection against severe disease provided by a booster, especially for older individuals and those with high-risk medical conditions.

Additionally, the U.S. and other wealthy countries can do more to distribute vaccines abroad. The Western world has been parsimonious with its approach to global vaccine equity. Even as anyone in the U.S. can walk into their local pharmacy and get a dose, still only 10 percent of those in low-income countries have been vaccinated. The pandemic won’t end here until it ends everywhere, and getting the rest of the world vaccinated is the best way to prevent new variants from emerging.

The second thing that institutions can do is to reduce spread with commonsense mitigation measures. How to do this? Two main things come to mind: Improve indoor air quality and expand flexibility for sick leave. Cleaning the air we breathe through improved ventilation and filtration would help cut the transmission of SARS-CoV-2 and a whole host of other respiratory viruses as well. And if you run a business with employees, see to it that your employees have enough paid leave so that they don’t have to choose between coming to work when feeling unwell and not getting paid. In addition, all institutions—be they universities or corporations—need to retain the flexibility for remote options for education and work that we’ve witnessed in the past few years.

And finally, the government can do more to approve and make available new therapeutics such as Evusheld, a monoclonal antibody cocktail to prevent infection, and Paxlovid, an oral antiviral that slashes the likelihood of hospitalization, both of which will play an important role in keeping people safe, including and especially immunocompromised people for whom vaccinations may not work as well. Unfortunately, these two drugs are still in short supply, and we need the government and health-care institutions to surge and stockpile more in advance of future waves.

Many vaccinated and boosted Americans are rightly worried about the virus’s continued spread, especially for immunocompromised people, and they want to do their part. As Ed Yong recently wrote, “People are still dying, and immunocompromised people disproportionately so.” But, notably, not one of the proposed strategies for improving the situation for immunocompromised people that Yong highlighted was to ask vaccinated and boosted people to stay home. Yong writes, “Exactly none of the people I talked with wants a permanent lockdown.” So what solutions does he point to? Institutional ones, or, as Yong puts it, “structural changes—better ventilation standards, widespread availability of tests, paid sick leave, and measures to improve vaccination rates. Above all else, they want flexibility, in both private and public spaces. That means remote-work and remote-school options, but also mask mandates for essential spaces such as grocery stores and pharmacies, which could be toggled on or off depending on a community’s caseload.”

This is the path to a better pandemic future—not just for healthy, young people but for everyone. The pandemic isn’t over, even for the boosted. But with cases plummeting, it should be an invitation for them to responsibly take pleasure in activities they’ve long been putting off. Treating them as trusted partners is not only consistent with the virtues of the vaccines. It’s also an investment in future preparedness. This group, by virtue of getting boosted in the first place, is among public health’s best allies. If we level with them now, they will be more willing to listen when the message and guidance change. Failing to do so risks losing their trust and attention completely.

The pandemic isn’t over, but that doesn’t mean it should stop all of us from living—especially those who have done the most important thing to protect themselves and others.