WASHINGTON — When will it all end?
That was the question posed to Dr. Anthony Fauci, the top medical adviser to President Biden, during a Wednesday briefing by the White House pandemic response team. It is a question that Americans have been asking, with variation, for months: How much longer will we have to wear masks? When will the sound of a stranger’s cough no longer incite fear of death?
Most broadly of all, when will the pandemic state of emergency finally come to a close, to be replaced by something resembling a pre-pandemic normal?
The answer Fauci offered on Wednesday is unlikely to offer much comfort to the impatient or the exhausted, in a reflection of the perilous period the nation is about to enter. According to an internal pandemic update circulated within the Biden administration on Wednesday, new infections rose by 14.1 percent between Nov. 8 and 15, while test positivity — the portion of diagnostic tests coming back positive — inched up 1.4 points, to 6.5 percent. During the same time period, hospitalizations rose by 5.4 percent. (Deaths fell by 4 percent, an encouraging development possibly reflecting high vaccination rates and the increasing reliance of therapeutic treatments.)
Parts of Europe have recently resumed restrictions, an inauspicious development, since what happens there tends to presage the path of the pandemic in the U.S. “The fourth wave is hitting our country with full force,” German Chancellor Angela Merkel said earlier this week.
American leaders haven’t made similar warnings, but their signals have decidedly taken on the tone of caution. Gone are the days when Fauci and others touted the freedom that would come with “herd immunity,” a concept consigned along with “hot vax summer” to the realm of hopes unrealized. With winter looming, the months ahead portend an uncomfortable, uncertain slog.
“We want control,” Fauci said. “And I think the confusion is, at what level of control are you going to accept it in its endemicity?”
A virus becomes endemic when it is no longer spreading at pandemic levels but is also impervious to actual eradication. Downgrading the coronavirus to an endemic pathogen would in effect concede that we will live with it for the foreseeable future, but without the disruptions caused by pandemic spread.
The goal isn’t quite as modest as it seems, since only one virus — smallpox — has ever been eradicated. If the coronavirus became endemic, it would be relegated to a seasonal problem, similar to the influenza that invariably shows up with the cold weather.
But the U.S. isn’t there yet, the medical establishment agrees. As another top adviser to President Biden — Andy Slavitt, who left his post in June — put it in a recent Washington Post op-ed, “the pandemic is not done yet.”
Offering his own reasoning, Fauci said on Wednesday that the number of daily infections, hospitalizations and deaths would have to be “far, far lower” than they are today for the sense of emergency to begin to lift. Currently, the nation is averaging nearly 90,000 new cases per day, and 1,000 new deaths, according to the Centers for Disease Control and Prevention.
Yes, vaccination would prevent most of those deaths and hospitalizations. Only at this stage of the vaccination effort, many of the holdouts are turning out to be refusers, which leaves the Biden administration in a bind. With his workplace mandate now the subject of a federal court case, there is little the president can do to bring the end of the pandemic any closer. He has tried incentives and impatience, has vacillated between warning and hope. Yet even the White House, it turns out, has a limited arsenal against what Biden's predecessor took to calling "the invisible enemy."
“We want to get to the lowest possible level that we can get,” Fauci said on Wednesday, declining to say what that level should be. Fauci has previously said that fewer than 10,000 daily cases would be a sign that the battle against the pandemic had turned. The U.S. hit that benchmark in early July, only to see that success undone in a matter of days by the more contagious Delta variant.
The months-long fight against the Delta variant, combined with the politicization of both face masks and vaccines by pro-Trump media figures and elected officials, have left public health officials wary of making all but the most modest pronouncements or promises. Which, in turn, has led to confusion about the battle plan for what will soon be the third year of the pandemic.
“We’re sleepwalking into policy because we’re not setting goals,” Harvard occupational safety expert Joseph Allen recently told the Atlantic.
The administration's increasingly evident reticence was especially pronounced on Wednesday, with Fauci doing little to describe an endgame. “When we get to that low level, we will know it, rather than picking an arbitrary number,” he said.
When that will be, nobody seems to know. And now that winter is nearly here, it is hard to imagine that the pandemic will be ending anytime soon, at least in the official accounting.
“All data from Europe and what is happening in the U.S. supports, unfortunately, that we are in for another significant wave,” Dr. Eric Topol, founder and director of the Scripps Research Translational Institute in La Jolla, Calif., told Yahoo News in an email. “Unlikely to be as bad as Nov/Dec 2020, but it will not be good.”
Great progress has been made, to be sure, with 195 million people fully vaccinated in the U.S. Children are being vaccinated and schools are staying (mostly) open. Therapeutics in pill form that are exceptionally effective in preventing death from COVID-19 will soon be widely available. Rapid tests are also becoming easier to find, if not quite as easy as some would like.
Together, these weapons could help blunt a winter wave but are unlikely to make for a coronavirus-free season, leaving Americans to ponder if the long-promised return will actually ever come.
“We’re in a bit of a watershed moment,” Rupali Limaye, a vaccine specialist at Johns Hopkins, told Yahoo News. “We’re not making a lot of gains now,” she said, referring specifically to first doses administered to adults. And “the communication was just poor on boosters,” she added. Weeks after the first booster shots were administered, debates over their efficacy and necessity remain intense.
Limaye said that vaccination of children between the ages of 5 and 11, which began earlier this month, would be “critical.” Some 28 million children in that cohort are now eligible to be immunized. The effort is only two weeks old but has been highly encouraging to the White House, with an estimated 2.6 million children having been administered a first dose as of Wednesday evening.
The broader pandemic picture remains murky, however, and if the Biden administration’s top medical experts have become relatively cautious in their assertions in recent weeks, it is largely because the pandemic has always found a way to confound their expectations.
In late March, CDC Director Dr. Rochelle Walensky confessed to a feeling of “impending doom,” but a spring wave never materialized, and she was accused of doomsaying by some.
Then, on July 4, President Biden all but declared victory over the coronavirus, even as the Delta wave was spreading rapidly across the country. Within weeks, the CDC reinstated the mask guidance it had lifted in late May, ending the brief spell of normalcy much of the nation enjoyed in late spring and early summer.
The fall was marked by furious political battles over school mask mandates and vaccine requirements, with Republican governors like Ron DeSantis of Florida and Greg Abbott of Texas touting natural immunity, calling the efficacy of masks into question and celebrating personal freedom at the seeming expense of public health.
Those challenges have framed the public debate around the pandemic, potentially contributing to the lack of progress, with millions of eligible people unvaccinated, restrictions loosened and winter approaching. Then there’s the exhaustion of people who’ve done the right thing all along, only to find themselves living more or less as they did a year ago.
“While we should all be more optimistic than this time last year, we are not yet in a position to declare victory on the pandemic,” Boston Children’s Hospital epidemiologist John Brownstein recently told ABC News.
Even if no winter wave materializes, White House celebrations of victory over the virus are unlikely to come anytime soon. Vaccination benchmarks now go studiously unmentioned, though Biden was given to touting them throughout the spring, when it seemed like a matter of relative ease to meet them. Vaccination is still the way out of the pandemic, but until the Biden workplace mandate takes effect in early January (that is, of course, if it survives a majority-Republican appeals court in Ohio), there is little more that public health officials can do.
“Why don't we get as many people as we can get vaccinated vaccinated as quickly as possible,” Fauci said on Wednesday, “and get as many people who are eligible for boosters getting boosters as possible?”
There are masks, of course, at once maligned and effective. They are currently recommended by the CDC even for vaccinated individuals, a guidance that some high-vaccination areas believe they can finally dispense with.
On Tuesday, District of Columbia Mayor Muriel Bowser announced that Washington would lift its mask guidance for most indoor settings the following Monday. The White House, however, said that masking would continue on its grounds, even if staffers and reporters who work on campus have been vaccinated for months and many take every opportunity they can to go maskless.
Asked about when the masking guidance might change during Wednesday’s briefing, Walensky offered nothing concrete, pointing out that 85 percent of American counties were experiencing “substantial or high transmission,” meaning that masks needed to be worn there. She advised “moderate or low transmission for several weeks before releasing mask requirements.”
It may be that the pandemic has led to so many discouragements and disappointments, caution may be the easiest position to maintain as winter looms and uncertainties linger.
Fauci, who has been fighting infectious diseases for four decades, first gaining national attention for his work on HIV/AIDS in the 1980s, has sometimes appeared chastened by the coronavirus, and the nexus of public health, politics and cultural animosity. Earlier this week, he frankly discussed the threats his family has received at a discussion at the Bipartisan Policy Center.
Conservatives have attacked him for inaccurate or contradictory assertions on the origins of the pandemic, the need for masking and the vaccination rate at which community spread would stop, painting any miscalculations on his part as inherently malicious. Fauci may thus have little incentive to say just how or when the pandemic will end, though he and others agree it will be when vaccination becomes more prevalent than it is today.
“As far as we’re concerned, we don’t know, really, what that number is,” Fauci conceded at Wednesday’s briefing. “But we will know it when we get there.”
With additional reporting by Jana Winter.