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The pandemic endgame isn't here yet. But if we play our cards right, things will start getting better in 2023.

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A spinning wheel with alternating blue and red vaccine and mask options and a single small yellow option labeled "FREEDOM." The background is purple and smaller coronavirus shapes are scattered around.
"People feel like, 'Oh, we thought COVID was over.' Well, no. Half the US population is still not vaccinated. And the world is struggling to get vaccinated," the epidemiologist Saskia Popescu told Insider. Samantha Lee/Insider
  • The US hasn't vaccinated enough people to stop the Delta variant from spreading.

  • It's possible that by 2023 things might feel safer again, but only if more people get vaccinated.

  • Insider spoke with experts who said we need to better manage expectations for what's ahead.

  • See more stories on Insider's business page.

After more than 18 months of living with COVID-19, everyone's exhausted.

The Delta coronavirus variant is by some estimates a thousand times more potent than previous versions of the virus, which means masks are back (even for the vaccinated, in many places). The Centers for Disease Control and Prevention is stressing that "the war has changed" and not for the better.

But conversations with half a dozen of America's leading experts on COVID-19 make it clear we still shouldn't feel defeated.

Right now, we are the tortoise in the middle of a critical race against the virus, which appears to have the winning, twitch-like reflexes of a hare. It's becoming more contagious, even achieving mild infections and transmission in the fully vaccinated population, prompting new booster-dose guidance from the federal government.

"People are emotionally and mentally drained," the epidemiologist and infection-prevention expert Saskia Popescu said, lamenting how complicated it is to communicate the evolving science of the virus and to combat the novel virus itself.

Even so, the truth is we do still have the upper hand in the long run: Vaccines work and can help us win this war.

It's just going to take longer than many of us thought - at least a few more years before we can live truly postpandemic.

We're still headed in the right direction - we just have to be nimble

Young kids in masks walk up the stairs against a red wall at a primary school.
Primary-school students in their face masks. Ina Fassbender/AFP via Getty Images

This may be the most complex part of the pandemic.

About a quarter of the world is fully vaccinated (including just over half of the US). That is not nearly enough vaccine-induced immunity to end the pandemic, especially with new variants emerging.

Vaccines are doing a very good job keeping people alive, out of the hospital, and healthy. But just because the vaccines work doesn't mean the pandemic is over.

"I'm very depressed," the infectious-disease expert Dr. Carlos del Rio, a distinguished professor of medicine at Emory University, said about the sluggish pace of vaccine uptake across the US.

"We didn't set the right expectations," said the infectious-disease expert Mike Osterholm, the director of the University of Minnesota Center for Infectious Disease Research and Policy. "Most people feel like they don't need to worry anymore."

The vaccinated experts I spoke with are still taking lots of precautions and plan to keep doing so.

Dr. Paul Offit, a coinventor of the rotavirus vaccine, said he's not saying yes to any in-person conferences, even those scheduled for the end of 2022. "I'm waiting," he said.

So is Dr. Stanley Perlman, who's been studying coronaviruses for more than three decades. He's fully vaccinated, but is still double-masking when he goes to the movie theater and socially distancing when he has friends over to his home in Iowa (a state that's logging more than 700 new COVID-19 cases a day).

"I don't know anything else you can do on the individual level, except protect yourself and protect the people around you," he said.

Vaccine protection will most likely wane in the months and years ahead. That means mitigation measures like masks in indoor public spaces should still be a part of life while we work out an effective long-term disease-fighting strategy, whether it ends up looking like what we have for flu shots (boosters every year) or tetanus (boosters every decade).

"I am hopeful for the future, but I also know that this is going to be a lot longer of a struggle than people realize." Popescu said.

Yes, the vaccine goalposts have moved

a cdc vaccine card with an arrow pointing at the line that says 'other' for additional doses of vaccines
CDC vaccine cards already have extra lines on them for "other" doses. Lev Radin/Pacific Press/LightRocket via Getty Images

The US did not vaccinate fast enough to build up a strong base of viral protection before Delta took over. Instead, as some people got their shots, we all eased up rapidly on mitigation measures.

And with Delta here, the number of people who must get vaccinated for society-wide "herd immunity" protection to kick in has gone way up.

Offit shared some back-of-the-napkin math on this, based on a well-regarded formula he helped develop for herd immunity.

His calculation comes down to two variables: the infectiousness of a disease (which has gone up considerably for COVID-19 with Delta) and the effectiveness of the vaccines (which has gone down slightly for COVID-19 with Delta).

Estimating generously, Offit expects we need at least 90% of the country protected through some combination of vaccinations and previous infections to develop meaningful herd immunity.

Others agree with his rough calculus, which the US hasn't come close to achieving.

"One endgame would be getting 80 to 90% vaccination and/or previously infected," Perlman said. "That's the endgame. And vaccination is so much better than having infection, because some people will die from infection."

COVID-19 vaccines also give your body a stronger, broader form of viral protection than infection, teaching it how to fight back better, even in the face of new variants.

By not considering one another, we're only prolonging the pandemic

Three London police officers detain a anti-lockdown protestor on a sunny afternoon
An anti-lockdown protest in London. Henry Nicholls/Reuters

Whether vaccinated Americans are throwing their masks away or getting booster doses sooner than recommended in the hopes of beefing up personal immunity, they all share one thing in common with those who remain unvaccinated. Each mistakenly thinks they can win this race solo.

We are not in a pandemic of the unvaccinated. We're in a pandemic together, and it isn't over as long as some of us remain unvaccinated.

New data from an undervaccinated Colorado county showed how it really does take a village to fend off the virus, especially with Delta at play. Only 36% of vaccine-eligible residents in Mesa County got their COVID-19 shots.

Research subsequently found that the vaccine was less than 80% effective against Delta in that area, while in the rest of Colorado, where more residents were vaccinated, the vaccines were nearly 90% effective. In other words, an investment in your own health is an investment in your child's health and your neighbor's health too.

Kids under 12 still can't get vaccinated, and many others, including cancer patients, organ-transplant recipients, and older adults don't get the same protection from their vaccines that everyone else does. Until more people are vaccinated, none of them are safe.

Popescu said some public-health professionals had been surprised by the fierce pockets of vaccine hesitancy during a deadly pandemic, when we have strong data showing how effective and safe the vaccines are. At a time when children under 12 can't even get vaccines yet, eight states are making it all but illegal to protect them from disease and death by banning mask mandates in class.

​​"There was this assumption that because we all experienced this pandemic, everybody would get on board with these interventions, whether they were masks or vaccines," Popescu said. "The US has been a prime example on how that doesn't work. We have serious fractures in getting people to understand community health."

As a result, the viral finish line is being pushed back for all of us, time and time again.

We need to use every tool we have

a sandwich board outside a restaurant reads: please show PROOF of COVID-19 vaccination for indoor dining or bar
A sign at a restaurant on New York's Upper West Side on August 17, the first day you had to show proof of COVID-19 vaccination to participate in indoor dining in the city. Timothy Clary/AFP via Getty Images

If we consistently wear masks and vaccinate more eligible Americans, while being smart about ventilation and crowd control, we can beat the pandemic faster.

If we don't vaccinate more Americans, this virus will continue to surprise us with more terrifying developments.

"People need to understand that Delta is not the end of what the virus can do," Dr. James Hildreth, the president of Meharry Medical College, said. "If we could all get vaccinated - most of us get vaccinated - we not only protect ourselves in our communities, we limit the possibility that a scarier Delta will arise."

Don't lose hope or turn to anger. Adjust your timeline expectations.

two restaurant-goers hold up their CDC vaccine cards. proof of vaccination is mandatory for indoor dining in New York City now.
Alton Thibodeaux and his wife, Jean, waiting to go into a restaurant on New York's Upper West Side on August 17. Timothy Clary/AFP via Getty Images

There will most likely be enough vaccines for everyone on the planet by the end of 2023.

"We have got to get vaccines to the low- and middle-income countries, not just for humanitarian reasons, but because strategically that's where the variants are going to come from," Osterholm said. He added that fewer than 1.5% of people in the world's poorest countries had gotten a single vaccine dose and virus levels globally had waxed and waned in a somewhat unpredictable fashion.

Even after most of the world is vaccinated, the virus won't disappear. The best that we can hope for is that it will become an infectious nuisance that we can control and prevent, as we do with polio, measles, chickenpox, and other vaccine-preventable contagious diseases.

"We still give a polio vaccine, even though we haven't seen a case here in 40 years," Offit said. "The reason is that polio still exists in the world."

For the next couple of years, though, we must carefully navigate the waters of public life to avoid long-term illness and preventable deaths.

"I often think about what it must've been like during wartime, or depression, or some other point in our history where resilience had to be the order of the day," Hildreth said. "We're tired of the virus and we want to be done with it, but that's not going to solve the problem."

The specter of more contagious and dangerous coronavirus variants will remain until almost the entire world is vaccinated. At that point, hopefully we'll have built up enough immunity to protect ourselves - and one another - well from severe illness and death.

In a decade, the threat the coronavirus poses will most likely still feel more imminent than polio, which has been eliminated everywhere except Afghanistan and Pakistan.

But if we vaccinate almost everyone and discover more treatments, a COVID-19 diagnosis may eventually not feel much more dire than getting the common cold or flu, meriting a few days of bed rest.

"We will get to a point, I think, where we're comfortable that the incidence of cases and deaths is low enough that we don't feel we need to change our life anymore," Offit said.

It will probably not be this year or next. But at some point in 2023, life may feel the way it used to again.

Read the original article on Business Insider

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