Seven years ago, a group of U.S. government officials and I were sitting in the White House Situation Room, debating how health emergencies end.
For months, we had worked in West Africa and the West Wing, as Ebola took thousands of lives abroad and spurred deep fears and nasty politics at home.
All along, our team — led by President Barack Obama alongside local partners, international experts and 3,000 American troops on the ground — was driven by science and data: who was infected and how many were dying.
By January 2015, the data had shifted. While Ebola still persisted, case and mortality counts had dropped. The question before us was whether it was a lull or something more permanent. Many scientists, including well-respected government epidemiologists, voiced caution and warned that viruses change often. Though I and many others shared that concern, we believed Africans could ward off another surge with reasonable sanitary practices and other precautions that had become commonplace. By mid-February, Obama announced a withdrawal of U.S. forces and a transition to an “ongoing” response.
It’s time for a similar shift on Covid-19.
With Omicron’s astonishing surge and so many still dying tragically each day, Americans may feel like such a transition is a long way off. But with a less lethal and now receding variant and a better vaccinated and protected population, it’s clear the pandemic’s emergency stage is ending in the United States. As with Ebola, we must use the coming lull to transition from an emergency response to the management of an ongoing, persistent public health challenge.
That will require breaking the crisis politics and governing that have become ingrained habits over the last two years. At a polarized time, that move may cause worry, but it is the only way to manage an era with regular health crises. It also offers a path toward some semblance of the return to normalcy that so many crave, while giving us the opportunity to prepare for and prevent the next emergency.
This transition will begin not with a bang but with a whimper. In the coming weeks, Omicron will likely present far fewer deaths due to a lower mortality rate and far fewer infections because the variant has vastly increased the number of unvaccinated people now protected from Covid-19. Soon enough, people will stop seeing maps turn crimson with cases, their phone’s exposure alerts will grow quieter, and children and their parents will face fewer school interruptions. This lull will be bolstered by President Joe Biden’s recent decisions and other initiatives, which will ensure Americans have access to all the vaccines, masks, tests and treatments they need.
Yet America’s ability to pivot away from an emergency response is constrained by politics, which proved a bigger driver of how we tackled Covid-19 than the virus itself in the pandemic’s first two years. In many red communities, people sought to live their lives, minimizing social and economic costs while accepting higher case and death counts. Although this approach, endorsed by Florida GOP Gov. Ron DeSantis and others, was irresponsible during earlier, deadlier variants, it has proven a more reasonable fit with the less lethal Omicron. Meanwhile, in many blue areas, low risk tolerance saved lives earlier. But those who pushed for reflexive closures — such as the leaders of the Chicago Teachers Union — appeared to over-estimate Omicron’s health risks and under-emphasize the social and economic costs of more drastic measures.
In recent days, it’s become clear that many of our elected officials are ready to change course. A number of governors around the country, including in New York and New Jersey, are seizing on the changing Covid-19 data to drop mask mandates. Although these decisions reflect an admirable inclination to respond based on evolving risks, officials in red and blue states alike should decide mask policies as part of comprehensive strategies that seek to make this lull permanent and prevent another emergency.
Such an ongoing strategy must start with the science. The goal must be to make and keep Covid-19 endemic, akin to the flu, with no dramatic swings in severity. Our worry must shift from the number of cases to the potential for fatalities, as measured by any new variant’s predicted mortality compared to a population’s existing immunity. But that strategy should also consider the social, economic and educational needs of Americans. This is doable. After all, political leaders make complicated decisions every day related to similarly multidimensional threats like violent storms, salmonella outbreaks, and more.
There are three main pieces to consider.
First, help people protect themselves. Every American, save the immunocompromised, disabled and young children, can now make choices that all but eradicate the possibility of serious illness and death. We must continue providing people — especially the most vulnerable — with the necessary tests, vaccines, masks and treatments. Providing every tool needed for Covid-19 will empower people to make their own risk calculations.
Relatedly, governments should also use regulations and investments to improve physical infrastructure. Personal protection and masks should only be required where sufficient improvements are impossible — for example, on subways, buses, airport terminals, arenas and other places where ventilation cannot be improved, and people cannot distance from one another. With better ventilation and spacing and other measures, masking in schools does not have to be, and should not be, an ongoing practice.
Second, prevent the next variant from going global. Yes, another variant is likely to break out — a rho, pi, and so on are all but certain. But tools and initiatives can make these outbreaks less likely and less deadly. By doing far more to provide vaccines, treatments and tests to the world, the United States could limit the likelihood of new mutations. And by helping improve global surveillance and warning systems to find new outbreaks, we stand a better chance of containing them before they cross borders.
Third, prepare for the next emergency. Federal, state and local government officials should also support genomic surveillance at home, including monitoring of wastewater and air, and develop ways to signal acute severity, like storm warnings, of a new Covid-19 variant. If an emergency develops, we must be ready to respond with overwhelming force to significant changes in predicted mortality — surging financial, logistical and other resources to the hospitals, schools and infrastructure in vulnerable communities and hotspots.
In a pandemic, a lull is a terrible thing to waste. Seven years ago, we knew there were risks to moving away from the emergency response on Ebola, just as there are risks today. That we have had this debate twice in less than a decade is emblematic of the new era we live in. Covid-19 will still take some unexpected turns. It and other health threats will be a part of life for years to come. We can only survive them, and thrive despite them, by avoiding partisan bickering, seeing the risks for what they are, and developing sustainable ways to manage them.
