So what now?

Thankfully, case numbers are plummeting throughout the country. As we emerge from the holiday surge, we find ourselves in a similar situation as last spring, grateful for a reprieve. Hospitalizations and deaths are still pretty high, but those numbers lag, and I expect they will come down too.

How do we de-escalate? This is a real challenge in medicine; we're better at adding interventions than taking them away. But now's the time to figure out how to do this rationally and safely. Unfortunately, the issues are entangled with politics as mask mandates expire and vaccine efforts flag. How do we think about this? What should we be doing now?

I acknowledge that I live in a very COVID-careful part of the country and work in a COVID-cautious industry. As I've written and rewritten this blog, I've come to the conclusion that one question we have to ask ourselves is whether the role of public health is to protect the community at large or the most vulnerable individuals in our community.

For the average person, as prevalence of disease declines, it may be reasonable to shift from broad mandates to community, local, or individual decision-making. I'd prefer to wait until absolute numbers sink below pre-Delta levels, but I recognize the political capital for that is waning. Here, we weigh fatigue for rules, the importance of creating movement towards normalcy, and recognition that immunity protects healthy people significantly. We also recognize the counterarguments against mandates that we've heard time and again: personal choice, freedoms, overreach of government. I understand the many countries, states, and geographies letting restrictions lapse.

But for the vulnerable individual, the unvaccinated, the immunocompromised, the transplant patients, the very young children, COVID still poses a genuine risk. If the goal of public health is to protect those who need protection the most, then the answer is clear: we need to continue wearing masks, vaccinating more people, and developing advanced treatments.

The role of government and public health depends on one's political philosophy, and I don't make any pronouncements on what it should be. But I think we now live in two worlds: one in which immunized, healthy people can treat COVID as an endemic disease, and one in which the vulnerable still need to take precautions. The pandemic has worsened many societal inequalities, from wealth to race to jobs where we can or cannot work from home. This is a new inequality, and I worry it will persist and fracture our communities.

Ultimately, we cannot pretend the pandemic will never end in the same way we cannot pretend that there is no pandemic. It is definitely a good thing that the latest surge is waning and our society is opening up once more. We can talk about things that may have been taboo for many of us for the last two years: travel, concerts, celebrations, Disneyland, dancing. But our decisions must be nuanced and sensitive to those who are unlike ourselves. We must chart a path to a new normal, which may be different than pre-pandemic life.