Protecting ourselves as our 18 month pandemic fades into a "forever" endemic

Last update: Friday 9/17/21

If we assume that there will be no more Delta surprises, i.e., variants that profoundly disrupt our vaccination and mitigation efforts ... a very big "if" ... then we should expect that our pandemic will fade into an endless endemic wherein the number of new infections will remain more or less the same from one month to the next for some indefinite future time frame. The endemic will be self-sustaining, like seasonal flu; it won't require boosts from travelers returning from countries having higher rates of infection. New infections will occur (1) among the unvaccinated holdouts and (2) as breakthrough infections among the vaccinated.

Of course, redefining our involvement with the global pandemic as a local epidemic means abandoning our zero tolerance public policies for infections in the same way that we accept infections from seasonal flu. We have to learn to live with the coronavirus and adjust our lifestyles to this accommodation, accepting infections but encouraging vaccinations and treatments in order to minimize hospitalizations and deaths. Some other countries that are already moving in this direction include England, Australia, and possibly China:

• "Opening Its Economy as Delta Variant Surges, the U.K. Becomes a Covid-19 Test Case", Jason Douglas, Wall Street Journal, 7/21/21
  
  
• Australia, "Covid Zero Is No Longer Working for Australia", Edward Cliff and Brian Fernandes, NY Times, 9/8/21 
  
  
• China, "After Months as a Covid Success Story, China Tries to Tame Delta", Sui-Lee Wee and Elsie Chen, NY Times, 8/4/21

Public policies

It's easy to say that we should abandon zero tolerance for infections, but our politically divided public forums will make it difficult to mobilize a broad public consensus for this shift. Indeed, a few GOP governors have already abandoned zero tolerance for infections, most notably Governor DeSantis of Florida. DeSantis has been widely excoriated by the liberal/progressive media that focused on his opposition to mandates and the recent surge of infections in Florida, while ignoring his energetic promotion of vaccinations. According to the CDC, as of 9/15/21, Florida had fully vaccinated 83.4 percent of the most vulnerable segment of its population, those of age 65 and over -- a higher percentage than key Democratic states New York (83.2 percent), Illinois (77.5 percent), and California (79.6 percent).

Personal policies

Question: If our political divisions make it difficult for us to reach a consensus as to when we should abandon our current zero tolerance of infections, when will the pandemic become endemic?

Answer: When YOU say so, dear reader, when you make this determination based on your individual circumstances. Indeed, no matter where you live, be it in a zero tolerance state or in a non-zero state, health conscious residents of the U.S. should employ mitigations that match their personal circumstances, no matter what the CDC may say, because one size will not fit all; one set of mitigations will not be appropriate for everyone. The following paragraphs illustrate the differences between a few specific categories

• Unvaccinated persons -- If you haven't been vaccinated, get vaccinated as soon as possible. The existing vaccines are still highly effective in protecting fully vaccinated individuals against severe illness or death.
• Persons who are not fully vaccinated -- A few months ago it was determined that two shots of Moderna or Pfizer did not protect everyone against severe illness or death. Persons who have certain underlying health conditions, e.g., cancer victims, persons whose immune systems are compromised by medications, and older persons -- will not achieve full immunity with only two shots. If you are in one of these categories, you should get a booster shot as soon as possible. -- "An F.D.A. panel recommends authorizing Pfizer boosters for those over 65 or at high risk of severe Covid.", Noah Weiland and Sharon LaFraniere, NY Times, 9/17/21  

The remaining categories only include persons who are fully vaccinated. Being fully vaccinated, their biggest concern is not infecting others if they become breakthrough cases, i.e., if they themselves become infected.

• Persons who live in fully vaccinated bubbles -- If everyone with whom you have close face-to-face contact on your job, in your home, and in your social life has been fully vaccinated, you can return to life as you lived it before the pandemic. Well, not quite. You might live in a fully vaccinated bubble, but some of the vaccinated friends and associates in your bubble may have kids at home who have not been vaccinated. So you should get tested for the virus every week, most conveniently with self-test kits. If you become a breakthrough case, you should notify all of the people with whom you had close contact in the last couple of weeks and quarantine yourself for two weeks.
• Persons who do not live in fully vaccinated bubbles -- If some of the people with whom you have close face-to-face contact on your job, in your home, or in your social life have not been fully vaccinated, you should employ the full arsenal of mitigations in order to minimize your chances of becoming a breakthrough case, then infecting them. Your most prominent vulnerable contacts will be your unvaccinated children and your elderly relatives who have not been fully vaccinated, -- Wear masks in indoor public places, preferably N95 or KN95. These masks will protect you from contagion regardless of whether everyone else is wearing a mask. -- Maintain social distancing in indoor public places because this is the most powerful mitigation at your disposal, other than vaccination. -- Get tested every week, most conveniently with self-test kits. Notify all of your close contacts if you become a breakthrough infection, and quarantine yourself for two weeks.

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Related notes on this blog:

• "Downgrading the CDC's guidance", Last update: 7/25/21
  
  
• "Tracking Delta breakthroughs -- Part 4 (Mitigation via testing and contact tracing)", Last update:  9/5/21