By Alyssa Hui, Health

(March 07, 2022) – An end to the COVID-19 pandemic might finally be in sight for Americans after living nearly two years with the virus.

As COVID-19 cases drop in the U.S., many parts of the country are relaxing their restrictions and mitigations. Major cities like New York and Washington DC are lifting vaccine mandates in public indoor spaces while others are scaling back requirements to show proof of vaccination in bars, gyms, and restaurants. The Centers for Disease Control and Prevention (CDC) has even advised communities with low levels of transmission to drop universal masking.

In conjunction with all of these developments, President Biden, during his State of the Union address last week, announced new efforts to allow people to return to normal activities after two years of pandemic disruptions. As part of the White House’s new approach, a new National COVID-19 Preparedness Plan is set to be released on Wednesday of this week.

Given all of these headlines and changes, many are wondering if the pandemic is truly behind us and what lies ahead in our response as a nation.

“We are in the best place we’ve been since before the Delta surge, which happened in the spring of last year, so we’re doing well, but the pandemic isn’t over,” Eric Toner, MD, senior scholar and scientist in the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, told Health. “The number of new cases each day is still substantial, but much less than it was and the trajectory looks good. The only thing that we can’t judge is whether or not there will be a new variant that pops up that causes more problems.”

So what does the future look like when it comes to the continued evolution of the pandemic and our nation’s response? Here’s what you need to know.

What Are the Stages of a Pandemic Response and Where Are We Right Now?
First, it’s important to understand that there are five stages in a pandemic response, which Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and chief medical adviser to President Biden, outlined during the World Economic Forum’s Davos Agenda virtual conference on January 17. And despite appearances to the contrary, we are still in the first phase, or the “pandemic phase,” according to Dr. Fauci. The five pandemic stages are as follows:

1.Pandemic: This is the first phase of the pandemic, where the whole world is negatively impacted as we are right now, Dr. Fauci said.
2.Deceleration: The next stage is deceleration, in which the world sees a slowdown in the number of newly confirmed cases. However, Dr. Fauci said it could be too soon to know if natural immunity will cause new cases to fall and a new variant could always prevent the drop in cases.
3.Control: The third phase occurs when COVID-19 becomes an endemic disease and is at a level that no longer disrupts society. Hospitalization and death rates become small. COVID-19 at this stage would become a part of infectious diseases that many people commonly experience, similar to the flu or common cold.
4.Elimination: The fourth stage occurs when a virus still exists in the world but has been eradicated from certain regions, countries and cities. An example of this includes polio, which has been eradicated from many countries, but there are some strings of polio in Afghanistan and parts of Africa.
5.Eradication: The last stage entails global elimination of the virus, which Dr. Fauci said will not happen with COVID-19. Smallpox is the only infectious human disease that has ever been fully eradicated.

The nation is currently striving for deceleration right now, but remains at the mercy of the virus’s evolution, Anna Bershteyn, PhD, associate professor in the Department of Population Health at NYU Grossman School of Medicine, told Health.

“It’s quite possible that a very bad variant could still come along and possibly be more severe than past variants,” said Bershteyn.

Toner also added that we might even be transitioning from the deceleration stage into the control phase where the disease will be more of an endemic. Meaning—rather than trying to wipe the disease out, the reality is that we will have to learn how to live with it, he said.

What’s Driving Our Changing Response to the Pandemic?
As the virus evolves and the pandemic changes, so too does our response. Toner said one big factor driving our response on a daily, weekly, and monthly basis is the case counts and whether those are going down. Biden himself touted a dramatic reduction in cases numbers as well as readily-available vaccines and tests when announcing the country’s upcoming shift to the next phase in the country’s response to the pandemic.

Other factors impacting community and nationwide mandates and regulations include widespread immunity thanks to vaccinations and a large number of people who’ve been previously infected.

“Having been infected previously doesn’t protect you completely from reinfection, but it does afford significant immunity and protection,” Toner said. “Epidemic surges go up and down, and the reason they come down is in large part because enough people are immune and there’s no place for the virus to go.”

What Is the ‘Next Normal’?
While Biden promised the release of a report later this week that would detail the nation’s path forward, he may have been beaten to the punch, at least somewhat, by a 136-page report released titled Getting to and Sustaining the Next Normal: A Roadmap for Living with Covid. Written and reviewed by a long list of public health experts, the report details a suggested 12-point roadmap for moving beyond the COVID-19 pandemic, including how the country might begin dealing with coronavirus as an endemic issue similar to the flu.

Report authors call the phase ahead of us the “next normal” and say it will include a variety of changes small and large. To begin with, the focus of the country’s efforts would shift from COVID-19 to major respiratory illnesses such as the flu. The path forward, as outlined in the report, would also include an interim goal of reducing annual deaths to below the worst influenza season in the last decade.

The future might also involve the creation of an infectious disease dashboard that could be used to guide both the public and policymakers at all levels when it comes to introduction, modification, or even lifting of public health measures. The dashboard could also provide guidance on distribution of therapeutics and other necessary protections for those who are immunocompromised.

In addition, to ensure a more stable future, the nation will need to increase its surge production capacity for at-home rapid tests to 1 billion per month, while also supporting the development of new, more effective therapeutics, particularly oral anti-viral medications, suggest report authors.

However, even with the next normal on the horizon, the report cautions that as of March 1, the nation is not yet there. What’s more, even when we do get there, the next normal should not “induce complacency, inaction, or premature triumphalism.”

“To rapidly reach and sustain the next normal, the country must implement a comprehensive and coordinated roadmap to both address this pandemic and develop the capacity to confront future biosecurity threats,” the report states.

Will There Be Continued Threats From New Variants?
While the pandemic phase of COVID-19 appears to be winding down, or at least evolving, and plans are being formulated for the next normal, the threat of new and dangerous variants remains very real. The Getting to and Sustaining the Next Normal report makes clear that what comes next is living with the SARS-CoV-2 virus as a continuing threat that needs to be managed.

That future could very well include the emergence of new variants that can trigger spikes in case numbers or transmission, as seen with the Delta and Omicron variants.

“We will have new variants, COVID is not going to go away. I don’t think it’s likely to go away, and it’s not likely to be eliminated, and certainly not likely to be eradicated,” Jeanne Noble, MD, an associate professor of emergency medicine at the University of California, San Francisco, told Health.

“It’s not impossible that we won’t have a different variant that is actually more violent or causes more serious disease,” Dr. Noble added. “We will continue to have variants that will threaten us in various ways, but as population immunity grows and grows with each of these variants, we’re hoping it will just become a non-issue.”

But experts say no one knows when and if there will be another variant or wave and how severe or less severe it ends up being.

“There’s no reason to think we’re out of the woods and every reason to think another wave or variant could come,” Bershteyn said. “We don’t know exactly when it will come but we have to be ready for it whenever it does.”

Bershteyn added that because there are so many unknowns about potential future variants, it’s crucial to keep health and safety measures that we’ve been practicing for years, including mask restrictions, social distancing, hand hygiene, proof of vaccination, vaccine mandates, capacity limits on events and other protocols close by.

“Just like a heavy winter coat, you’re not going to throw it away just because the weather is nice. You have every reason to expect you might need it again,” she said. “When the weather is nice, go and enjoy the nice weather but be ready because bad weather comes back.”

What if You Are Immunocompromised?
Finally, as the nation moves forward with all of its modifications to our pandemic response, it’s important to remember that these transitions will mean different things for people who are immunocompromised or have underlying health conditions.

“When we peel back those measures like the masks and proof of vaccination we have to recognize that some people are really in a difficult position because they may be elderly or immunocompromised,” Bershteyn said. “We’re not going to make the young healthy people wear masks when the transmission is relatively low, but it’s important not to create a politicization or peer pressure because there are people who will continue to wear a mask or follow other health protocols for the protection of themselves if they’re at higher risk or other people who are in their household who they have close contact with.”

As these transitions in our response take place experts say we must maintain understanding, encouragement and support for those who will need to continue to follow certain health protocols for longer periods, regardless of where the nation might stand in its response and control over the pandemic.

  coronavirus, COVID-19