What will our long-term peace with COVID-19 look like?

On New Year’s Eve I watched revelers navigate crowded sidewalks on the fringes of San Francisco’s financial district, headed to events like a Gatsby-style bash with bottle service and a Black & White Ball in a mall.

The day before, the city had registered 1,820 new cases of COVID-19 – just two weeks after the 7-day rolling average was still hovering below 200. These partygoers likely realized what they were risking. Yet here they were, determined and decked out in evening wear.

A few days later and a bit further to the south, a line of people waiting for COVID-19 tests stretched six city blocks. The surge was official. The mayor nonetheless refrained from triggering any new restrictions.

We seem to be making a volatile peace with the pandemic. Taking more of what we can in bursts of “normal” life and accepting existential uncertainty in return.

The idea of simply eradicating COVID-19 like smallpox seems more unattainable every day. Instead, a growing familiarity with the disease, effective vaccines that make it possible to record fewer deaths, and political considerations have nudged us away from a hot war and closer to a stalemate.

What is still a pandemic may be shifting, thanks to the highly-infectious Omicron variant, into a more grimly predictable endemic phase.

Some experts have begun arguing for official strategies that account for this. An opinion piece published last week by former members of US President Joe Biden’s transition COVID-19 advisory board contends that leaders need to start clearly spelling out their goals for the “’new normal’ of life with COVID-19.”

“In delineating a national strategy,” the former advisers wrote, “humility is essential.”

Some people have been wondering aloud or in print if they should just give up, allow themselves to get Omicron, and be done with it (answer: no).

It’s unclear whether anyone in the 14^th century suggested they might just give up and catch the Black Death. Yet, depleted populations somehow managed to adapt to and move past a disease that also disproportionately killed older people and those with pre-existing conditions.

That early version of the plague, a scourge that persists into the present, spurred initial attempts at international disease control like the first quarantine. It also helped people grasp the importance of basic hygiene and social distancing for containing disease, and spawned early precursors of international health authorities.

“Ultimately, all pandemics burn themselves out,” Dr. Anthony Fauci, the top infectious disease expert in the US, said in an interview this past November. The choice with COVID-19, he added, is whether we want to let it kill and infect a lot more people in the process – or get more proactive.

In order to be proactive in the new normal, the former Biden advisers wrote in their opinion piece, real-time information systems will be necessary to more closely track COVID-19. The US, for example, still relies on imprecise estimates of the disease’s spread, projections, and limited monitoring of the genetic changes causing new variants, they wrote.

Vaccine mandates will also be necessary to cope, former Biden advisers wrote in a separate opinion piece.

That’s because at least 90% of the population will probably need immunity for a genuine “return to normalcy,” they wrote, and few countries have ever managed to hit a vaccination rate like that without requirements.

According to one tally, only a few countries have so far reached 90% in terms of people receiving at least one COVID-19 vaccine dose: the UAE, Cuba, and Chile.

Evidence suggests vaccination may remain a reliable way to limit fatalities as COVID-19 endures. In Canada, for example, the death rate from the disease fell from 2.95 per million in 2020 to 0.42 per million in 2021, as the country recorded one of the highest vaccination rates in the world.

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