Emergence of a Deadly Coronavirus

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This fall, unlike the one before it, and the one before that, America looks almost like its old self. Schools and universities are in session; malls, airports, and gyms are bustling with the pre-holiday rush; handwashing is passé, handshakes are back, and strangers are packed together on public transport, nary a mask to be seen. On its surface, the country seems ready to enjoy what some might say is our first post-pandemic winter.

Americans are certainly acting as if the crisis has abated, and so in that way, at least, you could argue that it has. “If you notice, no one’s wearing masks,” President Joe Biden told 60 Minutes in September, after proclaiming the pandemic “over.” Almost no emergency protections against the virus are left standing; we’re dismantling the few that are. At the same time, COVID is undeniably, as Biden says, “a problem.” Each passing day still brings hundreds of deaths and thousands of hospitalizations; untold numbers of people continue to deal with long COVID, as more join them. In several parts of the country, health-care systems are struggling to stay afloat. Local public-health departments, underfunded and understaffed, are hanging by a thread. And a double surge of COVID and flu may finally be brewing.

So we can call this winter “post-pandemic” if we want. But given the policy failures and institutional dysfunctions that have accumulated over the past three years, it won’t be anything like a pre-pandemic winter, either. The more we resist that reality, the worse it will become. If we treat this winter as normal, it will be anything but.

On the cusp of our third COVID winter, it may seem that SARS-CoV-2 has few plot twists left to toss us.

But the way in which we respond to COVID could still sprinkle in some chaos. During those first two winters, at least a few virus-mitigating policies and precautions remained in place—nearly all of which have since come down, lowering the hurdles the virus must clear, at a time when America’s health infrastructure is facing new and serious threats.

A riot of respiratory viruses, too, may spread as temperatures cool and people flock indoors. Rates of RSV are rising; flu returned early in the season from a nearly three-year sabbatical to clobber Australia, boding poorly for us in the north. Should flu show up here ahead of schedule, Americans, too, could be pummeled as we were around the start of 2018, “one of the worst seasons in the recent past,” says Srinivasan Venkatramanan, an infectious-disease modeler at the University of Virginia and a member of the COVID-19 Scenario Modeling Hub.

The consequences of this infectious churn are already starting to play out. In Jackson, Mississippi, health workers are watching SARS-CoV-2 and other respiratory viruses tear through children “like nothing we’ve ever seen before,” says Charlotte Hobbs, a pediatric-infectious-disease specialist at the University of Mississippi Medical Center. Flu season has yet to go into full swing, and Hobbs is already experiencing one of the roughest stretches she’s had in her nearly two decades of practicing. Some kids are being slammed with one virus after the other, their sicknesses separated by just a couple of weeks—an especially dangerous prospect for the very youngest among them, few of whom have received COVID shots.

The toll of doctor visits missed during the pandemic has ballooned as well. Left untreated, many people’s chronic conditions have worsened, and some specialists’ schedules remain booked out for months. Add to this the cases of long COVID that pile on with each passing surge of infections, and there are “more sick people than there used to be, period,” says Emily Landon, an infectious-disease physician at the University of Chicago. That’s with COVID case counts at a relative low, amid a massive undercount. Even if a new, antibody-dodging variant doesn’t come banging on the nation’s door, “the models predict an increase in infections,” Venkatramanan told me. (In parts of Europe, hospitalizations are already making a foreboding climb.)

And where the demand for care increases, supply does not always follow suit. Health workers continue to evacuate their posts. Some have taken early retirement, worried that COVID could exacerbate their chronic conditions, or vice versa; others have sought employment with better hours and pay, or left the profession entirely to salvage their mental health. A wave of illness this winter will pare down forces further, especially as the CDC backs off its recommendations for health-care workers to mask.

Clinical-laboratory staff at Deaconess Hospital, in Indiana, who are responsible for testing patient samples, are feeling similar strain, says April Abbott, the institution’s microbiology director. Abbott’s team has spent most of the past month below usual minimum-staffing levels, and has had to cut some duties and services to compensate, even after calling in reinforcements from other, already shorthanded parts of the lab. “We’re already at this threshold of barely making it,” Abbott told me. Symptoms of burnout have surged as well, while health workers continue to clock long hours, sometimes amid verbal abuse, physical attacks, and death threats. Infrastructure is especially fragile in America’s rural regions, which have suffered hospital closures and an especially large exodus of health workers. In Madison County, Montana, where real-estate values have risen, “the average nurse cannot afford a house,” says Margaret Bortko, a nurse practitioner and the region’s health officer and medical director. When help and facilities aren’t available, the outcome is straightforward, says Janice Probst, a rural-health researcher at the University of South Carolina: “You will have more deaths.”

In health departments, too, the workforce is threadbare. As local leaders tackle multiple infectious diseases at once, “it’s becoming a zero-sum game,” says Maria Sundaram, an epidemiologist at the Marshfield Clinic Research Institute. “With limited resources, do they go to monkeypox? To polio? To COVID-19? To influenza? We have to choose.” Mati Hlatshwayo Davis, the director of health in St. Louis, told me that her department has shrunk to a quarter of the size it was five years ago.

This winter is unlikely to be an encore of the pandemic’s worst days. Thanks to the growing roster of tools we now have to combat the coronavirus—among them, effective vaccines and antivirals—infected people are less often getting seriously sick; even long COVID seems to be at least a bit scarcer among people who are up-to-date on their shots. But considering how well our shots and treatments work, the plateau of suffering at which we’ve arrived is bizarrely, unacceptably high. More than a year has passed since the daily COVID death toll was around 200; nearly twice that number—roughly three times the daily toll during a moderate flu season—now seems to be a norm.

Part of the problem remains the nation’s failed approach to vaccines, says Avnika Amin, a vaccine epidemiologist at Emory University. Even with the allure of the newly reformulated COVID shot, “I’m not really getting a good sense that people are busting down the doors,” says Michael Dulitz, a health worker in Grand Forks, North Dakota.

The ongoing dry-up of emergency funds has also made the many tools of disease prevention and monitoring more difficult to access. Free at-home tests are no longer being shipped out en masse; asymptomatic testing is becoming less available; and vaccines and treatments are shifting to the private sector, putting them out of reach for many who live in poor regions or who are uninsured and can least afford to fall ill.

It doesn’t help, either, that the country’s level of preparedness lays out as a patchwork. People who vaccinate and mask tend to cluster, Amin told me, which means that not all American experiences of winter will be the same. Less prominent, less privileged parts of the country will quietly bear the brunt of outbreaks. “The biggest worry is the burden becoming unnoticed,” Venkatramanan told me. Without data, policies can’t change; the nation can’t react. “It’s like flying without altitude or speed sensors. You’re looking out the window and trying to guess.”

There’s an alternative winter the country might envision—one unencumbered by the policy backslides the U.S. has made in recent months, and one in which Americans acknowledge that COVID remains not just “a problem” but a crisis worth responding to.

In that version of reality, far more people would be up-to-date on their vaccines.

We won’t be getting that winter this year, or likely any year soon. Many policies have already reverted to their 2019 status quo; by other metrics, the nation’s well-being even seems to have regressed.

The pandemic has also prompted a deterioration of trust in several mainstays of public health. In many parts of the country, there’s worry that the vaccine hesitancy around COVID has “spread its tentacles into other diseases,” Hobbs told me, keeping parents from bringing their kids in for flu shots and other routine vaccines. Mississippi, once known for its stellar rate of immunizing children, now consistently ranks among those with the fewest young people vaccinated against COVID. In Montana, sweeping political changes, including legislation that bans employers from requiring vaccines of any kind, have made health-care settings less safe. Health workers, too, feel more imperiled than before. Since the start of the pandemic, Bortko’s own patients of 30 years, “who trusted me with their lives,” have pivoted to “yelling at us about vaccination concerns and mask mandates and quarantining and their freedoms,” she told me. “We have become public enemy No. 1.”

At the same time, many people with chronic and debilitating conditions are more vulnerable than they were before the pandemic began. The policies that protected them during the pandemic’s height are gone—and yet SARS-CoV-2 is still here, adding to the dangers they face. The losses have been written off, Bortko told me: Cases of long COVID in Madison County have been dismissed as products of “risk factors” that don’t apply to others; deaths, too, have been met with a shrug of “Oh, they were old; they were unhealthy.” If, this winter, COVID sickens or kills more people who are older, more people who are immunocompromised, more people of color, more essential and low-income workers, more people in rural communities, “there will be no press coverage,” Hlatshwayo Davis said. Americans already expect that members of these groups will die.

The winter’s path has not been set: Many Americans are still signing up for fall flu and COVID shots; we may luck out on the viral evolution front, too, and still be dealing largely with members of the Omicron clan for the next few months. But neither immunity nor a slowdown in variant emergence is a guarantee.

As the wave of COVID infections from the highly-contagious BA.5 subvariant finally subsided back in late July, new subvariants were already competing for dominance—and the opportunity to drive the next wave of infections.

A little over two months later, epidemiologists are close to naming a winner. In the United Kingdom, infections from a highly mutated subvariant called BQ.1.1 are doubling every week—a rate of growth that far exceeds other leading subvariants. In the U.S., BQ.1.1 is spreading twice as fast as its cousin subvariant BA.2.75.2.

That means BQ.1.1 is very contagious. But that’s not the subvariant’s most alarming quality. What’s most worrying is that it also evades certain antibodies. In fact, BQ.1.1 seems to be the first form of COVID against which antibody therapies—evusheld and bebtelovimab, for instance—don’t work at all.

Luckily, the best vaccines still work against BQ.1.1—especially the latest “bivalent” messenger-RNA boosters. Uptake of the new booster has been shockingly sluggish, however, meaning the new jabs aren’t yet offering much protection on a population level.

Last month, President Biden said what many Americans have long been thinking: “The pandemic is over.” With vaccinations, broader immunity and better treatments, the death toll from this virus is nowhere near what it was at the peak of the pandemic, and many Americans are returning to their pre-pandemic ways of life. As we head into the cold, flu and, most likely, COVID-19 season, as well as into an election that is about basically everything but COVID-19, we wondered: When did Americans stop caring about the coronavirus?

It’s hard to pinpoint exactly when public concern around the pandemic shifted for good, as there have been several inflection points. One way of seeing this is by looking at monthly surveys, like one from Axios/Ipsos that started in March 2020, to illustrate the crest and fall of Americans’ concerns around the pandemic. In the first three weeks of April 2020 — the thick of lockdown — just 19 percent of Americans said they had visited friends or relatives in the past week. That number has steadily risen over the two and a half years since, dipping occasionally when a new wave emerged. For example, an average of 62 percent of Americans said they visited friends or family during the summer of 2021, but that average dropped to 54 percent during the winter 2021 — the omicron-variant wave. And in the chart below, you can also see how the share of Americans who say they’re self-quarantining and wearing masks has declined, while the share who say they’ve returned to their pre-pandemic lives has increased:

One switch happened in June 2022, when the share of Americans who said they’d returned to their pre-pandemic lives rose higher than the percentage who said they still wore a mask outside the home at least sometimes. National survey data from the Annenberg Public Policy Center plots a similar course. In September 2021, 52 percent of Americans said they often or always wore a mask indoors when in contact with people outside their household, while just 11 percent said they never did. Those numbers plunged this year, with 27 percent of Americans in July 2022 saying they now never wore a mask, while just 11 percent said they always did. Likewise, in January 2022, 16 percent of Americans said their lives had already returned to their pre-pandemic normal, while 35 percent expected they were still more than a year away from that return. By July, 41 percent of Americans said their lives had returned to normal, and 19 percent said that normal was still a year away. Google trends also show that search interest in COVID-19 is at a pandemic low.1

We can also chart this shift in attention by looking at not just the poll responses but also the poll questions. In March 2021, half of all national polls tracked by FiveThirtyEight featured at least one COVID-19-related question. That share has slowly ticked down as other issues, such as inflation, have become more prevalent. Last month, just 14 percent of polls had at least one COVID-19 question, while 22 percent asked about inflation.

Starting in April 2021, you can see pollsters gradually asking more questions about other topics, while asking about COVID-19 less frequently. And largely, this tracks with Americans' views of what issues are most important to them. In April 2020, 45 percent of Americans named the COVID-19 pandemic as their top concern, according to Gallup. And in January this year, 20 percent of Americans said the pandemic was the biggest concern, while just 8 percent said the high cost of living or inflation. By March, a higher share of Americans named inflation (17 percent) as a top concern than the share who named the pandemic (3 percent).

The ebbing concern around COVID-19 is also reflected in the apathy around receiving booster shots. Gone are the days of strategically logging into your local pharmacy’s website at midnight to secure a vaccine appointment, or driving hundreds of miles just to get a jab.

Future generations (what's left of them) will not say good things about these times.

The 11.5 million figure represents only 5.3% of the 215.5 million people in the United States aged 12 or older who are eligible to get the new shot.

Roos, of the Netherlands, argued in a Twitter video Monday that following Small’s comments to him, millions of people around the world were duped by pharmaceutical companies and governments.
“Millions of people worldwide felt forced to get vaccinated because of the myth that ‘you do it for others,'” Roos said. “Now, this turned out to be a cheap lie” and “should be exposed,” he added.

Coercing and threatening people is a very short term strategy Jimmy, it breeds resentment, and raised middle digits.
So I'd reckon that low take up is blowback from all the government mandates and the fact that everyone still caught it vaccinated or not.

It is very strange when discussing information is viewed as coercing and threatening. The line that you cited actually comes from the CDC.

I have never gotten COVID, nor has my wife, nor has my two daughters nor their husbands, nor most of my grandchildren. The only ones that got COVID were the two smallest ones who were too young to get shots. For them, it produced only a minimal effect on them.

I was saying that the government and state policies of mandating the vaccines for employment and throwing people out of their jobs and homes if they didn't obey, produced a resentment and a desire to not comply in the public and that this accounts for much of the low uptake up of the boosters.