The COVID Endgame: Predictions on the future of vaccines, schools, media, science, and more

THE COVID ENDGAME: PREDICTIONS ON THE FUTURE OF VACCINES, SCHOOLS, MEDIA, SCIENCE, & MORE

Vinay Prasad, MD, MPH

Recently my Twitter feed filled with news about a boat

lodged in the Suez canal. The New York Times Magazine ran a long story on whether artificial intelligence can help us ascertain if coffee is indeed good for us. I breathed a sigh of relief, perhaps COVID-19 is winding down. The media is returning to their favorite, hard hitting stories.

Of course, I am not a fortune-teller, but in this essay, I want to take an educated guess as to how the next year might play out. Like most predictions for this pandemic, don't be surprised if my estimates are wildly off, and don't hold it against me. After all, we didn't do that for anyone else.

Vaccines

I have been amazed by the speed with which vaccines were developed and their efficacy. I am a long-standing critic of the pharmaceutical industry, but on this occasion, I give them credit. Job well done. As I type this, 90 million Americans have received at least one dose of the vaccine. An additional 30 million Americans have had documented infections with COVID-19 and recovered. Some additional fraction have had undocumented infections and recovered. The fraction of people susceptible to COVID-19 is shrinking by the minute, and that's good news. I expect more stories in the media to be about green tea, blueberries, red wine, and dark chocolate to make up for the fall in COVID-19 coverage.

Schools

In contrast with the brisk pace of vaccination, schools remain a struggle. Previously, Vladimir Kogan and I highlighted the urgent need to reopen in-person public schools. CDC guidance from just a few weeks ago recommended six feet of distance between students and reopening based on the community level of spread. Vlad Kogan and I investigated the data for both these claims, which would hamstring school opening. We found the recommendations to have no good support whatsoever. Amazingly, the CDC has agreed, and rescinded both of these policies, which pave the path to reopening schools.

I don't know what the future will hold, but I suspect that the moment kids get even a foot in the classroom, the dialog will shift. Teachers will remember why they love teaching. Kids will remember why they love school, and parents will feel a weight lift from their shoulders. Once the dam is cracked, it will open wide. I hope that shortly, schools around this nation will return to normal. The sooner the better, and once schools are open, we will have to survey the damage done to the kids, and work to mend it.

A Glorious Summer

More and more vaccination, warmer weather, and a public that cannot sustain any more restrictions mean we will have a vibrant and joyous summer. Parties, dinners, parks, the beach — I suspect we will see an outpouring of socializing. A summer of revelry may help heal the wounds of the past year, and just might relax some folks.

COVID-19 Outbreaks

I suspect that COVID-19 will never be gone. It will return in bursts in the fall and winter for years to come. I suspect it may concentrate in nursing homes and care facilities, despite high levels of vaccination. It will also spread in pockets of the country where folks are reluctant to be vaccinated. It will take a few winters before it loses the urgency and anxiety of 2020, and when a patient is admitted in the winter time, we may merely ask, "is it flu or COVID-19?"

The Pundits

COVID-19 unleashed a broad swath of pundits. Many had never been in the limelight, a few have come to love it, and others (the wise ones) have started to hate it. I suspect that many COVID-19 pundits will pivot. Their expertise will shift to issues of nutritional epidemiology, exercise, gun violence, or other public health topics that retain national interest. Many others, particularly those with extremely specialized training, will be unable to pivot. I suspect we will hear less of them. I am OK with that.

The Media

The media will end the COVID epoch in a diminished position. In January and February of 2020, they repeatedly aired pundits who informed us that influenza was worse than COVID19. In March 2020, they realized the error of that messaging. Instead, they erred in the other direction, showing us photos of Americans enjoying the beach, and shaming them for that choice. Ironically, a beach — even a crowded one — is amongst the safest places for Americans to go. A media landscape whose first commitment is to attention — capturing as many views, eyeballs, and clicks as possible –has failed us. It cannot endure. Unless we reward thoughtful, nuanced, and informative work — even if it is slightly dull — we are going to continue to descend into sensationalism and distortion. Speaking of which: can artificial intelligence tell us if coffee is good for us?

Social Media

Outrage is the drug of choice on social media, and we are all addicted. When I started using Twitter in 2014, it was once a year that a major scandal would occur. Pre-COVID-19, it was once a month, and now, it is twice a week. A lifetime of good deeds can be undone with a single tweet! The person who offends is not just placed in the stocks and publicly shamed; inevitably, their employer is cc'd and calls for them to be fired begin. It hardly matters that in the U.S., losing a job often means losing healthcare, and any semblance of identity; the crowd clamors for total annihilation. Anyone who has suffered real personal problems — problems that keep you up at night — will realize that social media concerns are often a distraction from the challenges most Americans face. Yet, the outrage cycle continues. My only advice here is if you see an outrage mob: walk away from it. Correction: run away.

Science As Politics

Early in the pandemic, Jeff Flier and I wrote, "Society faces a risk even more toxic and deadly than COVID-19: that the conduct of science becomes indistinguishable from politics." That fear has been realized. Whether hydroxychloroquine or face masks or whether lockdowns provide net benefit, nearly every scientific issue has been sorted into political platforms and parties. This problem is corrosive and will haunt us for years to come. The more scientific disputes become tied to political identity, the more intractable and unscientific they will become.

I urge anyone who still considers themselves a scientist to do more to depoliticize disputes. That means the following: 1. If you use social media to present your scientific ideas, then do not use the same platform to advocate for political candidates. This back and forth merges the two sets of views in the minds of the readers. 2. Do not assume that folks who disagree with you on medical topics are from the opposing political party. They might be, or might not, but either way, it is irrelevant. 3. Understand that science is a method to ascertain how the world works, but does not prescribe policy. Policy is a choice based on values. Two folks can be equally committed to science, but have different values, and thus reach different policy conclusions.

4. Focus on policies, not partisanship. Decide which policies are right — for instance, what are your feelings on conflict of interest — and having decided that, hold people from both political parties accountable. Recently, I noted a double standard. Both Scott Gottlieb and Vivek Murthy had glaring conflicts of interest, and many of the folks who skewered Gottlieb did not hold Murthy to the same standard. This hypocrisy is untenable.

The COVID-19 endgame

COVID-19 will eventually end. Not with a bang, but with a whimper. The loss of lives is immense. The human suffering is massive. I mourn those we lost. Moreover, our institutions, our culture, our politics, our media are also diminished. We are weaker and more vulnerable than ever before. Not only to a future pandemic threat, but any calamity that requires humans to work together and take action in a setting of scientific uncertainty. Many of us are unmoored, and suffering. We are hollow and stuffed, and searching for a new effigy online. A new target for outrage. This summer, when cases fall, when vaccination grows, put down your iPads and phones, and meet real people in real life. Human contact alone may save us.

Vinay Prasad, MD, MPH, is a hematologistoncologist and associate professor of medicine at UCSF, and author of Malignant: How Bad Policy and Bad Evidence Harm People With Cancer. This commentary originally appeared on MedPage.

Introducing New SFMMS staff associate, Ashley Coskey!

Originally from the Bay Area, I moved to Portland, OR to attend Lewis & Clark College, where I received my B.A. in Political Science in 2020. Prior to joining SFMMS as an Associate, I held a fellowship at Upstream Public Health and worked for the Democratic Party of Oregon during the 2020 election. These positions combined with COVID-19 emphasized the dire need to invest in public health to reduce health disparities. I am honored to be a part of a group committed to driving progressive change in healthcare delivery.