The "end" of the pandemic

Hi everyone! My post a few weeks ago was written on the day the WHO declared COVID-19 over as an international public health emergency. In real ways, I wrote that post as I was processing what that meant and how that felt to me. It was like I was experiencing a “closure” to a really difficult part of all of our lives. To me, it was like I was telling my soul it was ok to let go of some of the pandemic in a way - during that time, we went through profound personal losses - we left a church and lost a faith tradition we built decades on, I lost dear friends and family because of what I wrote, our family was attacked and threatened in ways I don’t think I want to fully talk about yet, I became “viralish” in gaining an incredible community (that’s you all here!) but that also meant gaining some non-incredible people (my choice words for them, especially if you came against my kids, are much more forceful than that), and…the list goes on. (BTW, I detail lots of this in my upcoming book, so I don’t want to rehash it all here).

So, my post was a bit of a closure for me - to give myself permission to let some of it go. Not all of it because it will be years of recovery for lots of us. But, some of it.

What I didn’t mean in the post was that I was “over” the pandemic or I thought it was over. I’m not giving up masking in crowded settings or in healthcare settings. (For the record, my hospital system at Duke still masks and I’m strongly applauding that!) I think that post was misunderstood by some of you that emailed or sent messages, and for that misunderstanding I am so sorry. Those emails were saying you were disappointed that I was giving up and leaving behind those that are still vulnerable to COVID-19. For that, I am sorry for the confusion. You were kind and gracious in your words, but still disappointed because you have a high-risk family member or you are high-risk. After some time of thinking about how to say it all better, I want to write you this post as a follow-up.

Here’s what I meant:

Have you read the book, “Haiti: After the Earthquake”, by Dr. Paul Farmer? It’s an incredibly hard and worthwhile read about the devastating earthquake in 2010 that killed 100,000 to 300,000 people, injuring thousands more, and collapsed 250,000 homes and 30,000 business buildings. There was the acute event of the 7.0 earthquake (with multiple aftershocks) that did the damage. But, then there was the ‘after’ that lasted much longer. And, then finally there was some semblance of normalcy again. Three phases - acute emergency event of the earthquake, the ‘after’ effects of rebuilding/recovery, and normalcyish.

Phase 1 - The acute event of COVID-19 to me was before vaccines and treatments. This was the earthquake that lasted a long time. Acute, devastating, scary, all-the-words.

Phase 2 - Then there is the ‘after’ the earthquake - Even after the vaccines and treatments, there were the devastating Delta wave and subsequent other spikes in cases/deaths - those are like the aftershocks of an earthquake. The aftershocks, or waves, are not as bad as they were, but still around. Because vaccines provide some level of population-protection against those horrific aftershocks again, I think we are now in the recovery part. But, that does not mean we are in the endemic phase yet, which brings me to Phase 3.

2010 Haiti Earthquake (history.com)

Phase 3 - This is when I would consider COVID-19 as endemic. Being ‘endemic’ would mean COVID-19 acts like the flu with cyclical, predictable waves of infection. For influenza (the flu), we can predict with fairly good certainty when flu season is. That’s endemicity (or at least a large part of it). This is the normalcy part where it is an awful disease, but predictable and we have vaccines and treatments. Here’s a great graphic from the NYT that illustrates the predictable nature of endemic diseases vs COVID.

With the flu, I and my family get the flu shot ever year and I am not scared of it. I got the flu last year and although it was yuk for a week, I got over it without any lasting effects. COVID-19 is not the flu and not that way! I still have a very healthy dose of caution with COVID-19. I do not want long-COVID whatsoever - that can be devastating as many of you know too well.

So what phase are we in now? With COVID-19, unlike the flu, I don’t think we are in the endemic phase yet. We are in this weird in-between time between the acute ‘earthquake’ and a normal, predictable nature of the disease. So I think we are in Phase 2.

It’s like a liminal space of after the acute earthquake but before the buildings are built back up or the families have enough food again.

It’s the recovery. For months after the Haiti earthquake, there was rebuilding and recovery. This started with treating the most severe traumas and injuries and providing housing, water, blankets to families.

Photo: Rebuilding Haiti: The post-earthquake path to recovery | UN News

This triage of tents and food and treating the severely injured is certainly not normal or ideal, but it wasn’t the earthquake either. Yes, there was definitely still fear of another earthquake and trauma from the devastation. It’s the liminal space of after the earthquake but before normalcy (however you call that) again. That normalcy will never be what it was pre-2020 for most of us in lots of ways. But, it will be normalish, predictable, and not near as scary. For all.

Again, we are not there yet. Being in the endemicity phase to me also means that will be the time when I’m not worried about a weird variant that evades vaccine protection. To me, I’m not convinced a vaccine-evading variant won’t happen. I don’t think we are there yet. We, as the global community, are not doing a great job at monitoring variants that arise. We are doing okish, especially South Africa and the WHO tracking groups. Although the variants that have emerged in the past year have been very similar to other variants, there’s still a need for vigilance. (This chart below shows the variants from Omicron lineage over the past several months. The most dominant currently in the US is XBB1.5.)

So, with the vaccines, available treatments, and variant history over the past year, I’m not holding my breath anymore like I did in Phase 1. But I am still cautious because we are in Phase 2. Phase 3 would be a full exhale and I look forward to that when we get there, for sure! When COVID is predictable and we have vaccines and treatments for all.

What does this mean for the way forward?

• Personally, my family and I still wear our masks in crowded areas. We will wear them on the plane ride to Africa next month (I’ll tell you more about that below!). Masks are still about keeping my family safe - but, also making sure I don’t transmit the virus to my friends or neighbors.

• We stay updated on our boosters and I make sure my high-risk family members get the updated boosters every chance they can.

• We continue advocating for research and treatments for long-COVID.

• We advocate for treatments for the acute infection of COVID, including and especially for those where the current treatments don’t work.

• We advocate for a better vaccine that will protect against lots of variants, even funky ones that pop up.

• We monitor cases and deaths from COVID. This is a lot harder to do after the emergency was lifted, and I’m frustrated that the US and other countries aren’t being as vigilant. But here we are. It matters how much virus is circulating too. The more virus is going around, the higher the risk of variants. If we want to have zero COVID (which I do!), we have to squash the virus - and to do that, we need to know where it’s circulating by monitoring (which we are not doing enough of).

  

  Dr Ellie Murray, ScD (@EpiEllie) / Twitter

• We can summarize all of this again with our community mantra - love your neighbor, starting with where the neighbors are on the margins. These are the people who are still high-risk despite vaccines and treatments, those that can’t afford to get healthcare if they need it, those that lost their jobs and savings due to long COVID, those experiencing anxiety and depression due to the trauma of the last 3 years of racism, the pandemic, and ugly politics…the list could go on.

This is the ‘after the earthquake’ of rebuilding and recovery. Of acknowledging that the earthquake did indeed happen, but also moving forward into whatever forward is for you. It’s not giving up or forgetting. It’s rebuilding and recovery, alongside the history and remembering.

It’s leaving no one behind as we continue forward. That’s means we go slower, with vigilance and solidarity and equity. And this part will last a while. This also reminds me of the Good Samaritan story who stopped for the left behind. Remember the Good Samaritan story this page is founded on where the man on the side of the road was left behind by twice before finally someone stooped to help, bandaged his wounds, and paid for lodging to recover? That’s who I want to be. Someone who notices and stops

.The And-Also of recovery and remembering is solidarity to me. When I say ‘In Solidarity’ I mean it with everything I can give. In fact, my upcoming book opens with that word and has an entire dedicated chapter to it. So, let’s rebuild and recover and remember together - in solidarity, in witness, in withness by noticing who is still on the side of the road and stopping.

I’m thinking of you today, dear friends, as we all walk forward however we can. I also hope that you have some friends to help carry you when needed.

In Solidarity,

Emily

PS: My family and I are headed to Tanzania soon for the month! I’ll be working and they will be playing. My posts in June/July will be written while looking at the great Kilimanjaro mountain and drinking the fantastic Tanzanian coffee. Also, please send all your thoughts and jazz-hands as I try to pack for a family of 4 for a month. =)