Is it time to live with COVID-19? Some scientists warn of ‘endemic delusion’ | Science

As surges of COVID-19 cases driven by the highly infectious Omicron variant recede, parts of the United States, Canada, and Europe are moving swiftly to lift constraints on a pandemic-fatigued public. Sweden, Denmark, and Norway have abolished nearly all ­COVID-19–related restrictions in recent weeks, and the United Kingdom announced it would do the same this month, dropping even the legal requirement that people quarantine after testing positive for SARS-CoV-2. In the United States, despite persistently high numbers of COVID-19–related deaths and busy hospitals, 10 governors, many known for being cautious in their pandemic response, last week announced immediate or impending ends to their states’ indoor or school mask mandates.

Some of those moves came with assertions that it’s time to “live with the disease” and treat the coronavirus as endemic—a stable, enduring figure in the panoply of human pathogens, alongside cold viruses and influenza. That suggestion troubles many scientists, who warn it is eroding governments’ commitment to tracking and responding to the pandemic—which could leave countries flying blind and unprepared for any new variant.

“Endemic delusion is probably what captures it the best,” says Kristian Andersen, an infectious disease researcher at Scripps Research who has been especially critical of recent moves by his home country of Denmark, which include an announcement that as of this month COVID-19 would no longer be categorized as a “socially critical disease” even though related death and hospitalization rates were still climbing there.

Still, many scientists acknowledge the challenges of steering public restrictions during the reign of the more infectious but generally less severe Omicron variant, when some of the metrics that previously guided policy have become less informative. For example, how meaningful are case counts as mild and asymptomatic infections increase and unreported at-home tests become ubiquitous? How much do incidental findings of COVID-19 in patients hospitalized for other conditions pollute the official numbers?

“The challenge for each and every health authority is to figure out, well, what should we track?” says Michael Bang Petersen, a political scientist at Aarhus University.

Denmark’s recent moves are a case in point. Petersen, a pandemic adviser to the Danish government, supports its decision to lift measures such as limits on nightlife hours, caps on attendance at indoor public events, and mandatory face masks or proof of vaccination for indoor venues. He argues the government could no longer justify the economic, social, and constitutional trade-offs of those restrictions amid promising signs, such as numbers of intensive care unit (ICU) patients that remain stable and below the health system’s capacity.

Andersen, however, calls keeping hospitals from overflowing “a pretty low bar.” Bringing down overall cases, and thereby reducing transmission, remains key, he argues, to minimizing risks of Long Covid and protecting the elderly and immunocompromised from infection.

In the United States, governors cited various metrics to justify recent decisions to lift or let expire indoor mask mandates. California Governor Gavin Newsom noted stable hospitalization rates and a 65% reduction in cases since Omicron’s peak in announcing the state’s mandate would end this week. But leaders also face political and economic pressures. States’ moves may be driven largely by the public’s impatience with restrictions, says epidemiologist Dustin Duncan of Columbia University.

“Even people who recognize the importance of masking, social distancing, all that stuff, may be more amenable to take more risk,” he says. “At the same time, to me, going maskless just seems egregious.” Indeed, the U.S. Centers for Disease Control and Prevention has held firm in recommending masks for indoor public spaces in areas of high transmission—which is nearly all of the country.

“I do feel it is on the early side” to lift indoor mask requirements in most states, says Emory University epidemiologist Jodie Guest—though recommendations may be a better option than requirements as case numbers plummet, she adds.

Still, with the United States logging more than 2000 daily deaths last week, “We cannot say we are at a level that’s tolerable to live with this virus,” Guest says. Her team has been developing rough guidelines for when a true endemic stage of COVID-19 has been reached: daily case rates below 30 per 100,000, ICUs below 80% of capacity, vaccination rates of at least 75%, and fewer than 100 COVID-19 deaths a day nationwide.

Deciding when to end mask requirements in schools is especially difficult, in part because of continued (but hard to prove) concerns the coverings impede learning and social development. “If you ask a bunch of scientists, ‘Should kids wear face masks in school?’ you’re probably going to get a lot of disagreement,” Andersen notes, “and I don’t know who is right.”

Guest says she doesn’t have as clear a sense of the numerical thresholds that could determine when schools should stop mandating masks. “I would be hesitant [to remove requirements] right now,” she says, adding the step could soon be justified in parts of the country.

Data to inform such debates may become less available or reliable if governments pivot too soon to an endemic view of the coronavirus, scientists say. As pandemic restrictions in Denmark relax, “people are becoming less motivated to get tested and we are beginning to downscale our test system,” Petersen says.

Some governments are limiting efforts to find and report cases. Sweden, long an outlier among European countries for its laissez-faire approach to the pandemic, ended widespread testing at mobile centers as cases declined from their Omicron peak. The United Kingdom is reportedly weighing ending free public testing for the virus in the coming weeks. Meanwhile, the Canadian province of Saskatchewan last week switched from providing daily to weekly reports of COVID-19 cases. And Tennessee last month joined several states already reporting case counts weekly. “Daily case counts matter,” Guest says. “Every time I lose the ability to have a number, it makes me nervous.”

Official counts are already becoming less meaningful as the reliance on at-home test increases, making other surveillance approaches all the more important. Last week, researchers took to Twitter in outrage after a U.K. news report claimed the United Kingdom might not continue to fund a long-
running study in which the Office for National Statistics (ONS) conducts repeated antibody surveys and SARS-CoV-2 testing of more than 100,000 randomly selected households. “What that’s meant is that you’ve had a way of seeing the prevalence in your population that does not depend on people accessing testing,” says Christina Pagel, a health services researcher at University College London.

Discontinuing the ONS study would also obscure data on asymptomatic cases, differences in disease burden between different ethnic and occupational groups, and the impact of Long Covid, Pagel says. She suspects the outcry will sway the U.K. government, which responded in the news report by saying no funding decision had been made and it “obviously” wanted to “maintain our world-leading surveillance capacity” for COVID-19.

But in the growing number of “back to normal” messages, Pagel sees leaders ignoring obvious next steps to protect public safety. Even researchers who aren’t speaking up to defend specific restrictions are urging governments to step up their COVID-19 fight, rather than scale it back. They want aggressive new pushes to reach the unvaccinated, distribute rapid tests, and make COVID-19 treatments much more accessible, for example. “Frankly, I don’t really think that 2 to 3 weeks more of a mask mandate is going to make much difference in the long run,” says KJ Seung, a health policy adviser at Partners In Health. “More alarming to me is that our public health system doesn’t seem to have any plan for dealing with the next surge.”

“I don’t particularly want to be in a future where I get COVID twice a year,” Pagel adds. Averting that future may mean adaptations such as technologies to improve indoor air quality and strong virus surveillance that can be ramped up at the first sign of another surge. “Why would we not make that effort?” she wonders. “It’s almost like having that conversation is considered a failure.”