The CDC recently celebrated the release of COVID-19 guidelines that will, agency leaders claimed in a press release, help us “move to a point where COVID-19 no longer severely disrupts our lives.” However, the guidance itself, which pares back many public health measures, explicitly states that its recommendations are based on a singular goal of “reducing medically significant illness and reducing strain on the health care system.” While a focus on ‘flattening the curve’ made sense in 2020, we have since learned that COVID-19 “severely disrupts our lives” in many other ways beyond just causing hospitalizations and deaths. COVID-19 also leads to Long COVID for some, disproportionately puts marginalized communities at risk and causes disruptions to schools, workplaces and critical industries, such as airlines. By not addressing these other important impacts of the virus, this new strategy fails to chart a course by which the virus won’t continue to “severely (disrupt) our lives.”
We initially believed COVID-19 primarily affected older people and others with high-risk medical conditions, but we now know that even young and healthy people with mild or asymptomatic infections can develop Long COVID and, while current vaccines reduce its risk, they do not eliminate it. Recent census data shows that 7.6 percent of American adults are currently experiencing symptoms consistent with Long COVID. A large study from the Netherlands found that one in eight people infected with COVID-19 went on to have at least one symptom of Long COVID. This ‘epidemic within a pandemic’ could yield a massive long-lasting health crisis with major impacts on health systems and the economy. Katie Bach of the Brookings Institution estimates 2 to 4 million people are out of work due to Long COVID, and its economic burden may amount to $170 to $230 billion a year in lost wages.
Even as the threat of hospitalization has receded for many Americans, COVID-19 continues to disrupt their lives. Many people who are infected may not need hospitalization, but still end up being sick enough to miss work or school for days at a time; 42 percent of Americans reported missing work during the Omicron surge due to COVID-related issues. Harvard researchers estimated that Boston students lost 1.5 million school days and parents lost 1 million days due to COVID during the last school year. This type of disruption will be costly for people and the economy over the long-term, especially since it may be possible to get reinfected multiple times a year.
Protecting the vulnerable has been a popular refrain throughout the pandemic; however, the virus has continued to carve an uneven path through American communities. Black Americans, for example, were hospitalized at four times the rate of white Americans during the peak of the Omicron wave. Immunocompromised people have accounted for more than one in ten hospitalizations since the start of the pandemic and remain at elevated risk of poor outcomes. Yet, despite accounting for disproportionate hospitalizations and deaths, our goals and policies have not provided added protection to these populations.
Policies framed only to limit strains on health systems are inadequate to live with a virus that continues to drive dysfunction and add to a growing toll of disability. A broader set of policy goals are needed to guide our response and investments.
First, guidance crafted only to keep hospital beds empty will not keep schools and workplaces full or planes in the sky. The CDC guidance only recommends masking at levels of COVID spread that threaten to limit impact on hospitals. Experts have demonstrated that it sets thresholds above the level to keep schools open stably and keep immunocompromised people safe. Unsurprisingly, many schools experienced disruption and closures from staff sicknesses well before reaching high community levels. Keeping schools open safely as well as key industries running should be an explicit goal of our policy response, with guidance designed specifically to achieve this purpose.
Second, policy decisions on the investment and deployment of next generation tools, including better vaccines, should not only aim to reduce the risk of severe acute illness, but also better prevent disability from Long COVID and disruptions caused by people getting sick from periodic reinfections. The costs of investments in vaccines that can block infection and transmission should be set against the costs of Long COVID and societal disruption and dysfunction.
Finally, while efforts are still needed to increase access to individual-level tools, more systemic and sustainable solutions are needed to remove the burden on individuals to navigate the pandemic on their own. Investments in ventilation and filtration to clean the air in all indoor spaces and policies to enable sick leave must become a priority and are critical to living with COVID — as well as future threats that may yield similar impacts.
Policies designed only to keep us out of the hospital are not enough to stop the virus from disrupting our lives in other ways. COVID-19 will continue to manage our schools, workplaces, and essential services until our policy goals expand to managing COVID and its impacts on these other areas of life. It’s time to set policy goals for the virus living with us, and not the one we wish was in our midst.
Anne N. Sosin is a policy fellow at Dartmouth’s Nelson A. Rockefeller Center for Public Policy. She is a public health practitioner, researcher, and educator focused on issues of health equity globally and in rural Northern New England. Her current research focuses on COVID-19 and rural health equity in Northern New England.
Ranu Dhillon is a global health physician at Harvard Medical School with a focus on epidemic response. He served as a special advisor to the president of Guinea, helping lead its national response to the West African Ebola epidemic. He has also worked on other epidemics including Zika, Lassa fever and COVID-19.