Opinion Here’s what it will take to end the covid-19 pandemic
By Leana S. Wen
October 6, 2021 at 12:32 p.m. EDT
What will it take to finally put this public health crisis behind us?
To start, we must first accept that covid-19 is here to stay for the foreseeable future. A “covid-zero” policy will not work, as even New Zealand, which until recently was issuing nationwide lockdowns for a single case, has conceded.
We should also acknowledge two realities: First, it’s unlikely we will see the virus suddenly become less lethal. In fact, new mutations could result in more contagious and more virulent variants. Even worse would be if such variants evade the protection of existing vaccines.
Second, while we should continue to try to achieve population immunity through widespread vaccination, we will likely not be able to suppress infections to very low levels any time soon. Anthony S. Fauci, the nation’s top infectious diseases expert, has said that the United States should aim for less than 10,000 new cases a day. That would be terrific, but realistically, I don’t think we can sustain it with only about 57 percent of Americans fully vaccinated, a lack of political will to bring back masking requirements and colder weather approaching that will drive people indoors.
Here’s the good news: Despite these realities, I believe we can turn covid-19 from an existential crisis into a manageable problem with three key actions.
First, we must have vaccines available for younger children.
While it is true that children who contract the disease tend not to become as ill as adults, hundreds of kids have died from covid-19. More than 1 in 4 new infections are in children. Until our kids can be inoculated with a vaccine that substantially reduces their likelihood of severe illness, many parents — such as me and my husband — are living as cautiously as if we were unvaccinated ourselves.
Thankfully, we may not have to wait much longer. The Food and Drug Administration has scheduled a meeting of its advisory committee to review Pfizer’s vaccine for 5-to-11-year-olds for Oct. 26. Assuming that Pfizer will submit its application on time and that the FDA will deem the vaccine safe and effective, this younger age group could start getting shots by Halloween. Pfizer has also said that data for children 6 months to 4 years old could be ready in late 2021, which makes authorization possible in early 2022.
Second, we need oral, outpatient treatment for covid-19.
This, too, is on the horizon in the not-too-distant future. Merck just announced remarkable results for an antiviral pill called molnupiravir that it says can cut hospitalization or death by about 50 percent. Molnupiravir is taken by mouth twice a day for five days, which is far more convenient than the existing treatment for early covid-19, monoclonal antibodies, which require a specialized treatment center for intravenous infusions or a series of shots.
To be clear, antiviral pills would not be a “cure” for covid-19, and it’s obviously much better to be vaccinated and not contract the virus in the first place. However, there are about 70 million Americans who have so far chosen to remain unvaccinated. If taking a pill means that infected patients are half as likely to require a hospital bed, that can help relieve the stress on our health-care system and save countless lives.
Molnupiravir has only been tested on unvaccinated people thus far, but it could potentially help lessen the severity of covid-19 for the vaccinated who have breakthrough infections, too. Ideally, researchers will also study this oral therapy to see if it works to prevent someone with a high-risk exposure from developing covid-19, as the medication Tamiflu does to both treat and prevent influenza.
In addition to Merck, several other pharmaceutical companies, including Roche and Pfizer, have oral antivirals in late-stage clinical trials. That means that within a few months, a combination of vaccination and early treatment could render covid-19 to be more like a mild flu than a potential death sentence.
Third, we must have free, readily available rapid tests.
The antiviral treatments and antibody infusions only work to stave off severe disease when taken early in the course of illness. That means infections must be detected as soon as possible. Moreover, around half of coronavirus transmission comes from asymptomatic people. Controlling covid-19 requires identifying these individuals before onward transmission occurs, which also hinges on testing.
Yet despite widespread recognition of the importance of prompt diagnosis and early detection, testing remains a hugely underutilized infection-control strategy in the United States. In this regard, we are far behind other countries. Britain has made free tests available to all its residents so that everyone can be tested twice a week. Canada is providing free rapid tests to businesses. Singapore and Japan dispense tests for a nominal sum through ubiquitous vending machines.
The United States can do this, too. Imagine if every family was given twice-weekly, at-home tests to take before kids go to school and parents head to work. Imagine, too, if it becomes the norm for friends and family to take rapid tests before getting together for weddings, birthday parties, and even casual dinners and happy hours. When implemented together with vaccine requirements, regular testing can replace the need for masking and distancing in schools, offices and social settings.
Unfortunately, we are not anywhere close to this. President Biden has said that he plans to make 280 million tests available for $7 each. As other experts have said, this is “far too few for far too much.” Thankfully, the White House has heeded the calls and announced on Wednesday that it plans to quadruple the number of at-home tests by December.
It needs to go even further. We need as big a push for testing as we had around vaccines, with the aim to produce enough tests for every American to be tested at least twice a week. With the addition of free, accessible testing, we could reach a point within the next several months when covid-19 is no longer a major consideration when making decisions around work, school, social engagements and travel.
The end of the pandemic is not an elusive concept. Barring the terrible circumstance of a much worse variant developing, I believe that we have already passed the darkest days of covid-19. The virus may be here to stay, but if we are armed with the right tools, it no longer needs to dominate our lives.
