25
notions of risk. Some people are adopt-
ing their own measures to reduce their
risk and voluntarily choosing to avoid
congregate settings, wear masks, and
take other precautions. Many people
are excessively vulnerable to COVID-
19 because of age or health conditions,
and those who remain worried should
have access to tools and support to
keep safe. There’s understandable ap-
prehension among parents torn be-
tween fears of the virus and the steps
to keep kids safe, especially toddlers.
But for those who feel more confident
about the declining risks, we can only
ask so much of the public for so long.
There is an amassed effect from the
disruptions. People are exhausted.
Livelihoods and people’s mental health
have been hurt by the diminished lives
we’ve had to compromise around.
Many children haven’t known a normal
school day for two years. The constant
disruptions take a cumulative toll. We
never agreed that the costs can out-
weigh the benefits. The problem is we
have no way of measuring these trade-
offs, and no framework for deciding
when to turn things on and, equally
important, turn them off.
Take the debate over pandemic and
endemic. There’s no clear nomencla-
ture for what it will mean when the
virus becomes a persistent but man-
ageable risk that doesn’t dominate
our lives. Public-health leaders have
different definitions of what it means
when the pandemic gives way to an
endemic state, where COVID-19 is
part of the predictable repertoire of
circulating pathogens. The simplest
way to define that transition is when
constant waves of excessive infec-
tion no longer plague the country, and
COVID-19 settles into a more predict-
able pattern that follows the seasons.Some, including me, think that 2022
will be the year that we make this
transition. Others still rate as high the
risk that another unexpected variant
emerges and wrecks that forecast.
Regardless, it will remain an ongo-
ing and persistent risk and will require
us to be more vigilant around respira-
tory diseases, especially in the winter-
time when these pathogens are most
prone to circulate. We’ll need to pro-
tect settings where vulnerable people
congregate and create incentives for
people to stay current with vaccines.
We’ll need to improve air quality and
filtration in indoor settings. We’ll
need to ensure widespread access to
testing and create new cultural norms
around staying home from work or
school when you don’t feel well. We
should distribute home diagnostic
tests widely so consumers have a small
stockpile on hand at all times. Masks
could be used on a voluntary basis
and become a tool for certain settings
and for brief periods, to deal with epi-
demic peaks. We also must continue
to innovate, investing in therapeutics
that can treat the sick and provide for
their wide distribution.
But so long as we remain mired in
a 2020 doctrine for measuring preva-
lence and how it correlates with risk,
we’re going to be unable to adapt
public- health measures to the virus’s
ebb and flow, or find a common touch-
stone for managing risk in our lives.
COVID-19 will remain a fearsome
virus for the foreseeable future, but
one that we must learn how to live
with. Federal health officials have
steered us through one of the hardest
periods in our country’s modern his-
tory, and helped preserve life, even as
we lost more than 900,000 of our fel-
low citizens.
We’ve gradually found a way to
coexist with this virus. Now we need
a glide path to what normal becomes
and a new math to guide how we
adapt to COVID-19 even if we never
fully defeat it.Dr. Gottlieb was commissioner of the
Food and Drug Administration from
2017 to 2019. He is a senior fellow at
the American Enterprise Institute and
a board member at Pfizer Inc.We’ve gradually
found a way to
coexist with this virus