The Washington Post - USA (2022-05-15)

SUNDAY, MAY 15 , 2022. THE WASHINGTON POST EZ RE A29

BY EZEKIEL J. EMANUEL

T

he covid-19 pandemic is over. That

is what most Americans seem to

believe as they cram together for

Formula One in Miami, sell out

basketball stadiums and fill restaurants

without masks.

This conventional wisdom is gravely

wrong. I will continue to wear my

N95 mask, limit my air and train travel,

and avoid eating at indoor restaurants.

When I teach, I will run a HEPA filter

and require all my students to wear

N95 masks, too.

Why? Largely because of long covid.

Many Americans will think me either

stupid or foolish. They will point to recent

data suggesting that about 60 percent of

Americans have already contracted omi-

cron or another coronavirus variant. So,

they argue, covid is endemic. Just accept

the inevitable.

This position reflects a triumph of de-

sire over data. A wealth of evidence shows

that covid-19 is not a mere cold or mild flu.

It is a serious infection. Indeed, the belief

that omicron was more mild than earlier

variants was wrong. It was just as deadly.

And it comes with worrisome complica-

tions. Of course, we now have effective

interventions, such as vaccines and treat-

ments, to prevent acute illness and death.

But we still do not know enough about the

complications that come after the initial

infection.

Though long covid was originally de-

scribed in May 2020, there is not even a

consensus definition for the condition.

Yet we know many devastating symptoms

can persist for months, including brain

fog, fatigue with minimal exertion, ex-

treme shortness of breath, insomnia and

dizziness.

If the risk of long covid were low,

I would agree that we should stop with

masking and other precautions. But while

we don’t know the precise frequency of the

condition (a failure of the National Insti-

tutes of Health and biomedical research-

ers), we do know it is not rare. Estimates

range from 0.5 percent of infections to

30 percent, with 10 percent being a com-

monly cited risk. Furthermore, there does

not seem to be a correlation between the

severity of the initial infection and the

odds of getting long covid. Plenty of people

with mild symptoms struggle with it.

Vaccines seem to help reduce the risks

of long covid, but they don’t make it

uncommon. Again the data are highly

variable. A Veterans Affairs study esti-

mates vaccination lowers the risk by

13 percent, while two British studies esti-

mate a 40 to 50 percent lower risk. Maybe

the best study, involving more than

240,000 U.S. patients, suggests vaccines

cut the risk of long covid from roughly

17 percent to 3 percent. That is not rare.

Worse still, we have no treatments for the

condition, and NIH has yet to establish a

platform to rapidly conduct robust clinical

trials to evaluate treatments, such as pro-

longed antiviral use, immune modulators

and other shots in the dark, such as anti-

cholesterol drugs or antidepressants.

And there might even be a “longer” covid.

We are just learning about the risks of heart

attacks and developing diabetes months or

years after infection. Covid-infected preg-

nant women faced an increased risk of

being hospitalized, being admitted to the

intensive care unit and having a preterm

delivery. And erectile dysfunction is a newly

documented risk. The long-term effects of

covid infection on the brain are not well

established, but depression and loss of gray

matter have been documented, though we

don’t know how serious or common they

will be.

I am not a worrywart. I am happy to take

plenty of risks — maybe too many, accord-

ing to my family. I ride an electric motorcy-

cle, for which the chance of dying is 1 in

100,000. Dying in a car accident is about 1

in 16,000 over a normal year.

But a 1-in-33 chance (or a 3 percent rate

of long covid) of brain fog, debilitating

fatigue, shortness of breath or any of the

other serious post-covid symptoms is way

too high for me to forgo unobtrusive pre-

cautions.

Consider that earlier this month, the

Food and Drug Administration restricted

the use of the Johnson & Johnson vaccine

because of 60 cases of a blood-clotting syn-

drome and nine deaths among nearly

19 million doses. That is a 1-in-300,000

chance of the blood-clotting syndrome and

a 1-in-2-million risk of death. Similarly, the

risk of myocarditis in young adult males

from the Pfizer and Moderna vaccines —

the cause of much alarm — is about 1 in

15,000 and 1 in 4,000, respectively. The risk

of long covid is far greater than any of these

outcomes.

Remember also that millions of Ameri-

cans with severe, chronic symptoms are

unable to work and need medical atten-

tion and support. This will cost all of us in

health coverage and disability payments.

By behaving as if covid is behind us, we are

creating a serious burden for the future.

Like everyone, I want this pandemic

nightmare to be over. But I also desperate-

ly fear living a debilitated life of mental

muddle or torpor. Keeping protective mea-

sures such as wearing masks and running

HEPA filters is not too much of an imposi-

tion to avoid that.

The writer, an oncologist, medical ethicist and

professor at the University of Pennsylvania,

served on the Covid-19 Advisory Board for the

Biden-Harris transition.

It’s time to stop

dismissing the

risk of long covid

W

ashington’s reaction to the leaked Su-

preme Court draft opinion overturning

Roe v. Wade has been typically myopic.

Republicans first tried to make people

believe that the issue wasn’t the opinion itself but the

leak. Now, they’re absurdly trying to portray Demo-

crats as supporters of infanticide. Democrats, in

turn, squabbled among themselves before a show

vote on a doomed abortion rights bill. And the news

media have reverted to our usual horse-race specu-

lation about how it will affect the midterms.

This small-bore response misses the radical

change to society that Justice Samuel Alito and his

co-conspirators are poised to ram down the throats

of Americans. Their stunning action might well

change the course of the midterms — but more

importantly, it is upending who we are as a people.

Assuming little changes from the draft, overturn-

ing Roe would be a shock to our way of life, the social

equivalent of the 9/11 attacks (which shattered our

sense of physical security) or the crash of 2008

(which undid our sense of financial security). As

epoch-making decisions go, this is Brown v. Board

of Education , but in reverse: taking away an

entrenched right Americans have relied upon for

half a century. We remember Brown because it

changed us forever, not because it altered the 1954

midterms.

It’s impossible to say what will result from the

trauma of overturning Roe , but the effects will be far

reaching and long lasting. Americans are not

prepared for this. Though people have been aware of

the possibility of Roe falling, as recently as last

month, just 20 percent thought it very likely or

definite that it would be overturned, an Economist-

YouGov poll found. Even now, after Alito’s draft,

only 57 percent of voters in a Morning Consult-

Politico poll believe it likely Roe will be overturned.

The political jockeying misses the overarching

significance: that the expectation of reproductive

freedom, of a woman’s autonomy over her own

body, built into the American psyche over two

generations, is about to be shattered. “This is

intrinsically horrific,” says Neal Katyal, a George-

town University law professor who served as acting

solicitor general during the Obama administra-

tion. “This huge right is being taken away. Every-

one has socialized expectations that have crystal-

lized around this.... I t totally disrupts social

expectations.”

There is simply no precedent for such a court-

induced shock. The 2013 Shelby County v. Holder

case eviscerated enforcement of the Voting Rights

Act of 1965, making it easier for states and counties

to disenfranchise Black voters. But the impact of

that case (involving “preclearance”), though devas-

tating, is indirect and complex. Overturning Roe is

dramatic, stark and clear.

Similarly, the court has waded into social contro-

versy before, such as in the 2015 Obergefell v. Hodges

case affirming marriage equality. But public opinion

had already shifted in support of same-sex marriage

by then — and the case was expanding freedom, not

curtailing it. The destruction of Roe rescinds a

freedom Americans have supported by a wide and

unchanging margin for 50 years.

Americans are riled. Only 14 percent of registered

voters said “happy” would very well describe how

they feel about the draft opinion striking down Roe ,

and another 20 percent were “somewhat” happy

about it, according to the Morning Consult-Politico

poll. Rather, they felt “angry” (43 percent), “wor-

ried” (50 percent), “frustrated” (50 percent) and

“helpless” (44 percent). Likewise, a CNN poll found

that anger at the prospective ruling outweighed

happiness by better than 2 to 1.

This shows the folly of Republicans’ attempt to

reframe the debate. Roe v. Wade isn’t some little-

known term such as “critical race theory” that can

be hijacked with disinformation. Americans under-

stand it as plainly as they understand Social

Security, and they aren’t going to be convinced that

the 50 years under Roe was a time of rampant killing

of viable fetuses.

Yet, as Democrats waged their symbolic effort to

codify Roe last week, Senate Minority Leader Mitch

McConnell (R-Ky.) alleged that they support “abor-

tion on demand through all nine months, until the

moment before the baby is born.”

“Just seconds away from delivery,” accused Texas

Gov. Greg Abbott (R).

“Even beyond birth,” Rep. Andy Barr (R-Ky.) said.

Americans are not stupid. They know Roe , and

they’ll know who the extremists are when, post- Roe ,

they see states considering or enacting legislation to

charge women with homicide for abortions, to ban

abortion even for life-threatening ectopic pregnan-

cies, to throw doctors in jail, and to forbid women

any relief even if they are raped — calling the rape of

a 13-year-old girl an “opportunity” for her.

I hope voters punish Republicans in November

for this assault on Americans’ freedom, and there’s

evidence they will. A new Monmouth poll shows

abortion has leaped to being the top concern of

25 percent of voters, virtually tied with the economy.

But it took years (and a stolen seat or two) to build

this destructive Supreme Court. The building back-

lash will have to be just as sustained.

DANA MILBANK

An attack on America’s social fabric

ASHLEE REZIN/ASSOCIATED PRESS

Abortion rights activists demonstrate on Michigan Avenue in Chicago on Wednesday.

BY MARJORIE DANNENFELSER

AND CHUCK DONOVAN

F

or the pro-life movement, the

excitement about the possible re-

versal of the 49-year-old prec-

edent of Roe v. Wade is real, even

as we know the road ahead is uneven.

There are strong views on both sides of

this issue, and this historic moment

arrives at a time when Americans seem

to have lost the will for civic engagement

and representative government.

In this environment, in addition to

seeking peaceful change through elec-

toral processes, the pro-life movement

has clear priorities.

First, we welcome the give-and-take of

the democratic process. For half a cen-

tury, a small cadre of unelected judges

has created abortion policy and wielded

unparalleled power to strike down even

the most modest statutes protecting

nascent life. Now, we hope, the people

will have a say and the chance to achieve

consensus.

We will not act impulsively or rashly.

Different states will reach different con-

clusions. Greenville, S.C., and New York

City’s Greenwich Village will choose dif-

ferently. Unfortunately, the Democratic

Party, once the home to stalwart anti-

abortion voices such as Pennsylvania

Gov. Robert Casey Sr. and Louisiana Rep.

Lindy Boggs, chose to rush a vote in

Congress on an extreme bill to mandate

abortion on demand. In the name of

codifying Roe , they would impose a

“super- Roe ” on all Americans — abortion

without limits, everywhere.

Americans consistently reject this

agenda. Sixty-five percent in an

A P-NORC Center for Public Affairs Re-

search poll last year said abortion

should be generally illegal after the first

trimester of pregnancy, 80 percent after

the second trimester. More recently, 65

percent of women supported a 15-week

limit such as Mississippi’s. The number

and variety of antiabortion laws enact-

ed in recent years show that the people

and their elected representatives are

ready to embrace the role reserved for

them by the Constitution.

With the opportunity to save millions

of lives finally on the table, we are eager

for lawmakers in the states to be as

ambitious as possible in their efforts to

build consensus.

Democratic governors such as Califor-

nia’s Gavin Newsom vow to make their

states into “sanctuaries” for abortion —

the opposite of what a sanctuary should

be. Fortunately, governors in pro-life

states are leading the charge to enact

meaningful protections for unborn chil-

dren and increasingly creative ways to

ensure mothers have the resources they

need to choose life.

Mississippi Gov. Tate Reeves (R), whose

state is at the heart of the challenge to Roe ,

has been exemplary in this regard, sign-

ing two new bills to boost pregnancy

centers and other community-based sup-

ports for pregnant women and their

children. Having spoken to more than 20

governors over the past few months, we

have been heartened by the way statewide

leaders are embracing this phase of the

pro-life movement.

Meanwhile, we agree that there is a

role for elected leaders in Congress, and

we will support the strongest federal

protections we can achieve. It is worth

remembering that legislation to protect

unborn children from painful late-term

abortions has already passed several

times in the House and received majority

support (though not the 60 votes needed

to overcome a filibuster) in the Senate.

There are many such common-ground

efforts that are already well within the

mainstream but need a president who

will sign them into law. Those who would

champion and sign these bills would

have a chance to distinguish themselves

in the upcoming midterms and ahead of

the 2024 presidential election.

We know that angry countercharges

to these statements will come. We should

be clear. The pro-life movement has

never abided, and will not now abide,

criminal charges against women who

seek or have abortions. Women are

harmed, not helped, by abortion. Given

support by the circles of protection that

should surround them — partners, fam-

ily, community, providers and govern-

ment — women will maximize their

decisions for life. We oppose any meas-

ure that would penalize those who have

already suffered grave hurt. In every

pregnancy there are two people inti-

mately connected, and we would sur-

round both with love.

We also reject the charge that our care

commences at conception and ends at

birth. The pro-life movement maintains

a vast network of pregnancy centers that

offer free care. The movement is building

maternity homes, backing child and

adoption tax-credit expansion, support-

ing massive alternatives-to-abortion

programs in Texas and as many other

states as will enact them. The social

safety net has tears, but the solution is to

sew them up — not dismember the

children who should be swaddled in it.

The Her Plan program of the Susan

B. Anthony List seeks to help local part-

ners identify and fill gaps. Another ex-

ample of creative leadership is Mississip-

pi’s groundbreaking $3.5 million tax

credit for donations to pregnancy re-

source centers to help serve families in

communities across the state.

Fifty years ago, no family in America

had access to a dazzling 3D image of their

son or daughter developing in the womb;

today such images appear on family

refrigerators. Fetal surgery is common-

place. Conditions such as spina bifida,

congenital diaphragmatic hernia, twin-

to-twin transfusion syndrome and doz-

ens more are being identified and treat-

ed in the womb. Public policy should also

seek to make these miracles available to

every child and family, not merely to a

favored few.

We pray that respect for all human life

will once again be recognized as the core

of our Constitution and national life. The

road ahead will be bumpy sometimes,

but the journey is worth our toil, sweat

and tears.

Marjorie Dannenfelser is president of the

Susan B. Anthony List. Chuck Donovan is

president of the group’s research arm, the

Charlotte Lozier Institute.

The road beyond Roe for the pro-life movement

The political jockeying misses the overarching significance: that the expectation of reproductive freedom, of a woman’s

autonomy over her own body, built into the American psyche over two generations, is about to be shattered.

sunday opinion