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Analysis: Analysis: Our pandemic reality is a dizzying mix of normalcy and looming concern

Confused? You’re not alone. Unlike the overwhelming anxiety that defined the spring of 2020 or the hope that came with the start of the US’ vaccination campaign, our current pandemic reality is far more muddled.

What the experts say

This stream of seemingly conflicting information raises the simple but loaded question: Where are we in the pandemic? We asked three experts just that. Their responses, sent via email, are below.

Dr. Leana Wen, a CNN medical analyst and public health professor at the George Washington University. People live in very different realities depending on their response to this question: How much do they want to keep avoiding Covid-19?

Some people remain extremely cautious. Perhaps they are immunocompromised or live with someone who is. Perhaps they do not want to risk the potential of long-haul covid. These individuals are still taking many precautions like avoiding indoor dining and masking at all times. They weigh the risk of the coronavirus in every interaction.

Others think of Covid-19 the way they think of the flu: They don’t want to get it, but they won’t turn their lives upside down in order to avoid it. For these individuals, there are tools that allow them to return to pre-pandemic normal. Vaccination and boosters remain very highly protective against severe disease; they can test before getting together with vulnerable individuals; and there are treatments that further reduce disease severity.

It’s reasonable for people to move on with their lives, as it is reasonable for others to continue to be very cautious. In the meantime, it’s to our government to prepare for what comes next, in case there’s a new, more dangerous variant that threatens to upend this period of relative lull.

Syra Madad, an epidemiologist at NYC Health + Hospital. Pandemics don’t have linear narratives, meaning there is a defined beginning, middle and an end. There are many possibilities — there could be a protracted ending, or with the right curveball (e.g., highly immune evasive variant or significant waning immunity), put the pandemic back to the middle.

My best guess would be the U.S. sits somewhere between the middle and end stage of the COVID-19 pandemic. We have high amounts of immunity in our population, but not enough to stave off future surges; we have antiviral therapies but there are barriers with access and supply; we have access to more testing, but demand has plummeted. The list goes on.

Globally, we’re very much still in the middle stage of the pandemic. With only 15% of people in low-income countries with just 1 dose of a COVID-19 vaccine compared to 4th doses being given out in high income countries — we are still a long way from saying, “the end” and anyone who says otherwise is likely living in lala land.

Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation. Our models do not suggest a substantial BA.2 surge in the US. Given wide circulation in the US of BA.2 already, we expect that even with a BA.2 surge, transmission should return to low levels over the summer months unless a major new variant emerges.

Looking ahead to the emergence of new variants that may be more severe than Omicron, there are several strategies for the US to pursue. First, maintain surveillance with a focus on early detection globally of new variants and monitoring of when any new variant may arrive in the US.

Second, ensure that there is widespread access to effective antivirals in advance of a new and potentially more severe variant. To date, there appears to be more policy discussion of vaccination and boosters than there is of antivirals; this imbalance should be corrected.

Third, time the delivery of boosters for the elderly and those with comorbidities to have maximum impact on the next new variant. There is not sufficient evidence at this time that BA.2 spread warrants a broader push on a fourth booster except in those at high risk.

Fourth, when and if transmission begins increasing substantially, individuals at risk should consider wearing a mask and socially distancing.

Global virus, global economy

Even as the US reaches for some normalcy, we’re not insulated from the global Covid-19 picture.

Take China for example. Nearly 400 million people across 45 cities are under full or partial lockdown as part of the country’s strict zero-Covid policy. Together they represent 40%, or $7.2 trillion, of annual gross domestic product for the world’s second-largest economy, according to data from Nomura Holdings.

Most alarming is the indefinite lockdown in Shanghai, a city of 25 million and one of China’s premiere manufacturing and export hubs.

As CNN’s Nicole Goodkind reports: Sony and Apple supplier plants in and around Shanghai are idle. Quanta, the world’s biggest contract notebook manufacturer and a MacBook maker, has stopped production entirely. The plant accounts for about 20% of Quanta’s notebook production capacity, and the company previously estimated it would ship 72 million units this year. Tesla has shuttered its Shanghai Giga factory, which produced about 2,000 electric cars a day

The prolonged disruptions to Chinese manufacturing and shipping could help accelerate a key Biden administration initiative aimed at reducing US dependence on Chinese products and supply chains.

But the task comes with serious immediate economic repercussions.

What can you do?

While the era of self-testing has brought convenience and consistency to our pandemic response, it’s also clouding our understanding of the virus’ presence.

Cases have long been undercounted, but one reason they may be so off is that the number of Covid-19 tests being done in non-traditional settings, like at home, has already surpassed the number being done in laboratories, according to the National Institutes of Health. As the use of at-home Covid-19 tests rises, so does the concern that most of those test results go unreported, leading to an undercount of the true number of Covid-19 cases across the country.

In fact, IHME estimates that only 7% of positive Covid-19 cases in the US are being detected, meaning case rates are actually 14.5 times higher than officially reported. The last time the infection detection rate was this low was at the outset of the pandemic, in March 2020.

The solution here is simple: Report positive results to both your health care provider and your local health department.

As Dr. Georges Benjamin, executive director of the American Public Health Association, told CNN’s Kristen Rogers, if you test positive, your health care provider might need to intervene with treatments such as monoclonal antibodies or antivirals to mitigate your symptoms, depending on your Covid-19 vaccination or health status.

And reporting positive test results to your local public health department helps experts understand the prevalence of a disease in different communities, he added.

“Presence of disease is an earlier indicator than the hospitalizations and can help us predict workforce needs, staffing needs for hospitals,” Benjamin said.

“If you know you’ve got a community that hasn’t had a lot of infection and all of a sudden you’re seeing it grow, then you can usually predict that two or three weeks from then, they’re going to be seeing more cases in the hospital (and) tragically, death, too. However, with this new BA.2 Omicron variant we are seeing infections but not many severe hospitalizations.”

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