We can do better than what was ‘normal’ before the pandemic

It’s a weird time in the pandemic. COVID-19 cases are once again climbing in some parts of the United States, but still falling from the January surge in other places. The omicron subvariant BA.2 is now dominant in the country, accounting for more than 50 percent of new cases in the week ending March 26, according to the U.S. Centers for Disease Control and Prevention.

BA.2 has already taken parts of the world by storm, spurring large outbreaks in Europe and Asia. With the rising spread of the subvariant in the United States, signs are pointing to another COVID-19 wave here, although it’s unclear how big it could be. There is a good amount of immunity from vaccination and infections from other omicron siblings to help flatten the next peak. But the highly transmissible subvariant is advancing at a time when many have tossed masks aside.

I can’t help but feel that we’re sitting ducks. There’s no movement yet to reinstate protective measures to prepare for the coming wave. Instead, there are loud calls to “return to normal.” But even though it’s been two years, this pandemic isn’t over, no matter how much we wish it were. And when people talk about “normal,” I am struck by what can’t be “normal” again.

For millions and millions of people who have lost children, partners, parents and friends, life won’t be the same. One study reported that the “mortality shock” of COVID-19 has left nine people bereaved for every one U.S. death. So for the more than 975,000 who have died of COVID-19 in the United States, there are close to 9 million who are grieving. Although the study didn’t calculate the ratio globally, more than 6 million have died worldwide, undoubtedly leaving tens of millions bereaved. At the global scale, researchers estimate that through October 2021, more than 5 million children have lost a parent or caregiver to COVID-19, putting these children’s health, development and future education at risk.

Adding to the loss, the pandemic robbed many people of the chance to be with their loved ones as they died or to gather for a funeral. Psychiatrists are concerned that cases of prolonged grief disorder could rise, considering the scale of this mass mourning event.

Many millions who weathered an infection with SARS-CoV-2 went on to develop debilitating symptoms from long COVID, preventing their return to “normal.” A recent report from the U.S. Government Accountability Office estimates that 7.7 to 23 million people in the United States may have developed the condition. Worldwide, an estimated 100 million people currently have, or have had, long-term symptoms from COVID-19, researchers reported in a preprint study last November. Many with long COVID can no longer work and are struggling to get financial assistance in the United States. Some have lost their homes.

And as masking and vaccine mandates have fallen away, people with compromised immune systems have no choice but to fend for themselves and remain vigilant about restricting their interactions. People taking drugs that suppress the immune system or who have immune system disorders can’t muster much protection, if any, following vaccination against the coronavirus. And if they get COVID-19, their weakened defenses put them at risk of more severe disease.

With all that people have endured — and continue to endure — during the pandemic, it would be a colossal missed opportunity to throw aside what we’ve learned from this experience. The pandemic brought wider attention to how racism fuels health disparities in the United States and renewed calls to make more progress dismantling inequities. With remote work and virtual school, many people with disabilities have gained important accommodations. The argument that internet access is a social determinant of health has been reinforced: Places that had limited access to broadband internet were associated with higher COVID-19 mortality rates in the United States, researchers reported this month in JAMA Network Open.

The pandemic could also provide the push to bring indoor air under public health’s wing, joining common goods like water and food. The recognition that the virus that causes COVID-19 is primarily spread through the air has also been a reminder of the airborne risk posed by other respiratory diseases, including influenza and tuberculosis. Improved ventilation — bringing fresh outdoor air inside — can temper an influenza outbreak, and it helped to control a real-world tuberculosis outbreak in Taiwan.

Paying attention to indoor air quality has also paid dividends during the COVID-19 pandemic. Schools that combined better ventilation with high-efficiency filters reduced the incidence of COVID-19 by 48 percent compared with schools that didn’t, researchers reported last year. This month, the Fondazione David Hume released not-yet-peer-reviewed results of an experiment in the Marche Region in Italy that looked at schools with and without controlled mechanical ventilation and the impact of different rates of air exchange. Replacing the air in a classroom 2.4 times per hour reduced the risk of COVID-19 spread by a factor of 1.7. More frequent exchanges reduced the risk even more, up to a factor of 5.7 with replacement 6 times an hour.

British scientists who advise the U.K. government would like buildings to display signs to inform the public of the status of the air inside. They have developed prototype placards with different icons and color-coding schemes to convey information such as whether a room is mechanically ventilated, uses filtration or monitors carbon dioxide, which is a proxy for how much fresh air a room gets. The group is testing options in a pilot program.

In the United States, the White House has launched the Clean Air in Buildings Challenge as part of the National COVID-19 Preparedness Plan. The Biden administration and Congress have made federal funding available to improve air quality in schools, public buildings and other structures. The Environmental Protection Agency has released recommendations on how to plan for and take action on indoor air quality.

“Healthy and clean indoor air should become an expectation for all of us,” Alondra Nelson, head of the White House Office of Science and Technology Policy, said at a webinar about the new initiatives on March 29. “It’s just as important as the food we eat and the water we drink.”

Making clean indoor air a public health priority, and putting in the work and money to make it a reality across the country, would go a long way to helping us prepare for infectious disease outbreaks to come. It also reinforces the public in public health, a commitment to protecting as many people as possible, just as masking mandates at appropriate times do. It’s how we get to some kind of “normal” that everyone can share in.

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