As we approach Year Three living with COVID-19, we are getting used to the feeling that pandemics do not die … they might just eventually fade away. 

The onset of the Omicron variant proves that COVID is not done with us yet. 

This next variant adds even more complexity to fighting the pandemic. Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, has said that fighting a fast-mutating virus “means that sometimes we take two steps forward and one step back.” 

And that complexity is compounded beyond the pure health aspects of the coronavirus: Economic and social impacts are reshaping communities and the civic commons, with the further wrinkle of social media amplifying both good information and misinformation.

We’re sick and tired of dealing with COVID-19.

There is no date certain when the pandemic will be over: People choose to behave as if they are “done” with COVID-19 before any authority will declare it to be so, based on U.S. consumer behaviors.

As the 1918 flu was epidemic when World War I was ending, people had a “feeling of wanting to put that whole decade to bed, and to embrace a new future,” Naomi Rogers, professor of the history of medicine at Yale University, observed. This set the stage for The Roaring ’20s, even though the flu was still prevalent in the U.S. 

“While we’re talking about a virus, a pandemic, in fact, we’re talking about people. And no matter what company, what government, wherever you go on the globe, people have been at this for a year and a half, some people working 24/7. And people are exhausted,” Eric Achtmann of the Pandemic Security Initiative pointed out in a McKinsey report on the COVID-19 path to recovery.

Data from the Kaiser Family Foundation found that three in five Americans feel “frustrated” about the status of COVID-19 vaccinations, with fewer people optimistic in November 2021 than in January 2021. That poll also learned that one year into the vaccination of millions of people around the world, U.S. consumers’ attitudes toward vaccinations were intensely polarized. 

What we know at the end of COVID Year Two and a year into vaccinations is that complications from the coronavirus do not tend to be life-threatening … where people are vaccinated. 

The new deaths of despair in the U.S. are among the unvaccinated.

By December 2020, COVID-19 became the No. 1 leading cause of death in the U.S., surpassing cancer and heart disease. By September 2021, the coronavirus was the top cause of mortality for people ages 35-54. 

After Delta became the most common variant in the pandemic, fully vaccinated people had a 10-fold reduced risk of death and over 10x lower rates of hospitalization, the CDC calculated.

Through May 2021, the NIH estimated that some 140,000 deaths could have been prevented through COVID-19 vaccination.

Muddling through or existential threat?

On the upside, vaccinations and emerging treatments that address the coronavirus are morphing it into less of a mortal disease than a really bad flu, enabling more people to live more normally. Economies have begun to recover, and many people are getting back to the workplace from months of operating in home offices.

Based on pipelines, we can expect that by late 2022, new vaccines will come onto market with new performance benchmarks, easier deployment and less stringent cold chain requirements. We will have a lot more information about who needs additional doses and under what circumstances, along with more personalized approaches to therapies that directly target the coronavirus.

For people in many parts of the world, COVID-19 has become something we can risk-manage. For people vaccinated and boosted living in communities with high vaccination rates and resources to purchase testing, the virus can morph from an existential threat into something people can live with and for which we can recalibrate personal risks.

But there are many people without that luxury and privilege, with the pandemic still representing an existential threat. There are different realities for people all over the world, including neighbors living in adjacent ZIP codes.

Eroding trust erodes public health.

In some parts of the world, health citizens carry vaccine “passports,” QR codes that embody an individual’s vaccine status and COVID-19 histories. In some places, these health identities engender uproar and protest based on the citizens’ perspectives on personal liberty.

How do institutions build trust to find a balance? Michael Ryan, executive director of WHO’s Health Emergencies Programme, says this is so difficult to do “because trust can take years to build and minutes to lose.”

He knows that people have genuine concerns that need to be answered with “radical transparency.” While such transparency can work against an institution in the short term, in the long term it builds trust.

This depends on a community’s view on their social contract: some citizens expect nations to take on socially based interventions, and others take on a more individualistic approach.

Beyond science … values and messengers

One of the pandemic’s complicating driving forces has been a tsunami of both good and bad information — the so-called “infodemic.”

Dr. Leana Wen wrote in the Washington Post that the public sector has to get much better at communicating that good information to health citizens.

It’s not just about science: It’s about people’s values. Messages are as much about the messenger as the message itself.

“Trust is not established overnight,” Wen said at the recent Financial Times Global Boardroom conference. Successful public health messengers “didn’t just show up and talk about vaccines or masks. They have been trusted in their community for a long time: people embedded in the communities they serve.”

Wen said that the idea that meeting people where they are is recognizing that science for them is not the only thing that factors into what people believe. We have to get the science right, to be sure — but that is not enough.

For some, a physician or scientific leader at the CDC or NIH is a powerful public health persuader. For other people, local health authorities, neighbors, religious leaders, the barber or community-based organization embedded in places they serve embody trustworthy health messengers.

Even seeing a life science company’s CEO on a cable news network can polarize health citizens: Some may feel comforted by hearing about a vaccine’s or therapy’s effectiveness data; others will see a profiteer from the public health crisis.

In rebooting pandemic-era communications, Wen suggests that we focus on other issues separate from COVID-19 to rebuild trust in public health. Instead of speaking directly to the coronavirus, Wen suggests a “return to fundamentals” and talking about how public health works on issues that are not so hyperpolarizing — such as maternal and child health or mental health — issues to help us combat the next pandemic and restore fundamental trust in public health.

“I don’t think I anticipated the degree to which the tribalism of our current society would actually interfere with abilities to size up medical information and make the kinds of decisions that were going to help people,” National Institutes of Health director Francis Collins said in a recent NPR interview.

“COVID is not going away. But by investing to protect ourselves against this and future threats, we can turn its legacy into something positive,” the Financial Times recently noted in its look into the pandemic’s lessons and legacies for medicines that deliver public good as well as profit.