President Joe Biden elucidated his thoughts on the status of the COVID-19 pandemic in an interview with “60 Minutes” last month. “The pandemic is over. … We still have a problem with COVID. We’re still doing a lot of work on it. But the pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape, and so, I think it’s changing.”
Leaving aside for a moment whether the pandemic is indeed over, a breakdown of that statement reveals some truth — the pandemic is changing — and some fiction — not everyone is in pretty good shape, and there are some problematic consequences. And whether to wear masks? That is a complicated question.
While the pandemic is in a different phase than it was 2½ years ago, to call it “over” displays a level of optimism that intrudes on certain facts. The U.S. will experience more than 250,000 COVID-19 deaths this year, based on how numbers are trending, fewer than in the previous two years but still a considerable number. That number is front-weighted — there were more deaths in the first half of the year than there will be in the second half — but even in the second half of 2022, American death totals from COVID-19 will approach the 58,000 of the 10-year Vietnam War.
There is another alarming factor to consider: overall excess deaths from all causes. In other words, how many people died in excess of the number who would have died in a typical year? This metric continues to rise, not only in the U.S. but in most European and Asian countries. The expected pattern following most pandemics is for excess deaths in a region to fall, presumably because the sickest people died during the pandemic, but this is not what is happening now.
No one is sure why excess deaths are increasing, but it is likely the result of several factors: consequences of previous COVID-19 infection, notably blood clots and heart problems; underappreciated social chaos of the pandemic, such as homicides, suicides, alcoholism and drugs; and the strain on the health care system resulting in delayed diagnoses and responses to serious and ultimately fatal conditions that have no connection to COVID-19.
Whatever the causes, the abundance of excess deaths has not shown signs of going away, and American life expectancy continues to decline, a reversal of a century-old pattern.
Equally disturbing are the consequences of long COVID-19, the health problems patients experience for months after contracting COVID-19. These difficulties can occur even after a trivial COVID-19 infection. According to the Centers for Disease Control and Prevention: “Older adults are less likely to have long COVID than younger adults. Nearly three times as many adults ages 50-59 currently have long COVID than those age 80 and older.” Especially concerning is a new report published by the prestigious science journal Nature. In a survey of more than 150,000 veterans, at one year after COVID-19 infection, there was a notable increase in neurological and musculoskeletal problems including strokes, cognition and memory disorders, and new mental health disability.
As the president noted, fewer people are wearing masks now. Based on declining case numbers nationwide, the CDC recently downgraded its recommended infection control measures, including stepping back from the mandatory use of face masks in health care facilities. The CDC now says facilities in regions without high transmission can “choose not to require” all doctors, patients and visitors to mask. Many disagree with those recommendations and continue to enforce mask mandates.
Hospitals and clinics are obviously a special situation. They are high-risk locations, and while those who work there may not need to mask where there are no patients, such as in staff meeting rooms and lobbies, it seems intuitively obvious that in certain areas such as chemotherapy units, wearing masks remains a sensible transmission precaution. Others at increased risk of serious COVID-19 illness may benefit from masking in crowded indoor settings.
Biden first declared independence from the pandemic on July 4, 2021, even as a delta variant surge was emerging that would end in more than 150,000 cases and 2,000 deaths per day by the end of that summer. President Donald Trump’s earlier predictions about the pandemic going away met with an equally unsuccessful outcome.
Rather than listen to presidents, we would do better to refer the question to one of cinema’s great academic thinkers from the 1978 movie “Animal House” — John “Bluto” Blutarsky, played by John Belushi. Sure, Bluto’s Faber College GPA was an unimpressive 0.0, but don’t let that fool you. He knew what he was talking when he said, “Over? Did you say ‘over’? Nothing is over until we decide it is.”
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert Weinstein is an infectious disease specialist at Rush University Medical Center.