24 marzo, 2021

COVID-19: When Will Our Lives Be ‘Normal’ Again?

Hi. I’m Art Caplan. I’m the head of the Division of Medical Ethics at the New York University Grossman School of Medicine.

COVID-19 has been with us, sadly, for more than a year. It has devastated life for many people, there have been 500,000 deaths, the economy is in a shambles in the United States and many other countries, travel is restricted, schools are closed, and recreation is difficult to achieve. Many people have been home quarantining, distancing, isolating, and trying to keep themselves and their loved ones safe. It’s been quite a burden on America and the world.

People are thinking, now that vaccines are beginning to appear, when are we going back to normal? When are we going to go back to the days that preceded COVID-19, with no masks, no distancing, and being able to go to work and not have to worry about sitting near a coworker and not feeling terrified if somebody sneezes? When will we be in a situation where we can actually shake hands, hug, go out on dates, and have physical contact with one another that many have missed so much in terms of either social presence or in family and personal relations?

I think it’s interesting as an ethics issue to ask the question, “What is normal?” What are we trying to get back to? That is not just a science question. Obviously, we want to know how well the vaccines work. Do they give herd immunity where many people are protected and the transmission of the virus goes down?

It’s partly a values question. We saw it with masking. Some people said, “I’m not wearing a mask. I don’t think I need to. I’ll take my chances. I don’t care about danger to others.” We didn’t arrest them. We didn’t lock them up. They wanted normality at the price of being dangerous to themselves and to others, and many states in the United States tolerated that. They did not enforce, if you will, the kind of quarantining, isolating, and masking that other parts of the country tried to achieve.

Normality, in other words, is something that is not imposed by medicine, imposed by public health, or imposed by some scientific algorithm. It’s a choice and it’s a choice about values. I’ll make a prediction about what it means to return to normal. When we get more than 40% or 50% of people vaccinated, I think we’re going to start to see people say, “I’ll take my chances. I want to go to sports events. I want to go to restaurants. I know we’re not at herd immunity yet, but I’m going out more.”

In my own case, I’m vaccinated and my wife is vaccinated. We’ve scheduled a couple of trips, which we have not done for more than a year, just for vacation. That’s definitely a shift back to normal. We’ll still mask and we’ll still socially distance. We’re not planning to run around to any bars or spas or anything. When we go on vacation, we will be somewhat isolated, partly because we want to make sure that we don’t inadvertently transmit the virus to somebody else.

Our notion of normality has started to expand and it’s pre–herd immunity. But what about the strains and the mutations? A virus mutates, new strains appear. It could be more infectious. It could be something that makes you even sicker. That is a possibility. There’s no doubt about it.

However, the vaccines that are out there do seem perhaps not to protect against all infections, but they look pretty good at keeping you out of the hospital or preventing death, even with many of the new strains that people are starting to identify. If it’s true that the vaccines don’t stop the virus from infecting you, but can keep you from going to the hospital or dying, then we’re kind of getting closer to a flu situation.

I think people will start to accept those risks and return to normal, even if there’s some danger that they might get sick from the virus. As long as they know they’re not going to be hospitalized and as long as they know they’re not going to die, I think that’s going to be normality inducing. People will say, “Good enough. Maybe I have to stay in bed for 3 days because the new strain of this virus got me even though I was vaccinated, but I’ll pay the price. Let me out of here.”

I think the world we’re headed toward is not one in which COVID-19 disappears. It never will. That virus is going to be around forever, circulating as many viruses do. What we’re going to have to do to get to normality is control it enough that we accept the risks.

For Americans who treasure their liberty, treasure their mobility, and treasure the opportunity to get out there and do what they want, I think they’re going to accept some risk that involves the threat of getting sick — not dying, but the threat of getting sick and even a minimal risk of transmitting the virus to others is just part of what it means to be able to regain your freedom.

I wouldn’t look for normality the way public health officials are dreaming about it, with herd immunity and perfect reduction of transmission to near zero. I suspect we’re going to see efforts to go back to normal before that happens.

I’m Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thanks for watching.