The pandemic is over.
That much is clear in popular sentiment among liberal commentators and policymakers. In early February, Anthony Fauci told the Financial Times that the U.S. was exiting “the full blown pandemic phase” of covid. As Democratic party Governors dropped some of the last remaining state mask mandates in unison in recent weeks, Bloomberg ran an article titled “Mask Mandates Didn’t Make Much of a Difference Anyway.” In The Atlantic, Yascha Mounk asked, “How much longer will the restrictions on everyday life drag on? What purpose do they still serve?”
Unfortunately, these shared sentiments are just that—sentiments, based in emotion or political calculation, bearing little relation to reality. More than 60,000 people died of covid in January alone; as of this writing, the U.S. has recorded more than 2,000 daily covid deaths for each of the last 30 days. Daily covid deaths have been above 1,000 for over 180 days (roughly half of an entire year).
In this context, what could possibly justify the impending declaration of the end of the pandemic? We have long warned that the end of the crisis would come as a sociological construction rather than as a meaningful end to covid’s ongoing burden on public health. In recent weeks, this process of normalizing the virus and the death, debility, and disability carried with it have become so pervasive that it feels as if at any moment the federal government will once again move to declare “independence from the virus.” But even without explicit state endorsement, the message is inescapable: in the minds of those entitled to speak, society is ready to move on, without many of us.
We do not have to accept this. Yet the pandemic’s socially constructed “ending” has been a long, ongoing process. Years of optimistic predictions, emphasis on personal responsibility, and reductive assumptions about individual risk have calcified into a set of positions now held by many of the most prominent voices on covid. But the talking points hawked by “respectable” pundits are largely indistinguishable from the worst views held by covid deniers, minimizers, and cranks. Their arguments rely on acceptance: first, on acceptance of their rosy worldview, and second, on accepting that the world has simply changed, and along with this change many more of us have become disposable.
In the process, these frameworks threaten the transformation of an idea called “focused protection”—once widely derided as the “let it rip” strategy—from its status as a once-fringe theory in right wing circles to a mainstream pillar of liberal pandemic policy. To understand the long chain of inferences that have led us to this point, it is helpful to start with ideas that have recently caught on and move backwards to their source.
A Targeted Approach
One of the most prominent new arguments for being “done with covid” is the idea that we now have tools to target our public health interventions towards the most vulnerable. In the words of New York Times newsletter writer David Leonhardt, “a targeted approach—lifting restrictions while taking specific measures to protect the vulnerable—can maximize public health.” In Yascha Mounk’s aforementioned Atlantic piece “Open Everything,” he strikes an even more dismissive tone: “Immunocompromised people and the elderly remain in significant danger through no fault of their own … That’s tragic. But it is not a sufficient reason to permanently change our society in ways that make it less free, sociable, and joyous.” Dropping pandemic protections is imagined in these narratives as a means of balancing ongoing “pandemic fatigue” and “malaise,” portraying it as an issue of simple cost-benefit analysis: what burden is the “healthy” public willing to bear to protect the vulnerable public?
Most importantly, these assurances rely on an idea of the medically vulnerable as always already separated from society. It is as if the immunocompromised were structurally prohibited, not only from being in community with others, but from being workers or living with people who work; as if those on chemotherapy, or with autoimmune disorders, or transplant recipients, live in a separated enclave. The future, for these vulnerable people, is openly imagined as a perpetual state of emergency by the likes of frequently-cited public health figure Leana Wen when she writes, “To be sure, I am not advising that we throw all caution out the window. There will be many who cannot let their guard down, including the immunocompromised and parents of young children. They will still choose to be careful and voluntarily limit their activities.”
This approach would be one thing if the medically vulnerable were the only people for whom the ongoing, unchecked spread of covid would pose a health risk (a fallacy we’ll return to below). But even if the immunocompromised and others were the only people at risk, the political economy of health in the U.S. socially structures and reproduces vulnerability. Without federal universal single payer, or a national health service, millions in the U.S. are left uninsured or underinsured. This makes the assertion that the vulnerable take it upon themselves to be more cautious in the months and years to come even more absurd: many will hear these messages and assume they are meant for other people, kept unaware of their own vulnerability. Similarly, we don’t even have a consensus national figure on how many immunocompromised people there are in the U.S. This makes it particularly easy to argue, as figures like Wen, Mounk, and Leonhardt do, that the vulnerable are a small subset of the population not worth public health efforts.
Ezekiel Emanuel, coronavirus advisor to the Biden transition team and best known for his belief that life isn’t as valuable after 75, used this argument explicitly in a February 18th appearance on MSNBC, saying: “I think we do have to acknowledge their fears … but there are 330 million Americans, about 7 million are immunocompromised, about 2.5%. The other 97.5% of Americans can’t continue to wear masks just to protect them.” The problem with this is that Emanuel is using the most restrictive definition of “immunocompromised” possible when he cites the population size as 2.5%, or 7 million people. According to Dr. Amanda Stevenson’s analysis of 2020 National Health interview survey data, the figure is likely closer to 38 million people (or 11% of the population).
Normalizing covid is built entirely on assumptions as fragile as these, which fall apart under even the lightest scrutiny. The idea that we can protect the vulnerable through “a targeted approach” itself contains several of these assumptions. Wen and Leonhardt have both recently published newsletters making similar claims about what such targeted approaches would look like, and both are scant on details. Both deploy the very few talking points that those in favor of normalizing covid seem to rely on any time anyone asks about the vulnerable or immunocompromised. These include, of all things, the increased prevalence of covid testing, with no explanation of how this is supposed to help the vulnerable in shared public space. Wen’s suggestion is to “test before visiting an at-risk grandparent,” before helpfully providing a link to order all of four free tests from the government.
In Leonhardt’s newsletter and in Wen’s appearances on CNN, both also espouse the virtues of “one way masking,” an idea popularized by J.G. Allen (otherwise notable for, as early as October 2021, loudly advocating to drop masking in schools as quickly as possible). “One-way masking” is the idea that the immunocompromised or otherwise vulnerable can fully protect themselves by wearing high quality masks, even if no one else around them is masking. No one ever explains how all of these masks are supposed to be paid for and by whom, assuming, as the normalization discourse suggests, that the vulnerable would likely be masking in order to interact with society, in any way, in perpetuity. Further, as Abdullah Shihipar has written, one-way masking is not a serious public health proposal; the claim that “one-way masking works” is not supported by the evidence. As Shihipar notes, we appear to have come a long way from the early-in-the-pandemic well understood norm that “my mask protects you.”
Finally, and most disturbingly, Wen, Leonhardt, and countless others are quick to note the existence of Pfizer’s new drug Paxlovid as a new, targeted protection for the immunocompromised. Even those in favor of maintaining things like mask mandates still occasionally point to Paxlovid as an otherwise silver lining in an understandably bleak situation. What almost no one mentions about Paxlovid is that the NIH’s treatment guidelines for the drug discourages concomitant use with immunosuppressants, meaning many vulnerable people ultimately won’t be able to (or shouldn’t) use the treatment.
Return to Great Barrington
Worse than the shallowness of the immediate arguments to drop covid protections is the source of the idea of taking a “targeted approach” to public health, an idea which bears more than a passing resemblance to “focused protection.” The term was first advanced by a group calling themselves “The Great Barrington Declaration” after an October 2020 meeting hosted by the American Institute for Economic Research (AIER), a conservative think tank located in Great Barrington, Massachusetts that is well-known as a champion of “individual rights,” “consumer choice,” “small government,” and “open markets.”
“Focused protection” was a novel term. It did not preexist the pandemic as a concept in public health literature. For the Great Barrington Declaration, however “focused protection” described a hypothetical and impossibly well-targeted pandemic response which seeks to shelter the vulnerable while allowing “regular” and “healthy” people to go about their normal lives. (See our forthcoming book Health Communism on why “health” is, in the words of SPK, “a biological fascist fantasy”).
The words of the Great Barrington Declaration bear striking resemblance to what has become the dominant sentiment in media narratives and the overwhelming majority of messaging from the federal government. “Those who are not vulnerable should immediately be allowed to resume life as normal,” they wrote. “Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume.” What then of the vulnerable? The high risk? The authors of the Declaration simply state: “People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.”
This rightly outraged liberals in fall of 2020, not least because members of the Great Barrington Declaration soon met with Trump administration officials Alex Azar and Scott Atlas. It would also later come out that a discussion with Great Barrington Declaration co-author Sunetra Gupta led U.K. Prime Minister Boris Johnson to “rule out lockdown” in fall of 2020. “Focused protection” was widely decried as the “let it rip” strategy, allowing unchecked spread to bring untold death, debility, and disability on the public while consigning the vulnerable to choose between indefinite isolation or death. The Harvard T.H. Chan School of Public Health put out a blog post celebrating the bounty of media mentions of faculty debunking the framework. In late November 2020, now-CDC Director Rochelle Walensky gave comment to The Lancet: Respiratory Medicine explaining why focused protection was a “dangerous fallacy unsupported by scientific fact.” The Great Barrington Declaration, she argued, “is predicated on the idea that you know who is going to get sick and you can somehow isolate and protect them, but there is absolutely no evidence that we can do this.”
It is striking that we are now pursuing the same strategy, and that in the place of pushback against these ideas, there is instead cheering from the most prominent voices on covid. In a recent Washington Post op-ed, Leana Wen featured the opinions of two backers of the “Urgency of Normal,” a document that explicitly uses the language of “focused protection” to advocate for the end of masking in schools. Monica Gandhi—another prominent covid pundit in her own right, and a frequent source for Leonhardt’s New York Times newsletter—published an open letter in December 2021 asking the Biden administration to adopt a “focused protection” strategy in planning the next phase of the pandemic. Gandhi has been cited so frequently by Leonhardt that she will appear in March at a NYT event with Leonhardt called “The Morning at Night,” a program “where The New York Times newsletter anchored by David Leonhardt is brought to life.” In this context, it is hard to see the language of “targeted” interventions as incidental, and not a refreshed and rehabilitated new spin on a tired, eugenic idea.
The Beyblade Strategy
Proponents of this “targeted approach” will argue that their idea differs from “focused protection” in that the latter idea emerged pre-vaccine. While the concerns of the medically vulnerable are hand-waved away, the unvaccinated are endlessly imagined as the only people dying, a viewpoint which frees people from caring about the astounding number of ongoing deaths. Mounk argues, for example, that “the unvaccinated are, implicitly, the main justification for ongoing restrictions—in that the pro-restriction camp points to the persistently high death toll from COVID-19 and these deaths are heavily concentrated among the unvaccinated. … We need not put our lives on hold for the indefinite future because others have decided to risk theirs.”
This sentiment is not unique to generalist opinion writers like Mounk. This Week In Virology, a roundtable podcast of virologists hosted by Columbia University Professor Vincent Racaniello that gained a significant following among liberals during the first year of the pandemic, has begun to repeatedly make this argument as well. In a recent episode, Racaniello said, “Early in the pandemic, when we didn’t have vaccines, I was all for masking … [but] there are people who have made the decision not to be vaccinated, I don’t particularly want to change my life for them. Why don’t they change their life for us?”
Racaniello then offered a caveat, premised on the idea that the vulnerable are fully atomized from society. “Unless—there are two cases where a mask may be appropriate. First of all, of course, less than 5 years of age where you can’t be vaccinated, and very elderly people, and perhaps—and also immunocompromised people, we have to be careful in their presence. But in my class at Columbia none of those apply and I think it would be better to have everyone’s masks off.” Racaniello assumes in this statement that his University students could not possibly count themselves among the vulnerable.
The centrality of these claims—they are also frequently invoked by Leonhardt and others—exposes how deeply many pundits have bought into the “pandemic of the unvaccinated” framework which the Biden administration has been relying on since last July. This claim rests on the assumptions that it is only the unvaccinated who are dying of covid, that everything possible has been done to improve the U.S.’ embarrassingly low vaccination rates; and therefore that death is visited upon the unvaccinated solely as a result of their own actions, not because of the greater public health threat. As Biden himself said in September 2021, “This is a pandemic of the unvaccinated. And it’s caused by the fact that … we still have nearly 80 million Americans who have failed to get the shot.” [Emphasis added].
By December 2021, Biden’s message had evolved into a threat: “We are looking at a winter of severe illness and death — if you’re unvaccinated — for themselves, their families, and the hospitals they’ll soon overwhelm.” According to a CNN report, the change in tone came as Biden’s advisors urged him to emphasize the burden of covid on the unvaccinated and to draw attention away from rising case numbers—and amid an ongoing conversation within the White House, according to HHS Secretary Xavier Beccera, on “how to refocus the public away from total cases toward the severity of illness.”
But this isn’t how public health works. Covid is not just a threat for the unvaccinated or immunocompromised. It is a threat to all of us. Since the CDC removed its page displaying information on breakthrough cases of fully vaccinated people who nevertheless died of covid, @wsbgnl has been cataloging breakthrough deaths reported by state and county health departments. As of February 12th 2022—even with some states not reporting this information and others reporting only incomplete or out of date information—over 41,000 breakthrough deaths have occurred.
Recent studies have suggested that 40–44% of hospitalized breakthrough cases of Covid-19 were in immunocompromised people. While some may assume this could mean it is largely the already-vulnerable who are suffering severe symptoms from breakthrough cases, as suggested by Walensky in early January, this figure would also show that more than half of breakthrough hospitalizations were in people who were not, in fact, immunocompromised. This leaves us all subject to a tragic morality play put on by actors who are not only oblivious to the consequences, but actively promoting a worldview in which covid-induced death, debility and disability are not only unrelated to state and collective inaction, but meaningless.
The Biden administration’s central pandemic strategy, and what is being demanded by the chorus of liberal pundits in their ear, is to “let it rip.” And while Walensky has promised the administration will be “taking steps” to protect the vulnerable, it is bleak indeed that, with those steps unannounced, it is unlikely that the administration feels any impetus to so much as pursue the “protection” component of “focused protection.”
It is no wonder that many who are immunocompromised find themselves asking, “What exactly is the plan for us?” It is no wonder that many of the medically vulnerable feel unwelcome in society or feel that their place in the world has been “further jeopardized” by covid.
The sociological production of the “end of the pandemic” means a wholesale rejection of social rights for the medically vulnerable, but it also means the creation of countless new medically vulnerable people. It means not only accepting tens or hundreds of thousands of additional covid deaths per year for the foreseeable future, but also denying that those deaths have meaning. Now is not the time to give up on fighting covid. If we do, the pandemic may be over, but the deaths will still be here.