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As public health interventions are lifted, who is bearing the burden?

Introduction by Croakey: Early in the pandemic, there seemed to be general agreement about the importance of solidarity in protecting those who were most at risk from COVID.

Somewhere along the way – as pandemic fatigue set in, the political narrative turned towards ‘individual responsibility’ and ‘pushing through’, and a section of the population became vocal in expressing their anger about public health interventions – we lost sight of this imperative.

Instead, the framing of daily reports on the COVID death toll so often feels like it is blaming victims and diminishing humanity – rather than showing any acknowledgement that we have failed to protect those who we’d identified previously as most in need of protection and care.

These concerns are not limited to Australia but are being felt in many other countries where a political and economic push to “resume normalcy” obscures the concerns that this raises for many.

Writing from California, Chinyere Cindy Amobi examines the options for millions of Americans who are immunocompromised or otherwise at higher risk of poor outcomes from infection, for whom “a ‘return to normal’ is not possible as long as the virus is running rampant”.

This story was originally published for the USC Annenberg Center for Health Journalism, under the headline ‘Health officials say COVID-19 may soon become endemic. That’s little comfort for some’. It is republished with permission.


Chinyere Cindy Amobi writes:

As the crush of infections from the Omicron variant pushes the United States closer to population immunity, many health officials and politicians have begun using the term “endemic” as a synonym for some semblance of normalcy. But as media outlets churn out article after article about “learning to live with COVID-19,” one segment of the country who has felt ignored from the start of the pandemic has once again been left out of the conversation.

For the millions of Americans who are immunocompromised or otherwise at higher risk of poor outcomes from infection, a “return to normal” is not possible as long as the virus is running rampant. Likewise, health care workers and other essential workers (who are largely people of colour) will continue to bear the brunt of exposure as the rest of the country decides what rate of infection and death is acceptable in exchange for a return to normal.

The chronically ill, individuals living with disability, and those who care about them are increasingly speaking out.

In an opinion piece for The Washington Post, Jon Gluck, editorial director of special projects at Medium, explores how COVID fatigue poses a grave threat to immunocompromised people like himself, whose treatment for a rare bone-marrow cancer has left his immune system weakened.

“As the public health saying goes, we may be done with COVID, but COVID isn’t done with us,” writes Gluck. “Until it is, our choice is to follow the rules or put everyone, especially the most defenceless among us, at increased, and undue, risk.”

Two countries

Freelance writer Marisa Kabas, who shared on her Twitter account that she recently had brain surgery and is seeking to avoid getting COVID-19 at all costs, wrote, “People saying that you need to accept that everyone’s going to get COVID at some point have never dealt with chronic illness and it shows.”

When you juxtapose these concerns and the lengths some vulnerable Americans are going to protect themselves during the pandemic with calls for us all to learn to live with COVID, two Americas appear: one in which people are exhausted with COVID precautions and ready to “live like it’s 2019” and another whose ability to survive and function in society depends on those very precautions.

It’s evident in the recent New York Times opinion piece “Waiting for Omicron,” in which columnist Michelle Goldberg discusses wanting to “get Omicron just to get it over with” after her young son tests positive. While Goldberg admits she occupies a somewhat privileged position – as someone healthy, vaccinated, and boosted, the odds of staving off a hospitalization or death are in her favour – the ambivalence she displays towards getting infected contrasts sharply with the anxiety and desperation of those with less optimal protections.

In a recent Twitter thread that went viral, a self-proclaimed public health nurse and medical geographer from the Street Medicine Team of Berkeley Free Clinic broke down the definition of endemic, how it’s been applied to other health crisis such HIV and tuberculosis (which continue to devastate vulnerable populations around the world but illicit less urgency in the US), and the assumptions that equate the ongoing vulnerability of certain groups of people with normalcy.

“If we get to the point where COVID is like HIV, where your privilege determines whether you get to ignore it, will that mean the pandemic is over?” the thread continues, adding that “this crisis won’t be over until it’s over everywhere”.

If the themes of this piece sound familiar, it’s because I and other immunocompromised people have been sounding the alarm since the beginning of the pandemic. Long before terms like endemic were bandied about in articles and political speeches, the American public at large has struggled to take seriously – or maintain that seriousness – a virus that posed the most risk to the sick and the elderly.

Even now, governors from states who were the most aggressive in pursuing pandemic precautions are signalling changes to their protocols, announcing plans to let state-wide mask mandates expire and considering an imminent end to mask mandates in schools. Other states have fallen back on government-run contract tracing or abandoned such efforts altogether.

Fantasies

But as Omicron and the variants to come before will likely prove, idyllic fantasies about a return to a pre-pandemic lifestyle will remain out of reach as long as millions are vulnerable to serious illness from the virus and large swaths of the American public fail to do the bare minimum in their power to prevent uncontrolled spread.

Surges will continue to stretch hospitals and their staff to their breaking points, forcing delays in the treatment of a host of chronic and acute conditions. Variants will continue to emerge, some of which may evade vaccines and immune responses. Countless patients will develop long COVID.

So how do we balance the inevitability of pandemic fatigue with sensitivity and care to those still vulnerable for the foreseeable future?

A thoughtful opinion piece from The New York Times, written by two physicians, may offer a road map.

Their recommendations are wide ranging: evidence-based precautions for those interacting with the immunocompromised (get tested, wear masks), more information from policy makers and doctors on steps the vulnerable and their healthcare teams can take to protect themselves (additional boosters and timing, antibody testing), access to pre-exposure monoclonal antibody treatments, and more.

The most significant aspect of the authors’ recommendations is that no one entity or group of people shoulders all the responsibility: it requires a full-court press. Until everyone shoulders the responsibility of curbing COVID-19’s relentless spread, dreams of normalcy will continue to elude us.

Likewise, until health equity and racial equity are truly incorporated into our health systems, future pandemics promise to play out the same way.

• Chinyere Cindy Amobi serves as a strategic communications specialist at the Berkeley Media Studies Group, helping to train community advocates and organizations in media advocacy and assisting in online engagement, newsletter development, and blogging. Amobi is also health editor at Radiant Health Magazine. Amobi formerly served as community editor of Center for Health Journalism Digital, tackling online community engagement and assisting with the coordination of social media, webinars and fellowship programs. Follow on Twitter: @FollowYourChi

Further reading

Read a Twitter thread by science writer Ed Yong regarding this article published by The Atlantic, ‘The Millions of People Stuck in Pandemic Limbo’.


See Croakey’s archive of stories on consumer health matters.

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