How Do We Get to a New, Better Normal on Covid?

Covid-19 has now been a defining part of our lives for a year and a half.  And we are now entering a new phase: trying to transition this disease from a society-crashing pandemic to a more manageable endemic disease.

On the Great Ideas Podcast, Matt Robison interviewed leading researcher Dr. Jodie Guest –  Professor and Vice-Chair in the Department of Epidemiology at the Rollins School of Public Health and School of Medicine at Emory University – to understand what we now know about Covid, and what is it going to take to get ourselves to a new and better normal.

She shared some eye-popping numbers (like how one Delta variant infection can quickly become 60 million) and outlined the pathway to a Covid future that we can live with.

Listen to the full conversation here:

 This conversation has been condensed and edited.

What do we now know about how people transmit Covid-19?

We are much more clear that it is transmitted through respiratory droplets. That is one of the reasons why masking still remains a critical way to prevent transmission. Some things that we originally thought have changed. Fomite transmission – i.e., touching something – is really not as big of a risk as we originally thought. Everyone washing their groceries and leaving their mail out in their garage is really not necessary.

How has transmission changed under the Delta variant?

The original strain of COVID-19 had an R0 [“R-naught”] of around 2.5. That means for every one person who was infected, an average of 2.5 people would get it from them.  And then those 2.5 people would each infect an average of 2.5 people. So if you go through 10 cycles of transmission like that, you end up with about 10,000 people infected from that one original case. Delta has a much higher R0 somewhere between five and eight.  So after 10 cycles, instead of 10,000 people, one person will have infected 60 million people.

Is the way we’re spreading Covid different too now?

Yes. At the beginning of the COVID-19 pandemic in the United States, a lot of transmission was driven by “Super-spreader” events. That is one of the reasons that the Delta variant is a big game-changer: now people have a very high viral load compared to the other types of COVID-19, regardless of whether or not you’re vaccinated. Because of that, almost everyone can transmit it really fast.  A big difference now though is if you’re vaccinated, even though you have this super high amount of virus initially, your body does get rid of it faster. So that slows down the spread a lot.

And what do we know about the risk of getting significantly sick from Covid these days?

These are some of the most effective vaccines we’ve ever seen, especially when it comes to keeping you from getting sick from COVID-19, keeping you from needing to be in the hospital, and keeping you from dying. If you are fully vaccinated, your risk of getting the infection is three times lower than someone who’s unvaccinated. But the risk of getting sick is eight times less. And the risk of being in a hospital or dying are 25 times less. That’s a huge difference.

One of the reasons that some people are vaccine hesitant is that some of the scientific guidance has changed over time.  Isn’t that the normal course of science?

Very much so. I think that’s incredibly important. Science is iterative. We study things over and over again to learn. Because of all that learning, we’re much more confident in our conclusions today than we were 18 months ago. But it can be confusing for the public. And so science communication is a real art. Was everything well explained in hindsight? No, probably not.  Plus, Delta changed things and science needed to keep up with that.  So that’s why guidance is changing. And that’s why we need our masks back on right now.

What does the Covid end game look like?

I think it is realistic that we will reach what we call an endemic level of COVID-19: a certain amount that we’re going to live with. But what I urge us not to accept is that that endemic level comes with a lot of death or with a lot of hospitalizations.  What we should be willing to accept is a future one where, because of our vaccination status, we might have a respiratory infection. We might need to stay away from other people. We might need to put our mask back on.  But we’re going to be very safe personally, and we’re not going to be spreading it to a bunch of other people because they’re going to be protected by their vaccine.

How do we get there?

It is very much about vaccination, but there are other ingredients as well.  Other public health prevention really is important. Our masks are really important because with the Delta variant people can transmit much more effectively. The other thing to consider is that the faster we vaccinate people and the more we keep our masks on right now, the less space we’re giving COVID-19 to change. Every single new case is another possibility of this virus mutating.

What have we learned for future pandemics?

We learned that underfunding the infrastructure of our public health system [and eliminating our pandemic response team, as happened two years before Covid] in the United States is a very bad idea. We also need to stop and consider what social media does. As scientists, I don’t think we were really prepared for the fight on Facebook.  And I think we’ve learned how much leadership matters. Ultimately, what we choose to do for each other is really important. Public health is about all of us.

We share edited excerpts from the Great Ideas podcast every week that explain how policies work and present innovative solutions for problems. Please subscribe, and to hear more about the future of Covid, check out the full episode on Apple, Spotify, Google, Anchor, Breaker, Pocket, RadioPublic, or Stitcher