But although vaccinated individuals are well protected, highly vaccinated communities can still be vulnerable, for three reasons. First, unvaccinated people aren’t randomly distributed. Instead, they tend to be geographically clustered and socially connected, creating vulnerable pockets that Delta can assault. Even in places with high vaccination rates, such as Vermont and Iceland, the variant is still spreading.
Here, then, is the current pandemic dilemma: Vaccines remain the best way for individuals to protect themselves, but societies cannot treat vaccines as their only defense. And for now, unvaccinated pockets are still large enough to sustain Delta surges, which can overwhelm hospitals, shut down schools, and create more chances for even worse variants to emerge. To prevent those outcomes, “we need to take advantage of every single tool we have at our disposal,” Bansal said. These should include better ventilation to reduce the spread of the virus, rapid tests to catch early infections, and forms of social support such as paid sick leave, eviction moratoriums, and free isolation sites that allow infected people to stay away from others. In states where cases are lower, such as Maine or Massachusetts, masks—the simplest, cheapest, and least disruptive of all the anti-COVID measures—might be enough.
There are better ways to do this. On a federal level, Congress could make funding contingent on local leaders being able to make their own choices, Lindsay Wiley of American University, an expert in public-health law, told me. On a state level, leaders could pass mask mandates like Nevada’s, which is “ideal,” Julia Raifman, a health-policy expert at Boston University, told me. It automatically turns on in counties that surpass the CDC’s definition of high transmission and shuts down in counties that fall below it. An off-ramp is always in sight, the public can see why decisions have been made, and “policy makers don’t have to constantly navigate the changing science,” Raifman said.
If endemicity is the future, then masks, distancing, and other precautions merely delay exposure to the virus—and to what end? “There’s still so much for us to buy time for,” Bansal told me. Suppressing the virus gives schools the best chance of staying open. It reduces the risk that even worse variants will evolve. It gives researchers time to better understand the long-term consequences of breakthrough infections. And much like last year, it protects the health-care system.
Curbing the coronavirus’s spread also protects millions of immunocompromised Americans, including organ-transplant recipients and people with autoimmune diseases, such as multiple sclerosis and lupus. Because they have to take drugs that suppress their immune system, they won’t benefit from vaccines and have no choice in the matter.
Finally, the U.S. simply needs more time to reach unvaccinated people. This group is often wrongly portrayed as a monolithic bunch of stubborn anti-vaxxers who have made their choice. But in addition to young children, it includes people with food insecurity, eviction risk, and low incomes. It includes people who still have concerns about safety and are waiting on the FDA’s full approval, people who come from marginalized communities and have reasonable skepticism about the medical establishment, and people who have neither the time to get their shots nor the leave to recover from side effects. Some holdouts are finally getting vaccinated because of the current Delta surge. Others are responding to efforts to bring vaccines into community settings like churches. It now takes more effort to raise vaccination rates, but “it’s not undoable,” Rhea Boyd, a pediatrician and public-health advocate, told me last month. Measures such as indoor masking will “give us the time to do the work.”
Since last January, commentators have dismissed the threat of COVID-19 by comparing it to the flu or common colds. The latter two illnesses are still benchmarks against which our response is judged—well, we don’t do that for the flu. But “a bad flu year is pretty bad!” Lindsay Wiley, at American University, told me, and it doesn’t have to be. Last year, the flu practically vanished. Asthma attacks plummeted. Respiratory infections are among the top-10 causes of death in the U.S. and around the world, but they can often be prevented—and without lockdowns or permanent mask mandates.
The ventilation in our buildings can be improved. Scientists should be able to create vaccines against the existing coronaviruses. Western people can wear masks when they’re sick, as many Asian societies already do. Workplaces can offer paid-sick-leave policies and schools can ditch attendance records “so that they’re not encouraging people to show up sick,” Wiley said. All of these measures could be as regular a part of our lives as seat belts, condoms, sunscreen, toothpaste, and all the other tools that we use to protect our health. The current pandemic surge and the inevitability of endemicity feel like defeats. They could, instead, be opportunities to rethink our attitudes about the viruses we allow ourselves to inhale.