— Everyone will meet with the virus eventually, but doing so safely (while vaccinated) is key

by Vinay Prasad, MD, MPH 

Each day we inch toward the end of COVID-19. The end is not when cases go to zero, but rather when we accept what has been true all along. Because of multiple animal reservoirs, because vaccinated people can still experience breakthrough infections, and because billions of people globally have yet to be vaccinated, the truth is clear: SARS-CoV-2 is an endemic virus.

Over the next decade, give or take a few years, every single person on earth has a date with this virus. We will all be exposed, and the virus might replicate in some of our respiratory mucosa. A few of us might get very sick, while many of us may only get mild illness or not get sick at all from our encounter. I prefer to meet the virus on the best terms: after two doses of the COVID-19 vaccine (as I have gotten).

When we truly come to accept that avoiding the virus for decades is impossible, many things change. Our policy goals change, and the restrictions we place on society change.

If you are an adult and have neither been vaccinated nor have natural immunity, you should seek out vaccination. If you are in a location with limited vaccine availability — and you are older or vulnerable — you might want to shield yourself, as best you can, while you wait for a vaccine. Kids who aren’t yet eligible for vaccines — and people in close contact with young kids or other unvaccinated people — may also choose to take precautions.

If instead you are among the majority of U.S. adults who have been vaccinated or have natural immunity to the virus, your choice is clear: you can continue to follow strict personal precautions (avoid weddings, skip parties, etc.) and delay your encounter with the virus, or you can loosen up those precautions and speed up the time to encountering it. What you can’t do is avoid it forever.

Some folks who are vulnerable may wish to get a booster prior to changing their behavior, but we have yet to see clinical outcomes improve from boosting in the general population, and it is possible that with more time, the booster will also wane and you might need a series of them. Despite all this, you may still eventually encounter the virus.

Healthy people, particularly young people who have been vaccinated (such as college students), might realistically not be able to do anything more to optimize their chances of remaining well when they encounter the virus. They can skip parties, avoid dating, and give up indoor restaurants, but practically this may just delay COVID-19 from age 22 to 30. The price paid for this delay will be the inconvenience of those precautions, and the events they did not experience along the way.

Thinking about meeting SARS-CoV-2 as a matter of when, and under what circumstances, rather than if, changes one’s policy choices. First, it stresses the importance of vaccination. It doesn’t matter if vaccines are not perfect or if you can still get sick — because they greatly reduce the chance of hospitalization and death, they are worth pursuing.

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