When the director general of the World Health Organization recently announced the end of the Public Health Emergency of International Concern, he was not saying the Covid pandemic is over so there’s no cause for concern. He was saying the phase of emergency response is over. It’s over because we have now acquired an additional, widely-circulating dangerous disease worldwide that will be with us way into the future.

The emergency “all hands on deck to stop this disease before it gets out of hand” phase is over. Now we’re in the phase where the best we can do is to address the ongoing damage of the disease.

I was sure that, by this time, we would be stomping out Covid sparks whenever and wherever they flare up. But clearly, we have resoundingly failed to contain the virus. At this point, we’re barely even tracking the illness. We have no expectation of non-pharmaceutical precautions, no universal access to vaccines, masks or treatment, and routine and on-demand testing is mostly dismantled.

Our “eyes on the disease” are not nearly as keen. Hospitalization rates, reported weekly rather than daily, are now our primary and lagging indicator of community transmission. “Excess” deaths will soon equilibrate to a “new normal,” so in a year or so we won’t even notice that they’re higher. Life expectancy will continue to decline, but not so dramatically, since “years of life lost” (YLL) are weighted towards early death (i.e. dying at 75 instead of 80 means five YLL, instead of 50 YLL if you die at age 30).

As of May 11, 2023, vaccine costs are fully covered only as long as pre-purchased supplies last. After that, coverage is only as good as your insurance (think equity). Coverage for testing and treatment will also vary by insurance type. For people on Medicaid, testing and treatment will remain covered at no cost through September 2024. For those without insurance, Covid-19 testing and treatment will no longer be covered.

Free tests and treatment may be available at local free clinics or community health centers, and local public health will work with Island Health Care, Health Imperatives and others to do our very best for the Island.

Given these circumstances, what can we expect from this disease going forward? We actually don’t even fully know yet (think post-polio syndrome, with a 30-year time lag to presentation). This is still a new disease. The scientists and researchers are learning but the public is not. And the public sector stays mostly silent, other than to cheerily urge vaccination. It’s a great example of the “silver bullet” mentality and the medicalization of public health.

But what we do know about Covid is that it causes cardiac, vascular, hematologic and neurologic organ damage; that rates of diabetes and heart disease will increase; that many people will go on to develop Long Covid, from minor and relatively transient symptoms to full-on disability for an indeterminate time period; and that immune system damage is as yet not well understood as to its extent or duration.

We also know that Covid has a mortality rate at least six times that of the flu, heavily skewed towards the end of life, and that the virus will inevitably mutate to throw off new variants, so there remains a possibility that some new variant may be better at evading our imperfect and waning immunity, another may be more virulent, or both. What is abundantly clear is that widespread, ongoing transmission vastly increases the likelihood of such mutations.

Furthermore, for those who care to look, Covid uncovers deep, stunningly deep inequity in our society, both racial and socioeconomic. It also brings out the blatant callousness of way too many members of our society: “Oh dear, they died? Were they old? Sick? Black/Native/Hispanic? I see. Thoughts and Prayers! Gotta live my life.”

Long Covid continues to add people who are now chronically sick, increasing the population with chronic illness. How many of us fit into one or more of these “never mind, then” categories? It’s ugly and cruel.

So whatever happened to Build Back Better? Some clear lessons of the pandemic would have been to change the social expectation of “pushing through” illness and instead “stressing stay home when you’re sick!” Obviously, this requires that there be universal paid sick leave and universal healthcare. After the costly lessons about the nature of airborne disease transmission, it is high time to amend building standards to mandate healthy indoor air, especially in schools. Further to airborne transmission, N95 masks should be mandatory in healthcare facilities, at a minimum, during respiratory illness season and in oncology.

In addition, in order to not fail as badly in the next pandemic, the country needs to maintain, upgrade and create national consistency in surveillance and response capability for infectious diseases at the local level. Health literacy in the general population, and the ability to discern reliable information, is the single most important factor in responding to outbreaks of infectious disease.

But this is not where we are today. The only measures we can choose to take as individuals now in this situation are to: stay home when we’re sick; get vaccinated; wear a well-fitted N95 in crowded, indoor spaces; wear an N95 in hospital and other clinical settings; avoid extended indoor gatherings; open windows to maintain the best possible ventilation; and test before getting together, especially with vulnerable people.

Good luck and God bless.

Marina Lent lives in Edgartown. She is the health agent for the Aquinnah board of health.