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The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

A tale of many pandemics: In year three, a matter of status and access

Philadelphia city officials reimposed an indoor mask mandate in April, even as most cities eased restrictions. (Spencer Platt/Getty Images)
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Charletta Brown has not had access to the same luxuries or flexibility available to some Americans during the coronavirus pandemic. She has gone into work every day, contending with repeated potential exposures. She is a breast cancer survivor on chemotherapy maintenance drugs, putting her at higher risk for severe infection.

The pandemic endured by the 56-year-old Brown is vastly different from the pandemic experienced by affluent, relatively healthy Americans with flexible work situations. As a customer service representative at the Acme grocery in Trooper, Pa., she cannot work from home. She has limited paid time off if she is exposed to the virus and, if she falls ill, is not sure where to get antivirals that the federal government says are in abundant supply.

“There are so many of us out here, and we want our voices to be heard and want people to understand that for us, we have to be here, this is how we take care of our families,” Brown said. “We have to come in and face this when the numbers go up.”

At this precarious moment in the pandemic — with cases comparatively low but poised to rise again — the reality is that people are experiencing many different pandemics depending on their job, health, socioeconomic status, housing and access to medical care.

For people who are healthy and have secure housing, medical care and paid time off from work, the pandemic has largely become manageable in its third year. Vaccinations and boosters mean they are at low risk of hospitalization or death and can probably find highly effective antivirals if they do become sick.

But for millions of Americans, the pandemic remains a ubiquitous threat to their lives and livelihoods. They are immunocompromised or otherwise at higher risk of severe illness, unable to take paid time off or to work from home, and they struggle to make ends meet. And while vaccinations are free and accessible, other tools — including rapid tests, N95 masks and antivirals — can be out of reach because of cost or accessibility.

“It’s been a tale of two pandemics all along. For some people, the pandemic has been an inconvenience, whereas for other people, the pandemic has led to substantial concerns and loss,” said Mercedes Carnethon, professor and vice chair of preventive medicine at Northwestern University’s Feinberg School of Medicine.

“I don’t predict much positive movement over the next few weeks unless the bottom falls out again like it did in December, and there are infrastructure problems. … Those who aren’t suffering aren’t going to be willing to make changes to protect those who are vulnerable,” Carnethon said.

As cases tick upward again in many parts of the country, driven by the highly transmissible omicron subvariant BA.2, there is little agreement about whether to reimpose restrictions such as mask mandates and whether Americans will be willing to go along after more than two years of life in the pandemic. Few elected leaders possess the appetite or political will to require masks and other public health measures, arguing that people now have the tools to protect themselves against the virus and should be left to exercise their best judgment.

Adding to the uncertainty is the spread of new, highly transmissible versions of the omicron variant in New York state and Europe. New York state officials announced Wednesday that two new omicron subvariants, dubbed BA.2.12 and BA.2.12.1, have become the dominant forms of the coronavirus in the central part of the state. For weeks, infection rates in central New York have been at least twice the state average, according to data from the state health department.

Government officials and experts are anxiously watching the national case count and hoping it doesn’t explode into another surge.

But they know that a tinderbox of risk factors exists. Most mask mandates and other public health restrictions have been lifted. Easter, Passover and Ramadan — holidays all marked by large, festive gatherings — converge this month, long-delayed weddings have resumed, and there is a general, growing desire to return to a pre-pandemic normal.

At least one major city, Philadelphia, has reinstated its mask mandate in public spaces, but it is an exception. Guidelines from the Centers for Disease Control and Prevention would not suggest an indoor mask mandate for that city, but Philadelphia’s leaders said their decision was justified by a modest rise in cases coupled with a legacy of health disparities that foreshadow worse public health consequences for Black and Brown communities.

Even if cases rise, few political leaders, including Democrats, are likely to follow Philadelphia’s example and reimpose restrictions, political strategists said. Polls show a sharp decrease in public support for mask mandates and a drop in support for governors’ handling of the pandemic more broadly across both parties.

A March Monmouth University poll found 34 percent of Americans supported instituting or reinstituting mask and social distancing guidelines in their state, down from 52 percent in January, 55 percent in December and 63 percent in September, when the delta wave cascaded through the country.

Monmouth national polls also asked people to rate their governor’s pandemic performance. In March, 59 percent said their governor was doing a good job, higher than the 53 percent for federal health agencies and 49 percent for President Biden. Ratings of governors are down from a peak of 73 percent in May 2020 but have remained in favorable territory for nearly all of the last two years.

One Democratic consultant said most Democratic governors will be unwilling to reimpose any sort of mandate because they believe constituents can protect themselves if they want to. Politicians also fear blowback from an exhausted public that, in many cases, is willing to live with the risks presented by the virus.

“People are exhausted, and people have psychologically, whether we think it’s good policy or not, they’ve moved on,” said the consultant, who spoke on the condition of anonymity to speak candidly. “I don’t think there’s an appetite politically to get into any mandate situation. … I’m not sure with an exhausted America there’s appetite on the ground for it, quite frankly.”

For someone like Brown, that exhaustion means she is perpetually facing peril.

“I know I’m always at risk, and, unfortunately, unless everyone does their part and has that mentality, I don’t know that we’re ever not going to be at risk,” said Brown, who said she also has to protect herself because extended family members aren’t vaccinated. “Am I fearful? No. I’ve gotten used to it: the feeling of knowing today could be the day I catch the virus.”

‘Devastating and life-changing’

The pandemic’s disparities were on full display after an outbreak at an elite Washington dinner this month. Dozens of people, including Biden Cabinet officials, members of Congress and journalists tested positive after the Gridiron Dinner, creating anxiety throughout Washington that the virus was again on the move.

But none of those people ended up hospitalized and nearly all appear to have had mild cases. (The hotel that held the dinner has declined to say how many members of its staff got infected.) It’s not clear how many of them, if any, accessed antivirals to help treat their infections, but most, if not all, would have had the access and knowledge to obtain the highly effective drugs.

Across the country, however, access to monoclonal antibodies and the Pfizer antiviral drug Paxlovid is scattershot at best, even though federal officials say there is ample supply. The availability of such effective drugs has given state and federal officials confidence that the virus is more manageable. But the ability to obtain the drugs after an infection is dependent on having reliable medical care, knowledge of how to navigate the health system and awareness that the drugs are available in the first place.

“You can have a therapy that works effectively in ideal circumstances. The effectiveness of that therapy can get lost when you have to disseminate it out and put it in a real-world setting,” Northwestern’s Carnethon said.

The pandemic, she said, is an “inconvenience” for people with resources and knowledge. “For people without that,” Carnethon said, “this remains devastating and life-changing.”

Inside the emergency room at Rhode Island’s Kent Hospital, Laura Forman has witnessed the pandemic’s disparities play out in often devastating ways.

She sees people afraid to test positive because it means missing work and income. She has seen homeless people test positive and get discharged because there are too few beds in the emergency room but then leave the hospital without resources to manage their infection.

“It’s hard to figure out how to protect people from this in a society which doesn’t afford them those protections. People think we all have equal protection from this and we don’t,” said Forman, the hospital’s chief of emergency medicine.

Eleanor Mayfield is well aware of how fortunate she is. A freelance medical writer who has worked from home for 30 years, Mayfield and her husband, both in their 60s, have been able to protect themselves when cases surge, and when cases decrease, enjoy going out — with precautions. The biggest change for Mayfield was that her husband, a college professor, also started working from home. Although they worry about the risk of long covid, neither has underlying conditions that put them at heightened risk of severe illness.

She’s also confident they could get antivirals if they did become infected.

“We’re fortunate in that … we have good health insurance and pretty ready access to doctors,” Mayfield said. “I’m very grateful.”

For Carolina DeVriendt, a coronavirus infection or even needing to quarantine is highly disruptive. She teaches third grade in Rockville, Md., and has four children of her own. When she contracted the coronavirus in October, she still taught school virtually.

DeVriendt also has a niece who is a recipient of a liver transplant and on immune-suppressing drugs.

“I always keep in mind, what would people do if they were in her situation, and what would be in the best interest for her?” DeVriendt said. “It breaks my heart that privilege or being comfortable overrides smartness.”

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