Everyone has COVID-19, but what does that mean? The revealing tale of two presidents.

It has been a remarkable few weeks across the world. In the middle of a burst of international summer travel COVID has broken out again. The specific virus causing this outbreak is now identified as BA.5, and it is causing infections and reinfections across the globe. Nearly everyone knows a close friend or associate who is infected, or they themselves are infected.

The media has vacillated on the meaning of this outbreak, both identifying the wide extent while downplaying its impact. Public health officials have also shown a degree of schizophrenia about this surge, pointing out the need to contain infections while also arguing against stringent isolation and mass requirements.

The biggest questions many have is why are we continuing to have infections and what does it mean about the long term for COVID-19? Dr. Fauci, in his retirement announcement, even suggested he couldn’t wait for the pandemic to end before retiring because, “that would be 150 years in the future.”

All of this noise proves we are in a situation where we have much more information than knowledge.

In 1918, the flu pandemic ended when people stopped dying. Period.

There was no identifying different virus variants, and people did not take notice if they had mild illnesses or runny noses, as long as they weren’t dropping dead in the streets.

In contrast, we can now watch the development of herd immunity associated with the struggle between man and virus in real time. We have remarkably sophisticated techniques for identifying virus infections and characterizing the evolution of COVID viruses. Unfortunately, this capability provides much information, but little actionable knowledge. Also, while the ability to monitor this process is clearly fascinating, the inability to put this information in some context creates incredible anxiety about how we should proceed as a society.

Fortunately, we have two sentinel events that provide clarity to our current situation. These events are the COVID-19 infections of the current and previous president.

When President Trump became infected with COVID-19, there were no vaccines and no approved therapies. Palpable anxiety existed throughout the country, accompanied by bizarre theater around moving him to a hospital for monitoring. He received experimental monoclonal antibody therapy; its use was based on a single, potentially inaccurate, evaluation of his blood oxygen levels. The infection was treated as a life-threatening event with great debate about whether his doctors had acted appropriately, clearly disrupting the entire country and making most citizens ill at ease.

This week, when President Biden became infected with COVID 19, the response was very different. He had been fully vaccinated and was treated with the effective antiviral therapy Paxlovid. There was certainly no panic and not even an attempt to move him to a hospital. Despite having many more medical issues than his predecessor, including atrial fibrillation, the expectation was that President Biden would survive without difficulty.

What these two episodes demonstrate is that we have transformed COVID-19 from a terrifying, life-threatening infection, to an annoyance. Anyone who is fully vaccinated, including at least a single vaccine booster, need not be afraid of COVID-19, even if they are of advanced age or have complicating medical problems. We still worry about our friends who have contracted COVID, but we don’t believe they are going to have severe illness or die. 

While this may seem to be a remarkable place to be 2 1/2 years after the beginning of the pandemic, it is essentially the same place, in the same amount of time, that the population arrived at after the 1918 flu epidemic. While the vaccines likely have saved countless numbers of lives by preventing acute deaths as we went through this process, what people are now observing is the real-time development of herd immunity — a process that has allowed the human population to survive infections over the millennia.

Each iteration of the virus is a response to the protection of human immunity. Since almost every person now has some form of immunity, the virus cannot allow these immune individuals to die after infection rather than live and spread the infection. 

In conclusion, we should not be complacent about getting the next round of vaccinations or aggressively using the other protections from COVID-19, either today or for the next few years (if not the 150 years predicted by Dr. Fauci). But we also should remember that the viruses now attacking us are very different from the one that decimated whole cities 2 1/2 years ago. 

It should be reassuring that these viruses won’t threaten our survival unless we let fear drive our decisions.