How does a pandemic start winding down? You’re looking at it

The pandemic isn’t over. But new cases nationally have dropped below 75,000 a day, less than half the number in August. The United States will soon reopen land borders to vaccinated visitors and lift several international travel restrictions. More than 2 million people boarded flights last Sunday, not too far from pre-pandemic travel levels.

Kids, many of them newly vaccine-eligible, are back in school, with no massive surge of new coronavirus infections. Some older students, forced to mask, wear their face coverings as if they were chin guards.

The holidays are coming, and it won’t be like 2020 this time. It’s already obvious in the Halloween decorations, so over-the-top it looks like people are overcompensating for last year’s depressed trick-or-treating.

The pandemic appears to be winding down in the United States in a thousand subtle ways, but without any singular milestone, or a cymbal-crashing announcement of freedom from the virus.

“It doesn’t end. We just stop caring. Or we care a lot less,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said when asked when the pandemic would be over. “I think for most people, it just fades into the background of their lives.”

There could still be a winter surge - respiratory viruses thrive when people huddle in heated rooms. Some experts said they expect at least a modest uptick in infections over the next few weeks. Last year’s brutal winter wave of infections, which peaked in January, was just getting rolling at this point on the calendar. And although aggregate national numbers are lower, many cold-weather states, particularly in the Mountain West, have recently seen a rise in cases and hospitalizations. Alaska, slipping into its dark winter, has the highest infection rate in the nation.

Infectious-disease experts and Biden administration officials are not about to make any definitive predictions about when the pandemic might end. The virus, SARS-CoV-2, is slippery and opportunistic. It is still mutating. It has appeared to lose traction several times over the past year and a half, only to surge anew as it took advantage of more lax behavior and the contagiousness of mutated variants.

Even so, the trends are favorable. With most people vaccinated and infection rates dropping, the United States has entered a new phase of the pandemic in which people are adapting to the persistent presence of an endemic but usually nonlethal pathogen. They really have no choice. The virus isn’t going away.

“I think it’s becoming slowly part of the furniture,” said Andrew Noymer, a University of California at Irvine epidemiologist. He is still wearing masks in grocery stores, but no longer does he always don one of the highly protective N95 masks. “I don’t want to wear scuba gear everywhere I go. This is just part of the human environment now.”

That’s the view as well of Robert M. Wachter, chair of the Department of Medicine at the University of California at San Francisco. Wachter is hardly complacent about the virus: This summer, he took to social media to warn people they needed to renew their vigilance as the delta variant took hold and breakthrough infections became more common.

But he’s vaccinated and boosted now, and making his risk calculations under the assumption that our current environment is roughly as good as it’s going to get. And he doesn’t want to forgo travel and indoor dining the rest of his life.

“My feeling now is that we’re nearing a steady state where things might get a little better or worse - for the next few years. It’s not great, but it is what it is,” Wachter said in an email.

“There’s no cavalry coming, so decisions now should be predicated on this being something near steady state. To me, particularly once I got my booster, it prompts me to accept a bit more risk - mainly because if I’m not comfortable doing it now, I’m basically saying that I won’t do it for several years, and maybe forever.”

The uncertainties over what the virus will do in coming months present a messaging challenge for the Biden administration. The White House needs people to see the pandemic as a real and present threat to public health, one that requires continued precautions and universal vaccination. Officials simultaneously want to be perceived as being on top of the situation.

What they don’t want to do is get caught prematurely celebrating the positive trends of recent weeks. That happened earlier this year, when vaccine uptake was going well, infection numbers were dropping, and the Biden administration felt confident enough to project the Fourth of July as the start of a summer largely free of the virus.

“Today, we’re closer than ever to declaring our independence from a deadly virus,” Biden said in his July 4 remarks. “We’ve gained the upper hand against this virus. We can live our lives, our kids can go back to school, our economy is roaring back.”

The delta variant, detected but underestimated, blew the “summer of freedom” to smithereens. A July 4 party on the South Lawn of the White House became Biden’s “aircraft carrier moment,” in the words of Noymer, the UC-Irvine epidemiologist. Noymer was invoking the episode during the Iraq War when President George W. Bush flew to a Navy ship and spoke under a “Mission Accomplished” banner even though the war was, as it turned out, years and many thousands of casualties from being over.

A July 4 weekend outbreak among mostly vaccinated partygoers in Provincetown, Mass., rattled the Centers for Disease Control and Prevention, and by the end of July, it had reimposed indoor mask guidance for the inoculated.

Officials are cautiously optimistic that the recent decline in cases and deaths could continue into the winter. But they also want the public to stay on task - taking precautions to limit viral spread. The vast majority of U.S. counties still have what the CDC classifies as high transmission.

More than 1,000 people are still dying of covid-19 every day in America. Someday, the coronavirus may be viewed more like influenza, but experts say we’re not there yet.

“Don’t you think people in 1943 were tired of World War II?” said Francis Collins, director of the National Institutes of Health.

For the record, that war lasted until the late summer of 1945.

“Somehow, we have to keep convincing people that this is not something being imposed upon them by the government. It’s being imposed on them by the virus. And we don’t want the virus to win,” Collins said.

Administration officials and many disease experts stress that the return to normalcy hinges on when and how many of the more than 60 million eligible Americans get vaccinated.

“Delta may be our last major wave of infection as covid transitions to a more endemic virus,” said Scott Gottlieb, a former Food and Drug Administration commissioner and Pfizer board member. “It’ll continue to evolve, probably requiring occasional updates to our vaccines every year or two, and it’s going to become a part of our lives like a second circulating flu. But we have the tools, if we use them right, and we have enough immunity already in our population now, to substantially reduce the death and severe disease it causes.”

Other experts are less confident the pandemic will fade away.

“I’m incredibly doubtful this is our last surge, and I think some geographic areas are going to be hit again,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a Biden transition pandemic adviser. “There’s this waning immunity issue. Is it or is it not occurring, and how much? Could we be back in the soup again when we’re in pretty darn good shape today? What will it be like in 12 months?”

Meanwhile, the American public, even while resuming many pre-pandemic activities, is keenly aware that normal life hasn’t returned. A recent Quinnipiac poll asked when things will be back to normal, and 81 percent of adults answered “about a year” or more, including 26 percent who answered “never.”

The Biden administration is well aware that the president’s approval ratings are in part tied to how Americans perceive his management of the pandemic. Biden’s approval ratings, according to Gallup, have fallen 14 percentage points since June, when delta hadn’t fully gained traction and the number of new daily cases was at a low point.

Biden’s health advisers have told him the most effective way to snuff out the pandemic is to continue to increase vaccinations. So the administration’s overriding focus during the next couple of months is to increase vaccinations, particularly through a rule Biden announced in September requiring businesses with more than 100 workers to mandate vaccinations among employees or have them face regular testing. That rule is expected to be finalized and implemented in coming weeks and affect about 100 million workers.

“We’re following the approach that has served us well from the beginning: keeping our eye on the ball, getting more people vaccinated,” said Jeff Zients, the White House coronavirus response coordinator. “The virus has proven to be unpredictable, and we cannot and will not let up.”

The trajectory of the pandemic is an urgent matter for people making holiday-season plans. Last year, millions of families chose not to gather as they traditionally would have. This year, they have a green light - or maybe a flashing yellow.

“I think people should feel comfortable in celebrating the holidays in a reasonably normal way, be they trick-or-treating for Halloween, you can feel the same way about Thanksgiving, you can feel the same way about Christmas,” Anthony Fauci, Biden’s chief medical adviser for the pandemic, said.

“We are still in a pandemic phase,” he said, but added, “We are inching more and more toward normal.”

As long as people are coming into hospitals with severe cases of covid, the pandemic is all too real for front-line health-care workers. And it’s very real for the millions of parents with unvaccinated children, Nuzzo noted. Though that anxiety could ease, with Friday’s Food and Drug Administration announcement that the Pfizer-BioNTech coronavirus vaccine has been authorized for children 5 to 11 years old.

Economic disruptions have eased a bit, but there are huge supply-chain issues, jobs going unfilled, businesses barely staying afloat. Social and political divisions generated by the pandemic and the government response have calcified into anger, conspiracy theories and self-destructiveness.

Experts agree there is virtually no chance of eradicating the coronavirus. But the goal, Fauci said, is to get out of the “pandemic phase” and get to a “control phase.” That would probably mean fewer than 10,000 new cases daily, and that the vast majority of people do not face a significant risk from the virus even if they were to contract breakthrough infections.

Some models have predicted a steady decline in cases right through the winter, while others show a rise. The University of Washington’s Institute for Health Metrics and Evaluation forecasts that infections will rise again in November and peak in midwinter, according to Ali Mokdad, epidemiologist at the institute. Any hint that cases are rising should trigger a rapid response, Mokdad said.

The infection fatality rate of the virus is much lower than when it first hit. That’s in large part because of vaccines, and to some hard-to-calculate degree because so many people have gotten sick, recovered and are walking around with antibodies to the virus. New therapeutics and better clinical practices also improve the chances a severe infection won’t be fatal.

“There is an end to it,” Fauci said of the pandemic. “I don’t think we’re going to eradicate the virus - we’ve only eradicated one virus in all of history, and that’s smallpox. The good news is we’re going in the right direction in the deflection of the curve.”

Last year, influential public health experts such as Fauci urged people to avoid holiday travel and indoor gatherings. This year is different: Fauci, for his part, hopes at least one of his three daughters will be able to make it home for Thanksgiving.

By Christmas, he hopes the entire family will be together again. He plans to make timpano, a decadent Italian dish shaped like a drum and popularized by Stanley Tucci in the 1996 film “Big Night.” It’s a Fauci family tradition.