The United States will soon pass another grim milestone: a half million Americans dead of COVID-19. But, for a variety of reasons, including increased social distancing after the holidays, the daily count of new cases is declining. The curve is bending downward. And yet—there is always another “and yet” in this interminable story—distribution of the vaccine is not nearly as far-reaching, rapid, or efficient as anyone wants. The Biden Administration is promising widespread vaccination by the end of July, and a kind of normalcy by Christmas.
A couple of months ago, I spoke with the New Yorker staff writer Atul Gawande, a Boston-based surgeon and public-health expert, who was a member of Joe Biden’s advisory board on the pandemic during the Presidential transition. In conversation for The New Yorker Radio Hour, Gawande provided a blunt assessment of the Trump Administration’s disastrous and heedless handling of the worst public-health crisis in a century, but he also offered notes of genuine optimism. Recently, we decided to check in again and see where this fast-moving and mutating virus is going. In the latest issue of The New Yorker, Gawande published a deeply reported and revealing account of the COVID-19 crisis and how it has played out in Minot, North Dakota, a city of forty-eight thousand people in Ward County that was, in the fall, the worst-hit county in the worst-hit state in the Union. “Every day seems to bring another test of whether our democracy can succeed in managing the problems of a country as big, varied, and individualistic as ours,” he writes, and thus begins an emblematic tale of the American experience in a hard and frightening time.
Gawande and I spoke earlier this week for the Radio Hour about the latest developments—medical and political. Our conversation has been edited for length and clarity.
How is the vaccine rollout going?
At the very beginning, it seemed like we were all breakthrough and no follow-through. We’ve hit 1.7 million vaccines a day—basically, the capacity to deliver vaccination has been rising steadily—and around February 26th we’ll have the presentation of the Johnson & Johnson data on their vaccine to the F.D.A., which could mean it’s likely we’ll see an approval within a week after that, and a whole new supply chain coming. So where we are on vaccine delivery is in the top five in the world, and with more supply on the way. So I consider us to be starting to turn the corner here.
You were a member of Joe Biden’s advisory committee during the Presidential transition. Why is this so darn hard?
The first thing is that we, as a health-care system, are not equipped to make sure we get to every corner of the population. Instead, you have the existing health-care systems only able to do portions of the population, and that leaves big holes. In Israel and in the U.K., they have a commitment to a national health system, where everybody has a doctor; therefore, everybody has a connection to the system and everybody can be accessed and reached and given directions on where to go get vaccinated. So those are two places that have done better than we have.
The second thing that makes it challenging is the vaccines themselves. This is not like delivering a flu vaccine, where it can sit on the shelf in your doctor’s office until you show up for your appointment. In this particular case, first of all, they need special care, because it’s got to be at very cold temperatures. Also, it’s two shots, which means organizing for multiple visits.
I guess what’s so disturbing to me is the amount of resistance that we see to vaccines.
The vaccine definitely has brought a level of anxiety, but the actual anti-vaccine attack has been relatively muted. As more vaccine rolls out, and we’re past forty million people vaccinated now, we all know somebody who’s been vaccinated. They’re seeing what the effects are. They’re seeing that we haven’t seen unusual deaths or anything like that, and so the vaccine confidence has risen enormously. We now have more than seventy per cent of Americans reporting that if they had the chance to get the vaccine today, they would take it. That is higher than we’ve seen, and I think that will continue to rise.
Now, the last time we spoke, it was December, and you told me that you thought we might return to normal sometime this summer. Given the new information about mutations and the rate of vaccination, where does your answer stand now?
So it has gotten more complicated. I didn’t imagine we would have strains that would potentially evade the vaccines. Also, we have the complexity that the trials in kids are not going to come out with results to indicate how you can vaccinate the population under eighteen. That won’t be done until the end of summer. The trials in ages six and up are only beginning now. So that’s a big part of the population that will still potentially be affected by COVID.
So where will we be? My suspicion is that we’re going to be in a world by the end of summer where we don’t have hospitalizations and don’t have deaths in anything like the numbers we’ve had. We will have it down below flu-level numbers. And once we’re below flu-level numbers, the country is going to want to throw the masks away.
And that’s a mistake?
Well, I think it’s going to be a real debate, because if our goal was to get to zero cases, then we aren’t going to get there. So this is going to be a political debate. The public-health answer isn’t always just get to zero. We need to be able to get back to our lives, and we’re going to have a real debate, even among public-health people, about where to draw that line. I compare it to when we decided we were going to move the speed limit back up from fifty-five miles an hour to sixty-five miles an hour, knowing that was going to mean thousands of deaths a year. It continues to be debated. But we decided this was where we drew the line, and it was a political decision as much as a public-health one.
When will I be able to do things like go to the movies, to Yankee Stadium, take a flight without a mask, and not be thinking about this all the time?
This is what makes it hard. I think that the most likely thing is that COVID gets beaten down to become an endemic, chronic, flu-like illness that circulates, that we will have developed some antiviral treatments as well, that many people continue to wear masks. I think we will also have discovered that wearing the mask stops the flu, which it did this last year, and any remaining COVID in circulation. And we’re going to have some changes in norms, where there are people who decide, You know what, it’s perfectly fine to wear the mask when I travel. By the fall, it will feel much more like normal.
