Viewpoint: It's time to recalibrate expectations about the COVID-19 endgame

It's time for the U.S. medical and scientific communities to have a candid conversation with Americans about the ultimate goals of COVID-19 vaccination and the pandemic's end, infectious disease specialist Céline R. Gounder, MD, wrote in a commentary for The Atlantic. 

Dr. Gounder is an internist, infectious disease specialist and epidemiologist at the NYU Grossman School of Medicine and Bellevue Hospital in New York City. 

In her commentary, she argued that Americans need to recalibrate their expectations about what makes a vaccine successful. Some are under the impression that the goal of vaccination is to eliminate SARS-CoV-2 infections completely, and their trust is then shaken when breakthrough cases occur. 

Noting that eradication is unattainable, regardless of how many booster shots are administered, Dr. Gounder said it now falls on physicians, scientists and public health leaders to point to what the precise goal of vaccination is: to slow the spread, save lives and turn COVID-19 into a disease that society can live with. 

"The public discussion of the pandemic has become distorted by a presumption that vaccination can and should eliminate COVID-19 entirely," she wrote. "Under such an unattainable standard, each breakthrough infection looks like evidence that the vaccines are not working. But in reality, they continue to perform extremely well."

Noting that vaccines alone won't prevent all infections or eliminate the virus, Dr. Gounder suggested widespread vaccination could turn COVID-19 into something closer to influenza. The flu does not shut down economies or prevent normal socialization. 

"As a society, Americans have shown that we are willing to live with 12,000 to 60,000 deaths from influenza each year," wrote Dr. Gounder. "COVID-19 is more dangerous than the flu. Approximately 630,000 Americans have died of the coronavirus to date. But if we could cut the death rate by 90 percent or more, it would be on par with what we see in a bad flu season." 

Dr. Gounder encouraged health experts and public officials to explain that the most important benefit of vaccination is at the population level. 

"The more people get vaccinated, the less transmission occurs in the community, reducing everyone's risk of infection," she wrote. "Over the long term, other precautions, such as better ventilation and air filtration, can reduce the risk even further. And just as face coverings became the norm for many people in East Asia after outbreaks of SARS and the avian flu, they will likely become part of America's COVID-19 endgame too — at least during times of the year when respiratory infections are most likely to spread." 

Read Dr. Gounder's commentary in full here.

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