This week, the C.D.C. acknowledged what scientists have been saying for months: The risk of catching the coronavirus from surfaces is low.
April 8, 2021
When the coronavirus began to spread in the United States last spring, many experts warned of the danger posed by surfaces. Researchers reported that the virus could survive for days on plastic or stainless steel, and the Centers for Disease Control and Prevention advised that if someone touched one of these contaminated surfaces — and then touched their eyes, nose or mouth — they could become infected.
Americans responded in kind, wiping down groceries, quarantining mail and clearing drugstore shelves of Clorox wipes. Facebook closed two of its offices for a “deep cleaning.” New York’s Metropolitan Transportation Authority began disinfecting subway cars every night.
“People can be affected with the virus that causes Covid-19 through contact with contaminated surfaces and objects,” Dr. Rochelle Walensky, the director of the C.D.C., said at a White House briefing on Monday. “However, evidence has demonstrated that the risk by this route of infection of transmission is actually low.”
The admission is long overdue, scientists say.
“Finally,” said Linsey Marr, an expert on airborne viruses at Virginia Tech. “We’ve known this for a long time and yet people are still focusing so much on surface cleaning.” She added, “There’s really no evidence that anyone has ever gotten Covid-19 by touching a contaminated surface.”
During the early days of the pandemic, many experts believed that the virus spread primarily through large respiratory droplets. These droplets are too heavy to travel long distances through the air but can fall onto objects and surfaces.
In this context, a focus on scrubbing down every surface seemed to make sense. “Surface cleaning is more familiar,” Dr. Marr said. “We know how to do it. You can see people doing it, you see the clean surface. And so I think it makes people feel safer.”
But over the last year, it has become increasingly clear that the virus spreads primarily through the air — in both large and small droplets, which can remain aloft longer — and that scouring door handles and subway seats does little to keep people safe.
“The scientific basis for all this concern about surfaces is very slim — slim to none,” said Emanuel Goldman, a microbiologist at Rutgers University, who wrote last summer that the risk of surface transmission had been overblown. “This is a virus you get by breathing. It’s not a virus you get by touching.”
The C.D.C. has previously acknowledged that surfaces are not the primary way that the virus spreads. But the agency’s statements this week went further.
“The most important part of this update is that they’re clearly communicating to the public the correct, low risk from surfaces, which is not a message that has been clearly communicated for the past year,” said Joseph Allen, a building safety expert at the Harvard T.H. Chan School of Public Health.
Catching the virus from surfaces remains theoretically possible, he noted. But it requires many things to go wrong: a lot of fresh, infectious viral particles to be deposited on a surface, and then for a relatively large quantity of them to be quickly transferred to someone’s hand and then to their face. “Presence on a surface does not equal risk,” Dr. Allen said.
In most cases, cleaning with simple soap and water — in addition to hand-washing and mask-wearing — is enough to keep the odds of surface transmission low, the C.D.C.’s updated cleaning guidelines say. In most everyday scenarios and environments, people do not need to use chemical disinfectants, the agency notes.
“What this does very usefully, I think, is tell us what we don’t need to do,” said Donald Milton, an aerosol scientist at the University of Maryland. “Doing a lot of spraying and misting of chemicals isn’t helpful.”
Still, the guidelines do suggest that if someone who has Covid-19 has been in a particular space within the last day, the area should be both cleaned and disinfected.
“Disinfection is only recommended in indoor settings — schools and homes — where there has been a suspected or confirmed case of Covid-19 within the last 24 hours,” Dr. Walensky said during the White House briefing. “Also, in most cases, fogging, fumigation and wide-area or electrostatic spraying is not recommended as a primary method of disinfection and has several safety risks to consider.”
And the new cleaning guidelines do not apply to health care facilities, which may require more intensive cleaning and disinfection.
Saskia Popescu, an infectious disease epidemiologist at George Mason University, said that she was happy to see the new guidance, which “reflects our evolving data on transmission throughout the pandemic.”
But she noted that it remained important to continue doing some regular cleaning — and maintaining good hand-washing practices — to reduce the risk of contracting not just the coronavirus but any other pathogens that might be lingering on a particular surface.
Dr. Allen said that the school and business officials he has spoken with this week expressed relief over the updated guidelines, which will allow them to pull back on some of their intensive cleaning regimens. “This frees up a lot of organizations to spend that money better,” he said.
Schools, businesses and other institutions that want to keep people safe should shift their attention from surfaces to air quality, he said, and invest in improved ventilation and filtration.
“This should be the end of deep cleaning,” Dr. Allen said, noting that the misplaced focus on surfaces has had real costs. “It has led to closed playgrounds, it has led to taking nets off basketball courts, it has led to quarantining books in the library. It has led to entire missed school days for deep cleaning. It has led to not being able to share a pencil. So that’s all that hygiene theater, and it’s a direct result of not properly classifying surface transmission as low risk.”
On Monday, the U.S. reached a heartbreaking 500,000 deaths from COVID-19.
But widespread death from COVID-19 isn’t necessarily inevitable.
Data from Johns Hopkins University shows that some countries have had few cases and fewer deaths per capita. The U.S. has had 152 deaths per 100,000 people, for example, versus .03 in Burundi and .04 in Taiwan.
There are many reasons for these differences among countries, but a study in The LancetPlanetary Health published last month suggests that a key factor may be cultural.
The study looks at “loose” nations — those with relaxed social norms and fewer rules and restrictions — and “tight” nations, those with stricter rules and restrictions and harsher disciplinary measures. And it found that “loose” nations had five times more cases (7,132 cases per million people versus 1,428 per million) and over eight times more deaths from COVID-19 (183 deaths per million people versus 21 per million) than “tight” countries during the first ten months of the pandemic.
Gelfand says her past research suggested that tight cultures may be better equipped to respond to a global pandemic than loose cultures because their citizensmay be more willing to cooperate with rules, and that the pandemic “is the first time we have been able to examine how countries around the world respond to the same collective threat simultaneously.”
For the Lancet article, the researchers examined data from 57 countries in the fall of 2020 using the online database “Our World in Data,” which provides daily updates on COVID-19 cases and deaths. They paired this information with previous research classifying each of the countries on a scale of cultural tightness or looseness. Results revealed that nations categorized as looser — like the U.S., Brazil and Spain — experienced significantly more cases and deaths from COVID-19 by October 2020 than countries like South Korea, Taiwan and Singapore, which have much tighter cultures.
NPR talks to Gelfand about the findings and about how understanding the concepts of “looser” and “tighter” nations might lead to measures that help prevent COVID-19 cases and deaths as the pandemic continues.
This interview has been edited for length and clarity.
How did your past research bring you to your current findings about the pandemic?
One of the things I’ve been looking at for many years is how strictly cultures abide by social norms. All cultures have social norms that are kind of unwritten rules for social behavior. We don’t face backward in elevators. We don’t start singing loudly in movie theaters. And we behave this way because it helps us to coordinate with other human beings, to help our societies function. [Norms] are really the glue that keep us together.
One thing we learned during our earlier work is that some cultures abide by social norms quite strictly. And these differences are not random. Tight cultures tend to have had a lot of threat in their histories from Mother Nature, like disasters, famine and pathogen outbreaks, and non-natural threats such as invasions on their territory. And the idea is when you have a lot of collective threat you need strict rules. They help people coordinate and predict each other’s behavior. So, in a sense, you can think about it from an evolutionary perspective that following rules helps us to survive chaos and crisis.
Can you change a culture to make it tighter?
Yes, but you need leadership to tell you this is a really dangerous situation. And you need people from the bottom up being willing to sacrifice some of the freedom for rules to keep the whole country safe. And that’s what’s happening in New Zealand, where they had few cases and few deaths per million, and where they’re really very egalitarian. My interpretation is that people said look, “We all have to follow the rules to keep people safe.”
Can you give us some examples of how tight and loose cultures operate when there’s not a pandemic going on?
Tight cultures have a lot of order and discipline — they have a lot less crime and more monitoring of [citizens’] behavior and [more] security personnel and police per capita. Loose cultures struggle with order.
Loose cultures corner the market on openness toward people from different races and religion and are far more creative in terms of idea generation and ability to think outside the box. Tight cultures struggle with openness.
Do you think it’s possible to tighten up as needed?
Yeah, absolutely. I mean I would call that ambidexterity — the ability to tighten up when there’s an objective threat and to loosen up when the threat is diminished. People who don’t like the idea of tightening would need to understand that this is temporary and the quicker we tighten the quicker it will reduce the threat and the quicker we can get back to our freedom-loving behavior.
I imagine people are worried, though, about long-term consequences of tightening up.
We shouldn’t confuse authoritarianism with tightness.
Following rules in terms of wearing masks and social distancing will help get us back faster to opening up the economy and to saving our freedom. And we can also look to other cultures that have been able to open up with greater success, like Taiwan for example. Increased self-regulation and [abidance of] physical distancing, wearing masks and avoiding large crowds allowed the country to keep both the infection and mortality rates low without shutting down the economy entirely. We need to think of this as being situation-specific in terms of following certain types of rules.
It requires using cultural intelligence to understand when we deploy tightness and when we deploy looseness. And my optimistic view is that we’re going to learn how to communicate about threats better, how to nudge people to follow rules, so that people understand the danger but also feel empowered to deal with it.
[In the U.S., for example, we] need to have national unity to cope with collective threat so that we are prepared as a nation to come together like we have in the past during other collected threats, such as after September 11.
Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz
When the polio vaccine was declared safe and effective, the news was met with jubilant celebration. Church bells rang across the nation, and factories blew their whistles. “Polio routed!” newspaper headlines exclaimed. “An historic victory,” “monumental,” “sensational,” newscasters declared. People erupted with joy across the United States. Some danced in the streets; others wept. Kids were sent home from school to celebrate.
One might have expected the initial approval of the coronavirus vaccines to spark similar jubilation—especially after a brutal pandemic year. But that didn’t happen. Instead, the steady drumbeat of good news about the vaccines has been met with a chorus of relentless pessimism.
The problem is not that the good news isn’t being reported, or that we should throw caution to the wind just yet. It’s that neither the reporting nor the public-health messaging has reflected the truly amazing reality of these vaccines. There is nothing wrong with realism and caution, but effective communication requires a sense of proportion—distinguishing between due alarm and alarmism; warranted, measured caution and doombait; worst-case scenarios and claims of impending catastrophe. We need to be able to celebrate profoundly positive news while noting the work that still lies ahead. However, instead of balanced optimism since the launch of the vaccines, the public has been offered a lot of misguided fretting over new virus variants, subjected to misleading debates about the inferiority of certain vaccines, and presented with long lists of things vaccinated people still cannot do, while media outlets wonder whether the pandemic will ever end.
This pessimism is sapping people of energy to get through the winter, and the rest of this pandemic. Anti-vaccination groups and those opposing the current public-health measures have been vigorously amplifying the pessimistic messages—especially the idea that getting vaccinated doesn’t mean being able to do more—telling their audiences that there is no point in compliance, or in eventual vaccination, because it will not lead to any positive changes. They are using the moment and the messaging to deepen mistrust of public-health authorities, accusing them of moving the goalposts and implying that we’re being conned. Either the vaccines aren’t as good as claimed, they suggest, or the real goal of pandemic-safety measures is to control the public, not the virus.
Five key fallacies and pitfalls have affected public-health messaging, as well as media coverage, and have played an outsize role in derailing an effective pandemic response. These problems were deepened by the ways that we—the public—developed to cope with a dreadful situation under great uncertainty. And now, even as vaccines offer brilliant hope, and even though, at least in the United States, we no longer have to deal with the problem of a misinformer in chief, some officials and media outlets are repeating many of the same mistakes in handling the vaccine rollout.
The pandemic has given us an unwelcome societal stress test, revealing the cracks and weaknesses in our institutions and our systems. Some of these are common to many contemporary problems, including political dysfunction and the way our public sphere operates. Others are more particular, though not exclusive, to the current challenge—including a gap between how academic research operates and how the public understands that research, and the ways in which the psychology of coping with the pandemic have distorted our response to it.
Recognizing all these dynamics is important, not only for seeing us through this pandemic—yes, it is going to end—but also to understand how our society functions, and how it fails. We need to start shoring up our defenses, not just against future pandemics but against all the myriad challenges we face—political, environmental, societal, and technological. None of these problems is impossible to remedy, but first we have to acknowledge them and start working to fix them—and we’re running out of time.
The past 12 months were incredibly challenging for almost everyone. Public-health officials were fighting a devastating pandemic and, at least in this country, an administration hell-bent on undermining them. The World Health Organization was not structured or funded for independence or agility, but still worked hard to contain the disease. Many researchers and experts noted the absence of timely and trustworthy guidelines from authorities, and tried to fill the void by communicating their findings directly to the public on social media. Reporters tried to keep the public informed under time and knowledge constraints, which were made more severe by the worsening media landscape. And the rest of us were trying to survive as best we could, looking for guidance where we could, and sharing information when we could, but always under difficult, murky conditions.
Despite all these good intentions, much of the public-health messaging has been profoundly counterproductive. In five specific ways, the assumptions made by public officials, the choices made by traditional media, the way our digital public sphere operates, and communication patterns between academic communities and the public proved flawed.
One of the most important problems undermining the pandemic response has been the mistrust and paternalism that some public-health agencies and experts have exhibited toward the public. A key reason for this stance seems to be that some experts feared that people would respond to something that increased their safety—such as masks, rapid tests, or vaccines—by behaving recklessly. They worried that a heightened sense of safety would lead members of the public to take risks that would not just undermine any gains, but reverse them.
The theory that things that improve our safety might provide a false sense of security and lead to reckless behavior is attractive—it’s contrarian and clever, and fits the “here’s something surprising we smart folks thought about” mold that appeals to, well, people who think of themselves as smart. Unsurprisingly, such fears have greeted efforts to persuade the public to adopt almost every advance in safety, including seat belts, helmets, and condoms.
But time and again, the numbers tell a different story: Even if safety improvements cause a few people to behave recklessly, the benefitsoverwhelmthe ill effects. In any case, most people are already interested in staying safe from a dangerous pathogen. Further, even at the beginning of the pandemic, sociological theory predictedthat wearing masks would be associated with increased adherence to other precautionary measures—people interested in staying safe are interested in staying safe—and empirical research quickly confirmedexactly that. Unfortunately, though, the theory of risk compensation—and its implicit assumptions—continue to haunt our approach, in part because there hasn’t been a reckoning with the initial missteps.
Rules in Place of Mechanisms and Intuitions
Much of the public messaging focused on offering a series of clear rules to ordinary people, instead of explaining in detail the mechanisms of viral transmission for this pathogen. A focus on explaining transmission mechanisms, and updating our understanding over time, would have helped empower people to make informed calculations about risk in different settings. Instead, both the CDC and the WHO chose to offer fixed guidelines that lent a false sense of precision.
In the United States, the public was initially told that “close contact” meant coming within six feet of an infected individual, for 15 minutes or more. This messaging led to ridiculous gaming of the rules; some establishments moved people around at the 14th minute to avoid passing the threshold. It also led to situations in which people working indoors with others, but just outside the cutoff of six feet, felt that they could take their mask off. None of this made any practical sense. What happened at minute 16? Was seven feet okay? Faux precision isn’t more informative; it’s misleading.
All of this was complicated by the fact that key public-health agencies like the CDC and the WHO were late to acknowledge the importance of some key infection mechanisms, such as aerosol transmission. Even when they did so, the shift happened without a proportional change in the guidelines or the messaging—it was easy for the general public to miss its significance.
Frustrated by the lack of public communication from health authorities, I wrote an article last July on what we then knew about the transmission of this pathogen—including how it could be spread via aerosols that can float and accumulate, especially in poorly ventilated indoor spaces. To this day, I’m contacted by people who describe workplaces that are following the formal guidelines, but in ways that defy reason: They’ve installed plexiglass, but barred workers from opening their windows; they’ve mandated masks, but only when workers are within six feet of one another, while permitting them to be taken off indoors during breaks.
Perhaps worst of all, our messaging and guidelines elided the difference between outdoor and indoor spaces, where, given the importance of aerosol transmission, the same precautions should not apply. This is especially important because this pathogen is overdispersed: Much of the spread is driven by a few people infecting many others at once, while most people do not transmit the virus at all.
After I wrote an article explaining how overdispersion and super-spreading were driving the pandemic, I discovered that this mechanism had also been poorly explained. I was inundated by messages from people, including elected officials around the world, saying they had no idea that this was the case. None of it was secret—numerous academic papers and articles had been written about it—but it had not been integrated into our messaging or our guidelines despite its great importance.
Crucially, super-spreading isn’t equally distributed; poorly ventilated indoor spaces can facilitate the spread of the virus over longer distances, and in shorter periods of time, than the guidelines suggested, and help fuel the pandemic.
Outdoors? It’s the opposite.
There is a solid scientific reason for the fact that there are relatively few documented cases of transmission outdoors, even after a year of epidemiological work: The open air dilutes the virus very quickly, and the sun helps deactivate it, providing further protection. And super-spreading—the biggest driver of the pandemic— appears to be an exclusively indoor phenomenon. I’ve been tracking every report I can find for the past year, and have yet to find a confirmed super-spreading event that occurred solely outdoors. Such events might well have taken place, but if the risk were great enough to justify altering our lives, I would expect at least a few to have been documented by now.
And yet our guidelines do not reflect these differences, and our messaging has not helped people understand these facts so that they can make better choices. I published my first article pleading for parks to be kept open on April 7, 2020—but outdoor activities are still banned by some authorities today, a full year after this dreaded virus began to spread globally.
We’d have been much better off if we gave people a realistic intuition about this virus’s transmission mechanisms. Our public guidelines should have been more like Japan’s, which emphasize avoiding the three C’s—closed spaces, crowded places, and close contact—that are driving the pandemic.
Scolding and Shaming
Throughout the past year, traditional and social media have been caught up in a cycle of shaming—made worse by being so unscientific and misguided. How dare you go to the beach? newspapers have scolded us for months, despite lacking evidence that this posed any significant threat to public health. It wasn’t just talk: Many cities closed parks and outdoor recreational spaces, even as they kept open indoor dining and gyms. Just this month, UC Berkeley and the University of Massachusetts at Amherst both banned students from taking even solitary walks outdoors.
Even when authorities relax the rules a bit, they do not always follow through in a sensible manner. In the United Kingdom, after some locales finally started allowing children to play on playgrounds—something that was already way overdue—they quickly ruled that parents must not socialize while their kids have a normal moment. Why not? Who knows?
On social media, meanwhile, pictures of people outdoors without masks draw reprimands, insults, and confident predictions of super-spreading—and yet few note when super-spreading fails to follow.
While visible but low-risk activities attract the scolds, other actual risks—in workplaces and crowded households, exacerbated by the lack of testing or paid sick leave—are not as easily accessible to photographers. Stefan Baral, an associate epidemiology professor at the Johns Hopkins Bloomberg School of Public Health, says that it’s almost as if we’ve “designed a public-health response most suitable for higher-income” groups and the “Twitter generation”—stay home; have your groceries delivered; focus on the behaviors you can photograph and shame online—rather than provide the support and conditionsnecessary for more people to keep themselves safe.
And the viral videos shaming people for failing to take sensible precautions, such as wearing masks indoors, do not necessarily help. For one thing, fretting over the occasional person throwing a tantrum while going unmasked in a supermarket distorts the reality: Most of the public has been complying with mask wearing. Worse, shaming is often an ineffective way of getting people to change their behavior, and it entrenches polarization and discourages disclosure, making it harder to fight the virus. Instead, we should be emphasizing safer behavior and stressing how many people are doing their part, while encouraging others to do the same.
Amidst all the mistrust and the scolding, a crucial public-health concept fell by the wayside. Harm reduction is the recognition that if there is an unmet and yet crucial human need, we cannot simply wish it away; we need to advise people on how to do what they seek to do more safely. Risk can never be completely eliminated; life requires more than futile attempts to bring risk down to zero. Pretending we can will away complexities and trade-offs with absolutism is counterproductive. Consider abstinence-only education: Not letting teenagers know about ways to have safer sex results in more of them having sex with no protections.
As Julia Marcus, an epidemiologist and associate professor at Harvard Medical School, told me, “When officials assume that risks can be easily eliminated, they might neglect the other things that matter to people: staying fed and housed, being close to loved ones, or just enjoying their lives. Public health works best when it helps people find safer ways to get what they need and want.””
Another problem with absolutism is the “abstinence violation” effect, Joshua Barocas, an assistant professor at the Boston University School of Medicine and Infectious Diseases, told me. When we set perfection as the only option, it can cause people who fall short of that standard in one small, particular way to decide that they’ve already failed, and might as well give up entirely. Most people who have attempted a diet or a new exercise regimen are familiar with this psychological state. The better approach is encouraging risk reduction and layered mitigation—emphasizing that every little bit helps—while also recognizing that a risk-free life is neither possible nor desirable.
Socializing is not a luxury—kids need to play with one another, and adults need to interact. Your kids can play together outdoors, and outdoor time is the best chance to catch up with your neighbors is not just a sensible message; it’s a way to decrease transmission risks. Some kids will play and some adults will socialize no matter what the scolds say or public-health officials decree, and they’ll do it indoors, out of sight of the scolding.
And if they don’t? Then kids will be deprived of an essential activity, and adults will be deprived of human companionship. Socializing is perhaps the most important predictor of health and longevity, after not smoking and perhaps exercise and a healthy diet. We need to help people socialize more safely, not encourage them to stop socializing entirely.
The Balance Between Knowledge And Action
Last but not least, the pandemic response has been distorted by a poor balance between knowledge, risk, certainty, and action.
Sometimes, public-health authorities insisted that we did not know enough to act, when the preponderance of evidence already justified precautionary action. Wearing masks, for example, posed few downsides, and held the prospect of mitigating the exponential threat we faced. The wait for certainty hampered our response to airborne transmission, even though there was almost no evidence for—and increasing evidence against—the importance of fomites, or objects that can carry infection. And yet, we emphasized the risk of surface transmission while refusing to properly address the risk of airborne transmission, despite increasing evidence. The difference lay not in the level of evidence and scientific support for either theory—which, if anything, quickly tilted in favor of airborne transmission, and not fomites, being crucial—but in the fact that fomite transmission had been a key part of the medical canon, and airborne transmission had not.
Sometimes, experts and the public discussion failed to emphasize that we were balancing risks, as in the recurring cycles of debate over lockdowns or school openings. We should have done more to acknowledge that there were no good options, only trade-offs between different downsides. As a result, instead of recognizing the difficulty of the situation, too many people accused those on the other side of being callous and uncaring.
And sometimes, the way that academics communicate clashed with how the public constructs knowledge. In academia, publishing is the coin of the realm, and it is often done through rejecting the null hypothesis—meaning that many papers do not seek to prove something conclusively, but instead, to reject the possibility that a variable has no relationship with the effect they are measuring (beyond chance). If that sounds convoluted, it is—there are historical reasons for this methodology and big arguments within academia about its merits, but for the moment, this remains standard practice.
At crucial points during the pandemic, though, this resulted in mistranslations and fueled misunderstandings, which were further muddled by differing stances toward prior scientific knowledge and theory. Yes, we faced a novel coronavirus, but we should have started by assuming that we could make some reasonable projections from prior knowledge, while looking out for anything that might prove different. That prior experience should have made us mindful of seasonality, the key role of overdispersion, and aerosol transmission. A keen eye for what was different from the past would have alerted us earlier to the importance of presymptomatic transmission.
Thus, on January 14, 2020, the WHO stated that there was “no clear evidence of human-to-human transmission.” It should have said, “There is increasing likelihood that human-to-human transmission is taking place, but we haven’t yet proven this, because we have no access to Wuhan, China.” (Cases were already popping up around the world at that point.) Acting as if there was human-to-human transmission during the early weeks of the pandemic would have been wise and preventive.
Later that spring, WHO officials stated that there was “currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection,” producing many articles laden with panic and despair. Instead, it should have said: “We expect the immune system to function against this virus, and to provide some immunity for some period of time, but it is still hard to know specifics because it is so early.”
Similarly, since the vaccines were announced, too many statements have emphasized that we don’t yet know if vaccines prevent transmission. Instead, public-health authorities should have said that we have many reasons to expect, and increasing amounts of data to suggest, that vaccines will blunt infectiousness, but that we’re waiting for additional data to be more precise about it. That’s been unfortunate, because while many, many things have gone wrong during this pandemic, the vaccines are one thing that has gone very, very right.
As late as April 2020, Anthony Fauci was slammed for being too optimistic for suggesting we might plausibly have vaccines in a year to 18 months. We had vaccines much, much sooner than that: The first two vaccine trials concluded a mere eight months after the WHO declared a pandemic in March 2020.
Moreover, they have delivered spectacular results. In June 2020, the FDA said a vaccine that was merely 50 percent efficacious in preventing symptomatic COVID-19 would receive emergency approval—that such a benefit would be sufficient to justify shipping it out immediately. Just a few months after that, the trials of the Moderna and Pfizer vaccines concluded by reporting not just a stunning 95 percent efficacy, but also a complete elimination of hospitalization or death among the vaccinated. Even severe disease was practically gone: The lone case classified as “severe” among 30,000 vaccinated individuals in the trials was so mild that the patient needed no medical care, and her case would not have been considered severe if her oxygen saturation had been a single percent higher.
These are exhilarating developments, because global, widespread, and rapid vaccination is our way out of this pandemic. Vaccines that drastically reduce hospitalizations and deaths, and that diminish even severe disease to a rare event, are the closest things we have had in this pandemic to a miracle—though of course they are the product of scientific research, creativity, and hard work. They are going to be the panacea and the endgame.
And yet, two months into an accelerating vaccination campaign in the United States, it would be hard to blame people if they missed the news that things are getting better.
Yes, there are new variants of the virus, which may eventually require booster shots, but at least so far, the existing vaccines are standing up to them well—very, very well. Manufacturers are already working on new vaccines or variant-focused booster versions, in case they prove necessary, and the authorizing agencies are ready for a quick turnaround if and when updates are needed. Reports from places that have vaccinated large numbers of individuals, and even trials in places where variants are widespread, are exceedingly encouraging, with dramatic reductions in cases and, crucially, hospitalizations and deaths among the vaccinated. Global equity and access to vaccines remain crucial concerns, but the supply is increasing.
Here in the United States, despite the rocky rollout and the need to smooth access and ensure equity, it’s become clear that toward the end of spring 2021, supply will be more than sufficient. It may sound hard to believe today, as many who are desperate for vaccinations await their turn, but in the near future, we may have to discuss what to do with excess doses.
So why isn’t this story more widely appreciated?
Part of the problem with the vaccines was the timing—the trials concluded immediately after the U.S. election, and their results got overshadowed in the weeks of political turmoil. The first, modest headline announcing the Pfizer-BioNTech results in The New York Times was a single column, “Vaccine Is Over 90% Effective, Pfizer’s Early Data Says,” below a banner headline spanning the page: “BIDEN CALLS FOR UNITED FRONT AS VIRUS RAGES.” That was both understandable—the nation was weary—and a loss for the public.
Just a few days later, Moderna reported a similar 94.5 percent efficacy. If anything, that provided even more cause for celebration, because it confirmed that the stunning numbers coming out of Pfizer weren’t a fluke. But, still amid the political turmoil, the Moderna report got a mere two columns on The New York Times’ front page with an equally modest headline: “Another Vaccine Appears to Work Against the Virus.”
So we didn’t get our initial vaccine jubilation.
But as soon as we began vaccinating people, articles started warning the newly vaccinated about all they could not do. “COVID-19 Vaccine Doesn’t Mean You Can Party Like It’s 1999,” one headline admonished. And the buzzkill has continued right up to the present. “You’re fully vaccinated against the coronavirus—now what? Don’t expect to shed your mask and get back to normal activities right away,” began a recent Associated Press story.
People might well want to party after being vaccinated. Those shots will expand what we can do, first in our private lives and among other vaccinated people, and then, gradually, in our public lives as well. But once again, the authorities and the media seem more worried about potentially reckless behavior among the vaccinated, and about telling them what not to do, than with providing nuanced guidance reflecting trade-offs, uncertainty, and a recognition that vaccination can change behavior. No guideline can cover every situation, but careful, accurate, and updated information can empower everyone.
Take the messaging and public conversation around transmission risks from vaccinated people. It is, of course, important to be alert to such considerations: Many vaccines are “leaky” in that they prevent disease or severe disease, but not infection and transmission. In fact, completely blocking all infection—what’s often called “sterilizing immunity”—is a difficult goal, and something even many highly effective vaccines don’t attain, but that doesn’t stop them from being extremely useful.
As Paul Sax, an infectious-disease doctor at Boston’s Brigham & Women’s Hospital, put it in early December, it would be enormously surprising “if these highly effective vaccines didn’t also make people less likely to transmit.” From multiple studies, we already knew that asymptomatic individuals—those who never developed COVID-19 despite being infected—were much less likely to transmit the virus. The vaccine trials were reporting 95 percent reductions in any form of symptomatic disease. In December, we learned that Moderna had swabbed some portion of trial participants to detect asymptomatic, silent infections, and found an almost two-thirds reduction even in such cases. The good news kept pouring in. Multiple studies found that, even in those few cases where breakthrough disease occurred in vaccinated people, their viral loads were lower—which correlates with lower rates of transmission. Data from vaccinated populations further confirmed what many experts expected all along: Of course these vaccines reduce transmission.
What went wrong? The same thing that’s going wrong right now with the reporting on whether vaccines will protect recipients against the new viral variants. Some outlets emphasize the worst or misinterpret the research. Some public-health officials are wary of encouraging the relaxation of any precautions. Some prominent experts on social media—even those with seemingly solid credentials—tend to respond to everything with alarm and sirens. So the message that got heard was that vaccines will not prevent transmission, or that they won’t work against new variants, or that we don’t know if they will. What the public needs to hear, though, is that based on existing data, we expect them to work fairly well—but we’ll learn more about precisely how effective they’ll be over time, and that tweaks may make them even better.
A year into the pandemic, we’re still repeating the same mistakes.
The top-down messaging is not the only problem. The scolding, the strictness, the inability to discuss trade-offs, and the accusations of not caring about people dying not only have an enthusiastic audience, but portions of the public engage in these behaviors themselves. Maybe that’s partly because proclaiming the importance of individual actions makes us feel as if we are in the driver’s seat, despite all the uncertainty.
Psychologists talk about the “locus of control”—the strength of belief in control over your own destiny. They distinguish between people with more of an internal-control orientation—who believe that they are the primary actors—and those with an external one, who believe that society, fate, and other factors beyond their control greatly influence what happens to us. This focus on individual control goes along with something called the “fundamental attribution error”—when bad things happen to other people, we’re more likely to believe that they are personally at fault, but when they happen to us, we are more likely to blame the situation and circumstances beyond our control.
An individualistic locus of control is forged in the U.S. mythos—that we are a nation of strivers and people who pull ourselves up by our bootstraps. An internal-control orientation isn’t necessarily negative; it can facilitate resilience, rather than fatalism, by shifting the focus to what we can do as individuals even as things fall apart around us. This orientation seems to be common among children who not only survive but sometimes thrive in terrible situations—they take charge and have a go at it, and with some luck, pull through. It is probably even more attractive to educated, well-off people who feel that they have succeeded through their own actions.
You can see the attraction of an individualized, internal locus of control in a pandemic, as a pathogen without a cure spreads globally, interrupts our lives, makes us sick, and could prove fatal.
There have been very few things we could do at an individual level to reduce our risk beyond wearing masks, distancing, and disinfecting. The desire to exercise personal control against an invisible, pervasive enemy is likely why we’ve continued to emphasize scrubbing and cleaning surfaces, in what’s appropriately called “hygiene theater,” long after it became clear that fomites were not a key driver of the pandemic. Obsessive cleaning gave us something to do, and we weren’t about to give it up, even if it turned out to be useless. No wonder there was so much focus on telling others to stay home—even though it’s not a choice available to those who cannot work remotely—and so much scolding of those who dared to socialize or enjoy a moment outdoors.
And perhaps it was too much to expect a nation unwilling to release its tight grip on the bottle of bleach to greet the arrival of vaccines—however spectacular—by imagining the day we might start to let go of our masks.
The focus on individual actions has had its upsides, but it has also led to a sizable portion of pandemic victims being erased from public conversation. If our own actions drive everything, then some other individuals must be to blame when things go wrong for them. And throughout this pandemic, the mantra many of us kept repeating—“Wear a mask, stay home; wear a mask, stay home”—hid many of the real victims.
Study after study, in country after country, confirms that this disease has disproportionately hit the poor and minority groups, along with the elderly, who are particularly vulnerable to severe disease. Even among the elderly, though, those who are wealthier and enjoy greater access to health care have fared better.
The poor and minority groups are dying in disproportionately large numbers for the same reasons that they suffer from many other diseases: a lifetime of disadvantages, lack of access to health care, inferior working conditions, unsafe housing, and limited financial resources.
Many lacked the option of staying home precisely because they were working hard to enable others to do what they could not, by packing boxes, delivering groceries, producing food. And even those who could stay home faced other problems born of inequality: Crowded housing is associatedwith higher rates of COVID-19 infection and worse outcomes, likely because many of the essential workers who live in such housing bring the virus home to elderly relatives.
Individual responsibility certainly had a large role to play in fighting the pandemic, but many victims had little choice in what happened to them. By disproportionately focusing on individual choices, not only did we hide the real problem, but we failed to do more to provide safe working and living conditions for everyone.
For example, there has been a lot of consternation about indoor dining, an activity I certainly wouldn’t recommend. But even takeout and delivery can impose a terrible cost: One study of California found that line cooks are the highest-risk occupation for dying of COVID-19. Unless we provide restaurants with funds so they can stay closed, or provide restaurant workers with high-filtration masks, better ventilation, paid sick leave, frequent rapid testing, and other protections so that they can safely work, getting food to go can simply shift the risk to the most vulnerable. Unsafe workplaces may be low on our agenda, but they do pose a real danger. Bill Hanage, associate professor of epidemiology at Harvard, pointed me to a paper he co-authored: Workplace-safety complaints to OSHA—which oversees occupational-safety regulations—during the pandemic were predictive of increases in deaths 16 days later.
New data highlight the terrible toll of inequality: Life expectancy has decreased dramatically over the past year, with Black people losing the most from this disease, followed by members of the Hispanic community. Minorities are also more likely to die of COVID-19 at a younger age. But when the new CDC director, Rochelle Walensky, noted this terrible statistic, she immediately followed up by urging people to “continue to use proven prevention steps to slow the spread—wear a well-fitting mask, stay 6 ft away from those you do not live with, avoid crowds and poorly ventilated places, and wash hands often.”
Those recommendations aren’t wrong, but they are incomplete. None of these individual acts do enough to protect those to whom such choices aren’t available—and the CDC has yet to issue sufficient guidelines for workplace ventilation or to make higher-filtration masks mandatory, or even available, for essential workers. Nor are these proscriptions paired frequently enough with prescriptions: Socialize outdoors, keep parks open, and let children play with one another outdoors.
Vaccines are the tool that will end the pandemic. The story of their rollout combines some of our strengths and our weaknesses, revealing the limitations of the way we think and evaluate evidence, provide guidelines, and absorb and react to an uncertain and difficult situation.
But also, after a weary year, maybe it’s hard for everyone—including scientists, journalists, and public-health officials—to imagine the end, to have hope. We adjust to new conditions fairly quickly, even terrible new conditions. During this pandemic, we’ve adjusted to things many of us never thought were possible. Billions of people have led dramatically smaller, circumscribed lives, and dealt with closed schools, the inability to see loved ones, the loss of jobs, the absence of communal activities, and the threat and reality of illness and death.
Hope nourishes us during the worst times, but it is also dangerous. It upsets the delicate balance of survival—where we stop hoping and focus on getting by—and opens us up to crushing disappointment if things don’t pan out. After a terrible year, many things are understandably making it harder for us to dare to hope. But, especially in the United States, everything looks better by the day. Tragically, at least 28 million Americans have been confirmed to have been infected, but the real number is certainly much higher. By one estimate, as many as 80 million have already been infected with COVID-19, and many of those people now have some level of immunity. Another 46 million people have already received at least one dose of a vaccine, and we’re vaccinating millions more each day as the supply constraints ease. The vaccines are poised to reduce or nearly eliminate the things we worry most about—severe disease, hospitalization, and death.
Not all our problems are solved. We need to get through the next few months, as we race to vaccinate against more transmissible variants. We need to do more to address equity in the United States—because it is the right thing to do, and because failing to vaccinate the highest-risk people will slow the population impact. We need to make sure that vaccines don’t remain inaccessible to poorer countries. We need to keep up our epidemiological surveillance so that if we do notice something that looks like it may threaten our progress, we can respond swiftly.
And the public behavior of the vaccinated cannot change overnight—even if they are at much lower risk, it’s not reasonable to expect a grocery store to try to verify who’s vaccinated, or to have two classes of people with different rules. For now, it’s courteous and prudent for everyone to obey the same guidelines in many public places. Still, vaccinated people can feel more confident in doing things they may have avoided, just in case—getting a haircut, taking a trip to see a loved one, browsing for nonessential purchases in a store.
But it is time to imagine a better future, not just because it’s drawing nearer but because that’s how we get through what remains and keep our guard up as necessary. It’s also realistic—reflecting the genuine increased safety for the vaccinated.
Public-health agencies should immediately start providing expanded information to vaccinated people so they can make informed decisions about private behavior. This is justified by the encouraging data, and a great way to get the word out on how wonderful these vaccines really are. The delay itself has great human costs, especially for those among the elderly who have been isolated for so long.
Public-health authorities should also be louder and more explicit about the next steps, giving us guidelines for when we can expect easing in rules for public behavior as well. We need the exit strategy spelled out—but with graduated, targeted measures rather than a one-size-fits-all message. We need to let people know that getting a vaccine will almost immediately change their lives for the better, and why, and also when and how increased vaccination will change more than their individual risks and opportunities, and see us out of this pandemic.
We should encourage people to dream about the end of this pandemic by talking about it more, and more concretely: the numbers, hows, and whys. Offering clear guidance on how this will end can help strengthen people’s resolve to endure whatever is necessary for the moment—even if they are still unvaccinated—by building warranted and realistic anticipation of the pandemic’s end.
Hope will get us through this. And one day soon, you’ll be able to hop off the subway on your way to a concert, pick up a newspaper, and find the triumphant headline: “COVID Routed!”
Zeynep Tufekci is a contributing writer at The Atlantic and an associate professor at the University of North Carolina. She studies the interaction between digital technology, artificial intelligence, and society.
Many scientists are expecting another rise in infections. But this time the surge will be blunted by vaccines and, hopefully, widespread caution. By summer, Americans may be looking at a return to normal life.
Published Feb. 25, 2021Updated Feb. 26, 2021, 12:07 a.m. ET
Across the United States, and the world, the coronavirus seems to be loosening its stranglehold. The deadly curve of cases, hospitalizations and deaths has yo-yoed before, but never has it plunged so steeply and so fast.
Is this it, then? Is this the beginning of the end? After a year of being pummeled by grim statistics and scolded for wanting human contact, many Americans feel a long-promised deliverance is at hand.
Americans will win against the virus and regain many aspects of their pre-pandemic lives, most scientists now believe. Of the 21 interviewed for this article, all were optimistic that the worst of the pandemic is past. This summer, they said, life may begin to seem normal again.
But — of course, there’s always a but — researchers are also worried that Americans, so close to the finish line, may once again underestimate the virus.
So far, the two vaccines authorized in the United States are spectacularly effective, and after a slow start, the vaccination rollout is picking up momentum. A third vaccine is likely to be authorized shortly, adding to the nation’s supply.
But it will be many weeks before vaccinations make a dent in the pandemic. And now the virus is shape-shifting faster than expected, evolving into variants that may partly sidestep the immune system.
The latest variant was discovered in New York City only this week, and another worrisome version is spreading at a rapid pace through California. Scientists say a contagious variant first discovered in Britain will become the dominant form of the virus in the United States by the end of March.
The road back to normalcy is potholed with unknowns: how well vaccines prevent further spread of the virus; whether emerging variants remain susceptible enough to the vaccines; and how quickly the world is immunized, so as to halt further evolution of the virus.
But the greatest ambiguity is human behavior. Can Americans desperate for normalcy keep wearing masks and distancing themselves from family and friends? How much longer can communities keep businesses, offices and schools closed?
Covid-19 deaths will most likely never rise quite as precipitously as in the past, and the worst may be behind us. But if Americans let down their guard too soon — many states are already lifting restrictions — and if the variants spread in the United States as they have elsewhere, another spike in cases may well arrive in the coming weeks.
Scientists call it the fourth wave. The new variants mean “we’re essentially facing a pandemic within a pandemic,” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine.
The declines are real, but they disguise worrying trends.
The United States has now recorded 500,000 deaths amid the pandemic, a terrible milestone. As of Wednesday morning, at least 28.3 million people have been infected.
Yet the numbers are still at the horrific highs of November, scientists noted. At least 3,210 people died of Covid-19 on Wednesday alone. And there is no guarantee that these rates will continue to decrease.
“Very, very high case numbers are not a good thing, even if the trend is downward,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston. “Taking the first hint of a downward trend as a reason to reopen is how you get to even higher numbers.”
In late November, for example, Gov. Gina Raimondo of Rhode Island limited social gatherings and some commercial activities in the state. Eight days later, cases began to decline. The trend reversed eight days after the state’s pause lifted on Dec. 20.
The virus’s latest retreat in Rhode Island and most other states, experts said, results from a combination of factors: growing numbers of people with immunity to the virus, either from having been infected or from vaccination; changes in behavior in response to the surges of a few weeks ago; and a dash of seasonality — the effect of temperature and humidity on the survival of the virus.
The vaccines were first rolled out to residents of nursing homes and to the elderly, who are at highest risk of severe illness and death. That may explain some of the current decline in hospitalizations and deaths.
But young people drive the spread of the virus, and most of them have not yet been inoculated. And the bulk of the world’s vaccine supply has been bought up by wealthy nations, which have amassed one billion more doses than needed to immunize their populations.
Vaccination cannot explain why cases are dropping even in countries where not a single soul has been immunized, like Honduras, Kazakhstan or Libya. The biggest contributor to the sharp decline in infections is something more mundane, scientists say: behavioral change.
Leaders in the United States and elsewhere stepped up community restrictions after the holiday peaks. But individual choices have also been important, said Lindsay Wiley, an expert in public health law and ethics at American University in Washington.
“People voluntarily change their behavior as they see their local hospital get hit hard, as they hear about outbreaks in their area,” she said. “If that’s the reason that things are improving, then that’s something that can reverse pretty quickly, too.”
The downward curve of infections with the original coronavirus disguises an exponential rise in infections with B.1.1.7, the variant first identified in Britain, according to many researchers.
“We really are seeing two epidemic curves,” said Ashleigh Tuite, an infectious disease modeler at the University of Toronto.
The B.1.1.7 variant is thought to be more contagious and more deadly, and it is expected to become the predominant form of the virus in the United States by late March. The number of cases with the variant in the United States has risen from 76 in 12 states as of Jan. 13 to more than 1,800 in 45 states now. Actual infections may be much higher because of inadequate surveillance efforts in the United States.
Buoyed by the shrinking rates over all, however, governors are lifting restrictions across the United States and are under enormous pressure to reopen completely. Should that occur, B.1.1.7 and the other variants are likely to explode.
“Everybody is tired, and everybody wants things to open up again,” Dr. Tuite said. “Bending to political pressure right now, when things are really headed in the right direction, is going to end up costing us in the long term.”
Another wave may be coming, but it can be minimized.
Looking ahead to late March or April, the majority of scientists interviewed by The Times predicted a fourth wave of infections. But they stressed that it is not an inevitable surge, if government officials and individuals maintain precautions for a few more weeks.
A minority of experts were more sanguine, saying they expected powerful vaccines and an expanding rollout to stop the virus. And a few took the middle road.
“We’re at that crossroads, where it could go well or it could go badly,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
The vaccines have proved to be more effective than anyone could have hoped, so far preventing serious illness and death in nearly all recipients. At present, about 1.4 million Americans are vaccinated each day. More than 45 million Americans have received at least one dose.
A team of researchers at Fred Hutchinson Cancer Research Center in Seattle tried to calculate the number of vaccinations required per day to avoid a fourth wave. In a model completed before the variants surfaced, the scientists estimated that vaccinating just one million Americans a day would limit the magnitude of the fourth wave.
“But the new variants completely changed that,” said Dr. Joshua T. Schiffer, an infectious disease specialist who led the study. “It’s just very challenging scientifically — the ground is shifting very, very quickly.”
Natalie Dean, a biostatistician at the University of Florida, described herself as “a little more optimistic” than many other researchers. “We would be silly to undersell the vaccines,” she said, noting that they are effective against the fast-spreading B.1.1.7 variant.
But Dr. Dean worried about the forms of the virus detected in South Africa and Brazil that seem less vulnerable to the vaccines made by Pfizer and Moderna. (On Wednesday, Johnson & Johnson reported that its vaccine was relatively effective against the variant found in South Africa.)
About 50 infections with those two variants have been identified in the United States, but that could change. Because of the variants, scientists do not know how many people who were infected and had recovered are now vulnerable to reinfection.
South Africa and Brazil have reported reinfections with the new variants among people who had recovered from infections with the original version of the virus.
“That makes it a lot harder to say, ‘If we were to get to this level of vaccinations, we’d probably be OK,’” said Sarah Cobey, an evolutionary biologist at the University of Chicago.
Yet the biggest unknown is human behavior, experts said. The sharp drop in cases now may lead to complacency about masks and distancing, and to a wholesale lifting of restrictions on indoor dining, sporting events and more. Or … not.
“The single biggest lesson I’ve learned during the pandemic is that epidemiological modeling struggles with prediction, because so much of it depends on human behavioral factors,” said Carl Bergstrom, a biologist at the University of Washington in Seattle.
Taking into account the counterbalancing rises in both vaccinations and variants, along with the high likelihood that people will stop taking precautions, a fourth wave is highly likely this spring, the majority of experts told The Times.
Kristian Andersen, a virologist at the Scripps Research Institute in San Diego, said he was confident that the number of cases will continue to decline, then plateau in about a month. After mid-March, the curve in new cases will swing upward again.
In early to mid-April, “we’re going to start seeing hospitalizations go up,” he said. “It’s just a question of how much.”
Summer will feel like summer again, sort of.
Now the good news.
Despite the uncertainties, the experts predict that the last surge will subside in the United States sometime in the early summer. If the Biden administration can keep its promise to immunize every American adult by the end of the summer, the variants should be no match for the vaccines.
Combine vaccination with natural immunity and the human tendency to head outdoors as weather warms, and “it may not be exactly herd immunity, but maybe it’s sufficient to prevent any large outbreaks,” said Youyang Gu, an independent data scientist, who created some of the most prescient models of the pandemic.
Infections will continue to drop. More important, hospitalizations and deaths will fall to negligible levels — enough, hopefully, to reopen the country.
“Sometimes people lose vision of the fact that vaccines prevent hospitalization and death, which is really actually what most people care about,” said Stefan Baral, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
Even as the virus begins its swoon, people may still need to wear masks in public places and maintain social distance, because a significant percent of the population — including children — will not be immunized.
“Assuming that we keep a close eye on things in the summer and don’t go crazy, I think that we could look forward to a summer that is looking more normal, but hopefully in a way that is more carefully monitored than last summer,” said Emma Hodcroft, a molecular epidemiologist at the University of Bern in Switzerland.
Imagine: Groups of vaccinated people will be able to get together for barbecues and play dates, without fear of infecting one another. Beaches, parks and playgrounds will be full of mask-free people. Indoor dining will return, along with movie theaters, bowling alleys and shopping malls — although they may still require masks.
The virus will still be circulating, but the extent will depend in part on how well vaccines prevent not just illness and death, but also transmission. The data on whether vaccines stop the spread of the disease are encouraging, but immunization is unlikely to block transmission entirely.
“It’s not zero and it’s not 100 — exactly where that number is will be important,” said Shweta Bansal, an infectious disease modeler at Georgetown University. “It needs to be pretty darn high for us to be able to get away with vaccinating anything below 100 percent of the population, so that’s definitely something we’re watching.”
Over the long term — say, a year from now, when all the adults and children in the United States who want a vaccine have received them — will this virus finally be behind us?
Every expert interviewed by The Times said no. Even after the vast majority of the American population has been immunized, the virus will continue to pop up in clusters, taking advantage of pockets of vulnerability. Years from now, the coronavirus may be an annoyance, circulating at low levels, causing modest colds.
Many scientists said their greatest worry post-pandemic was that new variants may turn out to be significantly less susceptible to the vaccines. Billions of people worldwide will remain unprotected, and each infection gives the virus new opportunities to mutate.
“We won’t have useless vaccines. We might have slightly less good vaccines than we have at the moment,” said Andrew Read, an evolutionary microbiologist at Penn State University. “That’s not the end of the world, because we have really good vaccines right now.”
For now, every one of us can help by continuing to be careful for just a few more months, until the curve permanently flattens.
“Just hang in there a little bit longer,” Dr. Tuite said. “There’s a lot of optimism and hope, but I think we need to be prepared for the fact that the next several months are likely to continue to be difficult.”