People are tired of the pandemic, and they really, really want to know when it can stop. There has been a lot of talk in the media about “needing off-ramps.” This refers to having concrete metrics that signal when it is time to get rid of one bothersome safety measures or another, like masks, testing requirements, or capacity restrictions. We are on the highway of pandemic restrictions, this thinking goes, and in order to endure one more second of this car ride, we need to at least know when we will be allowed to get off at an exit, presumably to our destination of “normal.”
The proposed exit is often “soon.” In May, experts called for mask mandates to be reversed once adults had a fair chance to get vaccinated. A recent opinion piece in the New York Times also echoes that rhetoric, for children–some experts believe now that kids can get vaccinated, it is time to consider when we can get rid of masks in schools. Off-ramps have been discussed when it comes to routine asymptomatic testing; they’ve been posed as a salve for Americans who are just tired of following rules.
Reading these pieces, you would get the impression that the pandemic is more or less uniformly over in the United States—that our hospitalizations, cases, and deaths are all at low levels, that we have achieved a high rate of vaccination, and that these cumbersome restrictions nonetheless continue to be in place nationwide. None of this is true, nor is it close to being true. The U.S. continues to consistently be No. 1 in daily cases, deaths, and the amount of people hospitalized with COVID. We have a much lower vaccination rate than other Western nations. Only about six states maintain state wide mandates, along with some cities (especially those in California); but by and large, mask mandates are not a thing in much of the country. Large gatherings are continuing. Concerts and stadiums (indoor ones!) are filled to the brim. And now there’s worry over a new variant of the virus, Omicron. The variant was identified last week, after all those pieces about off-ramps were written—and while we won’t know for weeks the extent to which Omicron will be a concern, its presence makes clear that we’re hardly done with the twists and turns of the pandemic.
Beyond appearing in articles that are a bit out of touch, the off-ramp analogy itself poses a few problems. First, an “off-ramp”—or any discussion of ending a particular restriction—implies a fixed destination, one that could be located on a static map. The most commonly proposed point at which adults or kids can stop masking is simply a date, usually a few weeks after the vaccine has become approved and made available to those groups. This thinking ignores all realities on the ground in terms of infections, hospitalizations, vaccinations, and variants. It applies an individual responsibility framework that has failed consistently throughout this pandemic and ignores the safety of anyone who is unable to get vaccinated by a deadline, or who might not be protected by the vaccine for medical reasons. It ignores the fact that the situation with the virus can change: It’s no wonder that after advising that vaccinated adults not longer had to wear masks this summer, the Centers for Disease Control and Prevention had to quickly reverse its position.
OK, so why not base the off-ramps on local levels of cases? This is the second issue with the framing: It treats the removal of restrictions as a final destination. Once you go barreling down the exit ramp, there is no looping back around to return to the highway, at least not without significant confusion and some yelling from the back seat. And make no mistake, getting back on the highway of restrictions is, for the foreseeable future, inevitable: Local cases in a global pandemic don’t stay low forever, especially if you remove masking. This is the case in Denmark which got rid of all restrictions in September and is now considering reimposing them. The provinces of British Columbia and Alberta got rid of their mask mandates over the summer, only to reimpose them after a rise in cases. Germany, which has only fully vaccinated 67 percent of its citizens got rid of free testing in October—only to bring free testing back after a rise in cases and hospitalizations.
I do not mean to say that we should be simply masking forever, or even that we will need to do it consistently for the next few years. But I think that there are better ways for us to communicate a shift in advice, ones that take into account the likelihood that, as long as the pandemic is still happening, things will very likely shift again in the near future. In Nevada, for instance, the mask mandate acts like a switch—it flicks on when cases are high and turns off when cases are low. We could improve on this model by introducing the traffic light, which provides us with an additional warning period when cases are starting to tick up to stop them from rising further. Green periods would mean that it’s OK to not wear a mask (but it remains recommended in public crowded settings—why not mask up in Target, if it means you can more safely go maskless when socializing?). In yellow periods, people would start wearing masks in every indoor setting, as well as brace for a potential increase in restrictions. During red periods, people would be told to wear a mask and not gather in large groups. This metaphor’s usefulness is not limited to masking. It also could help inform testing frequency for businesses and educational institutions; testing for the unvaccinated during green, weekly testing for all during yellow, and daily testing during red. The traffic light communicates the fact that cases (and therefore restrictions) can always change. (Some have said that using case numbers for restrictions is a problematic metric because if everyone is vaccinated it may not lead to a rise in hospitalizations and deaths. This is a good point, but it requires answering some questions about what those other numbers should look like.)
The traffic light is easy to communicate and easy to display publicly and in businesses. You could imagine such a graphic being displayed on windows and doors, on the TV alongside the day’s weather, or through a widget or app on your phone. Even if a state refuses to enact a mask mandate for political reasons, communicating a traffic light warning system would help individuals assess and understand risk a lot faster than the current setup, which involves looking at the CDC map of counties of high transmission. Traffic lights take transmission levels into consideration, but they communicate how people should act, which is what people actually need to know, without doing any kind of extra interpretation on their own. And sure, let pundits bemoan and discuss the current traffic light status—hopefully, it will make the conversation around restrictions more accurate and nuanced.
Obviously, the thought of living through such a warning system in perpetuity is exhausting. There is one off-ramp we do legitimately need, and that is an off-ramp to the entire pandemic. This will happen when the disease becomes endemic. What an endemic virus looks like is not a basic fact of biology; it is largely up to public health authorities. To agree on when the virus will be endemic, we need clear metrics on what an endemic phase of COVID will look like. How many hospitalized and deaths will be considered low enough to be endemic? What does the symptomatology of mild breakthrough COVID look like right now and are there any long-term issues? How common are breakthroughs, really? How many people globally need to be vaccinated before the virus truly becomes a “mild flu”–like illness? When can all disabled and immunocompromised people leave their homes and safely interact with people? These are the questions that must be answered in order to determine when we can finally take an off-ramp from the pandemic. In the meantime, we’re still on the highway, with more than a thousand people dying each day whether we accept that fact or not.