Medical Examiner

How Should We Think About a Return to “Normal”?

People standing in a circle toasting with glasses of wine
Kelsey Chance/Unsplash

Listen to Political Gabfest:

There is a fascinating, frustrating debate on the left, or maybe just on the left Twitter, about whether people on the left—some named suspects are the New York Times’ David Leonhardt, economist Emily Oster, and writer Matt Yglesias—are too cavalierly calling for a return to normal life in vaccinated and blue America. Science, Leonhardt recently said, “argues for living your life in a way that reflects that you’ve been vaccinated.” The sentiment generated considerable pushback.

The Political Gabfest was joined on Thursday’s episode by Joseph Allen, who’s an associate professor at the Harvard T.H. Chan School of Public Health and director of its Healthy Buildings program. Allen recently wrote an op-ed for the Washington Post about the four factors the government should use to determine when to lift pandemic restrictions. Allen spoke with David Plotz, Emily Bazelon, and John Dickerson about his article and what it might mean to get back to normal. What is “normal” now? How would we measure it? And is it really time to talk about that? The conversation has been transcribed, condensed, and lightly edited for clarity.

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David Plotz: What does it even mean to get back to normal? Is there a normal to get back to, given how much the world has changed?

Joseph Allen: It’s been unnecessarily contentious, a lot of these debates. And I think it’s understandable that people feel differently about where we are in the pandemic, when to loosen controls, when to put them back. We’ve been white-knuckling for two years. Some people are ready to let go if they’ve been vaccinated, boosted, feel comfortable. Others are holding on tight. That’s totally understandable.

To your point about, what’s normal? We’re never going back to quote-unquote “normal” or 2019, right? Pandemics, like other disasters, fundamentally change societies. And we can actually use that to propel us to a better normal than we had. But at the same time, to think we’re not all fundamentally altered I think would be a mistake. And so my article was just about how do we know … or what data sources do we use for decision-making? So we know when it’s OK to pull back from controls, and when we might have to re-up them.

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We’ve stayed on red alert too long. Too many people are saying, “I’m done with this.” Their frustration is understandable. But we can use data actually to inform decision-making.

Plotz: Can you quickly just tell us the four factors that you said we should look at?

Allen: I think it’s four underutilized metrics. The first is the wastewater data. This is the data that we just sample from the water. Look, we shed this virus. When we go to the bathroom, it’s in our stool. So it’s a great unbiased metric.

Two, we should be looking at health care capacity. This is important, particularly for governors and mayors that are managing these large societal-collapse-type problems through a pandemic. So how much capacity do we have? Are we about to overrun?

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Three, an important measure that’s been overlooked, I think, is this question of, are you in the hospital due to COVID? You’re sick with COVID, it put you there, and that’s what you’re being treated for. Or did you show up at the hospital for something else, but because of routine screening, they detect it?

And the fourth measure is one that I’ve been harping on for a really long time. And that’s using risk-based analysis in our decision-making. So the two biggest determinants with risk are vaccination status and age. Yet, look at our policies, we barely incorporate that into decision-making. The most strict controls right now are on kids that have the lowest risk.

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John Dickerson: Should school capacity be included in your metrics as well? In other words, there are times when schools are so overburdened because people are out because you just don’t have enough substitute teachers. Which is a slightly different problem—it seems more like the hospital capacity thing. Would it be wise or instructive to add a school capacity metric in this new approach?

Allen: Well, I think kids have to be in school. I think closing schools will go down as one of the biggest mistakes of the entire pandemic. I don’t think there’s a question about that—it was a mistake. So the best metric you can track for how to keep people safe in school? Get all the adults vaccinated and boosted. There should be a mandate. And same thing for child care.

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Emily Bazelon: One of the other specific ideas that you have for this next phase is this idea that if you are concerned about your own risk, you can keep wearing a mask. Particularly an N95 mask, which gives lots of protection. I am latched onto this, I think, because it seems like a way out of the current norm of everyone wearing a mask, especially in school and university settings, which I think is hard on the kids who are at much less risk. And it’s different than how we thought about masking in the beginning of the pandemic.

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Allen: Masks definitely work. And that gives you protection regardless of what others around you are doing. That’s a key message. If you don’t feel safe going to the grocery store because some district said we’re going to pull back from masking, well, get vaccinated, get boosted. By all means, wear your high-grade mask.

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And this one-way masking with an N95, that’s about as low-risk as you can get. Look, I’m a certified industrial hygienist. I have set up programs and control programs and set up PPE, personal protective equipment controls. So fully understand masking. Good masks can protect you. And it doesn’t necessarily matter what others around you are doing.

Bazelon: Is that true for immunocompromised people?

Allen: Yes, absolutely. The N95 has a minimum effectiveness of 95 percent, if you focus on the two F’s, filtration and fit. N95 means it’s 95 percent effective at filtering. But you want to make sure that all the air is going through that filter, so you focus on the second F, the fit. Tight around your nose, flush against the face, under your chin.

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Plotz: How do we have a better debate about the return to normal?

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Allen: Maybe the first thing to do is we should stop pretending it’s such a clear dichotomy. It’s not right to say let it rip and anybody could do whatever the heck they want to do. It’s also not right to say we’re going to shutter things down again and pursue zero COVID.

It’s a false dichotomy. We have to protect the public, and we have the tools to also let people get back to some aspects of their life. A fundamental tenet of public health is that health is more than the absence of disease, right? We’ve been doing a disease avoidance for two years. Of course, that’s critically important, but there’s so much more to health. There’s well-being. There’s thriving. There’s kids being in school, socialization, learning. All of these other factors are really important. And I think we’ve treated it as all or nothing on either side.

Recognizing that the risk has changed for people who are vaccinated, and particularly vaccinated and boosted, doesn’t mean that we stop doing all the other things we need to do in public health. We continue to work hard to get the unvaccinated vaccinated. That’s the single biggest problem.

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