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The story of many pandemics: the third year, a question of status and access

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Charletta Brown hasn’t had access to the same luxury or flexibility that some Americans enjoy during the coronavirus pandemic. She went to work every day, facing repeated potential exposures. She is a breast cancer survivor on maintenance chemotherapy, which puts her at higher risk for serious infection.

The pandemic endured by Brown, 56, is very different from the pandemic experienced by affluent and relatively healthy Americans with flexible work situations. As a customer service representative at the Acme grocery store in Trooper, Pennsylvania, she cannot work from home. She has limited paid time off if she’s exposed to the virus and, if she gets sick, doesn’t know where to get the antivirals that the federal government says are plentiful.

“There are so many of us here, and we want our voices to be heard and people to understand that for us, we need to be here, this is how we take care of our families,” Brown said. “We have to step in and deal with that when the numbers go up.”

At this precarious moment of the pandemic – with cases relatively low but about to rise again – the reality is that people are experiencing many different pandemics depending on their job, health, socio-economic status , their housing and their access to medical care.

For people who are healthy and have safe housing, medical care and paid time off, the pandemic has largely become manageable in its third year. Vaccinations and boosters mean they are at a low risk of hospitalization or death, and they can probably find very effective antivirals if they get sick.

But for millions of Americans, the pandemic remains an ever-present threat to their lives and livelihoods. They are immunocompromised or at higher risk of serious illness, unable to take paid time off or work from home, and struggle to make ends meet. And while vaccinations are free and accessible, other tools — including rapid tests, N95 masks and antivirals — may be out of reach due to cost or accessibility.

“It has always been the story of two pandemics. For some people the pandemic has been an inconvenience, while for others the pandemic has resulted in significant worry and loss,” said Mercedes Carnethon, professor and vice chair of preventive medicine at the Feinberg School of Medicine. from Northwestern University.

“I don’t foresee much positive movement over the next few weeks unless the bottom drops like it did in December and there are infrastructure issues. … Those who are not suffering will not be willing to make changes to protect those who are vulnerable,” Carnethon said.

As cases rise again in many parts of the country, driven by the highly transmissible omicron subvariant BA.2, there is little agreement on whether to reimpose restrictions such as mask mandates and whether Americans will be ready to follow after more than two years of living in the pandemic. Few elected leaders possess the political appetite or will to demand masks and other public health measures, arguing that people now have the tools to protect themselves against the virus and should be left to their own best judgment.

The spread of new, highly transmissible versions of the omicron variant in New York State and Europe adds to the uncertainty. New York State officials announced on Wednesday that two new omicron subvariants, dubbed BA.2.12 and BA.2.12.1, have emerged as the dominant forms of the coronavirus in central New York. ‘State. For weeks, infection rates in central New York have been at least double the state average, according to state health department data.

Government officials and experts are eagerly watching the national case tally and hoping it doesn’t explode in a new wave.

But they know there is a powder keg of risk factors. Most mask mandates and other public health restrictions have been lifted. Easter, Passover and Ramadan – holidays all marked by large festive gatherings – are converging this month, long-delayed weddings have resumed and there is a general and growing desire to return to a pre-pandemic normal.

At least one major city, Philadelphia, has reinstated its mask mandate in public spaces, but this is an exception. Guidelines from the Centers for Disease Control and Prevention would not suggest an indoor mask mandate for this city, but Philadelphia leaders said their decision was justified by a modest increase in cases associated with a legacy of health disparities that foreshadow worse public health consequences for Black and Brown communities.

Even if cases rise, few political leaders, including Democrats, are likely to follow Philadelphia’s lead and reimpose restrictions, political strategists said. Polls show a sharp decline in public support for mask mandates and a decline in support for governors’ handling of the pandemic more broadly across both parties.

A Monmouth University poll in March found that 34% of Americans favor introducing or reinstating mask and social distancing guidelines in their state, up from 52% in January, 55% in December and 63% in September, when the delta wave swept over the country.

Monmouth’s national polls also asked people to rate their governor’s performance during the pandemic. In March, 59% said their governor was doing a good job, higher than 53% for federal health agencies and 49% for President Biden. Governor ratings are down from a peak of 73% in May 2020, but have remained in favorable territory for almost all of the past two years.

A Democratic consultant said most Democratic governors would be unwilling to reimpose any kind of term because they believed voters could protect themselves if they wished. Politicians also fear backlash from an exhausted public that in many cases is ready to live with the risks presented by the virus.

“People are burnt out, and people have psychologically, whether we think it’s good policy or not, they’ve moved on,” said the consultant, who spoke on condition of anonymity to speak. frankly. “I don’t think there’s a political appetite to get into a mandate situation. … I’m not sure with a depleted America there’s any appetite on the pitch, quite frankly.

For someone like Brown, that exhaustion means she’s in perpetual danger.

“I know I’m always at risk and unfortunately unless everyone does their part and has that mentality, I don’t know if we’ll ever be at risk,” said Brown, who also said to have to protect themselves because extended family members are not vaccinated. “Am I afraid? No. I got used to it: the feeling of knowing that today could be the day I catch the virus.

“Devastating and life changing”

The disparities of the pandemic were on full display after an outbreak at an elite dinner in Washington this month. Dozens of people, including Biden cabinet officials, members of Congress and journalists, tested positive after the Gridiron Dinner, creating anxiety across Washington that the virus was on the move again.

But none of these people have been hospitalized and almost all of them appear to have had mild cases. (The hotel that hosted the dinner declined to say how many of its staff were infected.) It’s unclear how many, if any, had access to antivirals to help treat their infections. , but most, if not all, would have had the access and knowledge to obtain the highly effective drugs.

Across the country, however, access to monoclonal antibodies and the Pfizer antiviral drug Paxlovid is scattered at best, though federal authorities say supply is plentiful. The availability of these effective drugs has given state and federal officials confidence that the virus is more manageable. But the ability to get the drugs after an infection depends on having reliable medical care, knowing how to navigate the healthcare system, and knowing that the drugs are available in the first place.

“You can have therapy that works effectively under ideal circumstances. The effectiveness of this therapy can get lost when you have to broadcast it and put it in a real environment,” Northwestern’s Carnethon said.

The pandemic, she said, is an “inconvenience” for people with resources and knowledge. “For people without it,” Carnethon said, “it remains devastating and life changing.”

Inside the emergency room at Kent Hospital in Rhode Island, Laura Forman witnessed the disparities of the pandemic play out in often devastating ways.

She sees people who are afraid of testing positive because it means they lack work and income. She has seen homeless people who test positive and be discharged because there were too few emergency room beds, but then leave the hospital with no resources to manage their infection.

“It’s hard to figure out how to protect people from that in a society that doesn’t offer them those protections. People think we all have equal protection against this and we don’t,” said Forman, the hospital’s chief of emergency medicine.

Eleanor Mayfield is well aware of her luck. A freelance medical writer who has worked from home for 30 years, Mayfield and her husband, both in their 60s, have been able to protect themselves when cases rise and, when cases drop, like to go out – with precautions. The biggest change for Mayfield was that her college professor husband also started working from home. Although they worry about the risk of long covid, neither have underlying conditions that put them at increased risk of serious illness.

She is also convinced that they could get antivirals if they were infected.

“We’re lucky in that … we have good health insurance and pretty easy access to doctors,” Mayfield said. “I’m very grateful.”

For Carolina DeVriendt, a coronavirus infection or even the need to quarantine is very disruptive. She teaches third grade in Rockville, Maryland, and has four children of her own. When she contracted the coronavirus in October, she was still teaching virtually.

DeVriendt also has a niece who received a liver transplant and is on immunosuppressive drugs.

“I always keep in mind, what would people do if they were in her situation, and what would be in her best interest?” said DeVriendt. “It breaks my heart that privilege or comfort trumps intelligence.”

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