The long tail of COVID-19

People wait in line outside the Military Hospital of Milan waiting to receive a COVID-19 vaccination in Milan on Monday, March 22, 2021. (Alessandro Grassani/The New York Times)

When the Centers for Disease Control and Prevention made an abrupt change to its guidance Thursday, stating that fully vaccinated people could stop wearing masks in most settings, it was welcomed, if not whiplash-inducing, news.

Vaccination is going relatively well in this country, although the number of people who receive a dose each day is down from its peak. And new cases, hospitalisations and deaths from the virus are decreasing.

Things could always get bad again, and the CDC could always update its guidance and reintroduce more aggressive restrictions. But right now, this moment feels to many like the beginning of the end of the pandemic. Still, even after the virus is brought under control it is still likely to have lingering effects. This is the long tail of COVID-19.

A study published last month by the Washington University School of Medicine in St. Louis, which the university says is believed to be the largest comprehensive study of long-term COVID-19 to date, found that "that COVID-19 survivors — including those not sick enough to be hospitalised — have an increased risk of death in the six months following diagnosis with the virus."

This is quite significant because more than 30 million Americans have already been infected with the virus. As the report put it, "The lingering effects of this disease will reverberate for many years and even decades."

We are seeing an extraordinary surge in gun violence in this country. As far as I can tell, evidence clearly connecting the gun violence crisis to the crisis of the virus has yet to be provided. But we do know that they are overlapping.

The Everytown for Gun Safety group issued a report earlier this month that put things into perspective this way:

"Record increases in gun sales, children homebound like never before, social isolation, and economic struggles due to COVID-19 put many people at increased risk for gun violence. In fact, 2020 was one of the deadliest years on record for the United States. Gun homicides and non-suicide-related shootings took approximately 19,300 lives, a 25% increase from 2019. While official 2020 data on all gun deaths is not yet available, an Everytown analysis of data from Gun Violence Archive reveals that gun violence-related deaths in 2020 will likely exceed 40,000, a rate of 12.3 gun deaths per 100,000 people. This translates to the highest rate of gun deaths in the last two decades."

I truly believe that we have failed to appreciate the national trauma that this pandemic has caused, much of which has been concentrated in already vulnerable communities: poor and working-class communities and Black and brown communities.

I also worry about racial disparities in COVID-19 infections and how this imbalance may become chronic. From a racial equality perspective, the way this country has dealt with HIV has not been encouraging.

The coronavirus and HIV are different from each other in countless ways. One is relatively easy to transmit and the other relatively hard. One lacks the social stigma of the other. One can kill in weeks while the other tends to kill over time. Vaccines for one are available for free, while treatments for the other can still be prohibitively expensive. But they both cause deadly infectious diseases that have hit vulnerable communities harder.

When HIV was believed to largely affect gay white men, many of them in big liberal cities and some of them famous, there was quite a bit of energy and media attention centred on finding a cure or treatment.

As treatments were developed and became widely available — including those that prevented transmission — infection rates among white people declined dramatically. So did media coverage. But at the same time, infection rates among Black people increased and still remain at epidemic proportions, even though treatments exist.

Could the same thing happen with this virus? Although there has been progress toward vaccine parity, Black and Hispanic people have received a disproportionately smaller share of vaccinations than have white people. Part of that is because of hesitancy, but part of it is also because of lack of access.

As NPR reported in April:

"While overall vaccination rates in Philadelphia are beginning to slow in the last couple of weeks, providers there — and echoed nationally — say the disparity between racial groups isn't the result of people who are hesitant to get vaccinated. Instead, they say barriers such as the location of vaccination sites, online-only sign-ups, appointment scheduling, transportation and other planning and access issues are to blame."

What will happen when the media attention fades, but the poverty and access issues don't? Will this become another chronic disease in the Black community that the media largely ignores?

I, as much as anyone, am looking forward to the moment that the country can get back to more of a pre-COVID-19 normal. But I'm also conscious of the fact that others may not be returning to normal, and that the health and well-being of many Americans may be affected by this disease long after the country declares a victory.

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