Is New York City the future of a post-pandemic world?

In Portugal and other places Covid-19 is "endemic." New York may be almost there. What could that mean moving forward?

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John M. Barry, distinguished scholar at Tulane University’s School of Public Health and Tropical Medicine, told me last week in an interview on my SiriusXM program, that in the “best case scenario” Covid-19 could actually become the common cold.

“Covid-19 could develop into a virus that favors the upper respiratory tract,” Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History, explained, “and in that case you end up with the common cold.” There’s a theory, he said, that that has already happened in history, since the cold is caused by coronaviruses. The belief is that an 1889 pandemic, known as the Russian flu, was not actually an influenza at all. Rather, it was a coronavirus which today everyone has likely been infected with, and is one of those that causes a mild cold.

As Barry explained, if Covid-19 evolves to stay in the upper respiratory system and its presence in the lungs diminishes, it will no longer be a great danger. And there is evidence that the delta variant could be on that trajectory, as it produces high viral load in the upper respiratory system, which is what makes it more transmissible. But it isn’t killing people due to lung infections at a higher rate.

There is of course a worst-case scenario. “We get a variant that is significantly more dangerous [and more severe] than delta and that also has the ability to evade the immune system,” he said. “I don’t think it’s likely, but it’s possible.”

But there is an in-between, too, in which Covid-19 becomes like the flu, killing some people but at a much lower rate and only among the most vulnerable. We’d have shots regularly, like the flu, and keep the numbers low. As it is right now, looking at the Covid-19 case numbers, which have come down dramatically in recent weeks, and the deaths, Barry said, “right now it would be like a very mild influenza year.”

He does say it’s possible, even likely, we’ll see a variant that is better at evading the immune system — so, perhaps there will be more breakthrough infections among the vaccinated — but not with more severe infection or deaths.

This would be endemic Covid-19, and some researchers believe New York City will soon be there if it is not already.

In Portugal, where 98% of adults are vaccinated, Covid-19 already reached endemicity — in which it’s a manageable illness, and not a major health threat. In New York City, which has had mandates for all city workers and most indoor events, from gyms and bars to restaurants and theaters, vaccination rates have surpassed 76%. But researchers believe the terrible first wave of Covid, which devastated New York City in 2020, also created a fair amount of immunity among the unvaccinated when other waves hit.

“We’re seeing it more as a chronic problem than as an immediate, huge pandemic problem like we were before,” Mangala Narasimhan, a critical-care pulmonologist and director of critical-care services at Northwell Health, told the Wall Street Journal last week, discussing New York City.

“New York and New Jersey are going to be in the U.S. where I would look first for the transition to endemicity,” or the point when the virus is still circulating in the background, but the disease is more manageable, Andrew Noymer, an infectious-disease epidemiologist and demographer at the University of California, Irvine, told the paper as well. Per the WSJ:

Life in the New York City area might be transitioning into a phase in which the virus is a present but diminished danger for most people, some epidemiologists and doctors say. Vaccination rates are higher than U.S. averages, and some people in the region likely have some immunity from infections during past surges. Masks are required in settings including public transit and schools, and officials mandated vaccinations for healthcare workers as well as employees and patrons at bars and restaurants.

This is a testament to enforcement of mandates and promotion of good public health by city leaders. But it’s also a testament to New Yorkers. As I wrote in September, in a piece headlined, “On Covid, we're living in two Americas. But media hasn't figured it out,” New York City has had the lowest infection rate in the entire state. And that is because the people living here have been cautious, protecting themselves and their neighbors:

Just think about that fact for a moment: New York City has the lowest positivity rate in the state and it continues to fall. This city is the largest, most densely populated city in America.

How is it possible that it has the lowest positivity rate in the state, with the highly contagious Delta variant dominating, while people in farm country have a higher rate? It’s simple: A much higher percentage of people are vaccinated, and they’re careful, while still socializing and going about their lives.

Don’t get me wrong: We have a long way to go. And as John M. Barry told me, while there is an even better-case scenario — in which Covid-19 becomes like the common cold — there is a worst-case scenario, in which a variant develops that evades the immune system and is more severe.

And as Andrew Noymer, the UC Irvine epidemiologist, told the WSJ, while the New York City area is where he’d look for the first signs of a transition to endemicity, “It’s also, quite frankly, the canary in the coal mine, conversely, if there is a significant winter wave.”

So we have to remain vigilant. But as I noted last month, New York is a place the media should be holding up for the rest of the country to emulate, as both its leaders and its residents are doing all the right things to get beyond the pandemic.

The packed crowds in Times Square and even what some might call the downsides of the comeback, like the sudden surge in the rental market — in which there are long lines and bidding wars for apartments, the likes of which hasn’t been seen in years — suggest that people feel confident about doing all the right things as well.

Let’s hope that feeling, as the scientific evidence suggests, indicates something very good will continue happening here, which can be a model for everywhere else.

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