Confidence in public health has eroded because we’ve been too slow to adapt the steps we take to changing notions of risk. Some people are adopting their own measures to reduce their risk and voluntarily choosing to avoid congregate settings, wear masks, and take other precautions. Many people are excessively vulnerable to COVID-19 because of age or health conditions, and those who remain worried should have access to tools and support to keep safe. There’s understandable apprehension among parents torn between fears of the virus and the steps to keep kids safe, especially toddlers. But for those who feel more confident about the declining risks, we can only ask so much of the public for so long. There is an amassed effect from the disruptions. People are exhausted. Livelihoods and people’s mental health have been hurt by the diminished lives we’ve had to compromise around. Many children haven’t known a normal school day for two years. The constant disruptions take a cumulative toll. We never agreed that the costs can outweigh the benefits. The problem is we have no way of measuring these trade-offs, and no framework for deciding when to turn things on and, equally important, turn them off.

Take the debate over pandemic and endemic. There’s no clear nomenclature for what it will mean when the virus becomes a persistent but manageable risk that doesn’t dominate our lives. Public-health leaders have different definitions of what it means when the pandemic gives way to an endemic state, where COVID-19 is part of the predictable repertoire of circulating pathogens. The simplest way to define that transition is when constant waves of excessive infection no longer plague the country, and COVID-19 settles into a more predictable pattern that follows the seasons. Some, including me, think that 2022 will be the year that we make this transition. Others still rate as high the risk that another unexpected variant emerges and wrecks that forecast.