We're still not taking the pandemic seriously

20 months after pandemic lockdowns first began in the U.S., government institutions and the public are still struggling to manage COVID-19 as the emergency it is.

Why it matters: Past crises, from the Great Depression to 9/11, led to lasting changes in American society and governance. But institutional inflexibility has left us at risk of further COVID waves and disruption and unprepared for the inevitable next pandemic.

Driving the news: On Friday, the FDA endorsed booster shots of the Pfizer-BioNTech and Moderna COVID-19 vaccines for anyone 18 and over.

• That will increase the number of Americans eligible for a booster by tens of millions, but it comes after a number of experts called for the FDA to speed up widespread booster approval and after several states were already moving on their own to expand eligibility.
• It will also come too late for Americans getting a booster now to have that added protection by the Thanksgiving holiday next week, as it takes one to two weeks for the full effect. COVID cases have risen 20% in the U.S. over the past two weeks.

The big picture: The delay and confusion around booster eligibility is just one example of the institutional inflexibility that has hobbled the U.S. pandemic response beyond better-known problems of political polarization and vaccine refusal.

• Despite clear evidence of the drawbacks of remote education, Detroit public schools this week announced students would go remote on Fridays in December in an effort to reduce COVID outbreaks.
• Part of the justification for the switch was to provide more time for deep cleaning facilities, even though it has long been clear the risk of contracting the virus from surfaces is low.
• Some government officials are recommending Americans who have family and friends over for indoor Thanksgiving celebrations remain masked and socially distant — advice that seems both unrealistic and outdated at this point.

Between the lines: Nowhere has the institutional conservatism toward COVID held back the U.S. more than around testing.

• While the vaccines are excellent at blunting sickness and death — and spread to a somewhat lesser degree — frequent and rapid diagnostics can identify the sick when they are contagious, making the tests the most highly effective and targeted public health tool in our arsenal.

Yes, but: Though rapid diagnostics are now more available, they still cost as much as $12 per test — far higher than in countries like Germany and the U.K. that have rolled them out widely with government support — and too high for most people to do regular screening.

• The FDA's decision to evaluate rapid antigen tests as medical devices rather than public health tools greatly slowed their rollout and increased their cost, Michael Mina, a former Harvard epidemiologist who just became chief scientific officer at the biotech software company eMed, told me recently.
• "The fault really lies in not having the wherewithal to say that this is a public health crisis," he said. "We don't have a strategy or even a legal infrastructure to talk about tests as a public health tool."

Context: There are many reasons the U.S., despite its wealth and expertise, has one of the highest COVID death rates in the world — not least an entrenched and politically polarized antivax movement, fueled in part by social media, that has helped keep full vaccination rates in the U.S. below poorer countries like Ecuador and Sri Lanka.

• But institutions and experts have also been slow to adjust to a changing reality, sticking to policies even after real-world evidence has undercut them — like the initial discouragement of mask wearing — and ignoring newer, more targeted interventions like widespread rapid testing.
• "The pandemic has proved to be a nearly two-year stress test that the United States flunked," sociologist Zeynep Tufekci wrote in the New York Times. As a result, when it comes to institutional trust, "America is bankrupt."

What to watch: What if any institutional changes come out of the pandemic.

• The Great Depression brought forth the New Deal, WWII the postwar system of Western alliances and international agencies, and 9/11 brought the Department of Homeland Security.
• None were perfect, but the magnitude of the responses underscored a belief that once-in-a-generation crises demand once-in-a-generation change.
• But there's little indication the pandemic will cause us to fundamentally rethink how to respond to health threats. Current legislative plans call for $10 billion in new funding for public health and pandemic planning, less than what the Biden administration originally wanted and far less than what experts have called for.

The bottom line: The nearly 800,000 Americans who've died so far from COVID-19 are proof we've lost this pandemic, but if the U.S. finally exits it without fundamental change, it'll be set up to lose the next one.