DANIEL ESTRIN, HOST:

COVID is still here, folks. Despite the vaccine rollouts, the boosters, the second boosters, these last few weeks, daily infections in the U.S. have been at about 130,000 cases a day, which leaves many of us wondering, are we going to need to live like this forever? Andy Slavitt has been thinking about that question, and he offers some answers in an essay in The Atlantic this week. Slavitt was a senior COVID adviser in the Biden administration. He also served as acting administrator of the Centers for Medicare and Medicaid under President Obama. Andy Slavitt, thank you for being here.

ANDY SLAVITT: It's great to be here.

ESTRIN: So you just had COVID, I understand. How are you feeling?

SLAVITT: It finally got me. You know, I've been vaccinated, and I got the monoclonal antibodies. And I felt better in about five or six days, so I'm very fortunate.

ESTRIN: Do you know where you got it?

SLAVITT: It's a bit of a mystery other than to say that I think, you know, BA.5, the current variant we have, can find holes in anybody's story. It's a pretty aggressive variant, as we all know.

ESTRIN: So how would you describe this weird moment we're in? I mean, in your essay, you call it a pandemic rut.

SLAVITT: Well, I think we're just in this extended period of time where for many people, it feels like they can't answer the question, how is this going to improve? How is this going to get better? What's going to change? We're in this state that's, you know, still a pandemic, not quite an endemic. But there is a consistency to it, which is, you know, in the U.S., at least 500 or so, 400 to 500 people a day dying. It's constantly around us. And even if it doesn't kill us, it keeps us out of work, keeps us out of school, disrupts our social life. And people don't really see the scenarios under which that's likely to change.

ESTRIN: Well, your essay is called "The Three COVID Developments I'm Still Holding Out Hope For." So hope is a good word. Let's talk about those three things. First of all, you say that the unpredictability of the virus could - well, the virus could mutate in more predictable ways. So what would that look like?

SLAVITT: Well, if this virus were - it had exactly the same properties, but it only visited us, say, once a year, it would be remarkably different situation. It would mean that we could plan our lives. It would mean that, like the flu, we could get an annual update based on the local variant. Right now, it's very hard to do that because the variant changes month to month, and so you don't necessarily get the booster right. It would mean that people who are immunocompromised or older or frailer could at least spend much of the year not in fear, and so that's a scenario that's hard to foresee right now. But many of the scenarios that have happened to us, many of the things that have changed have been very difficult to see in advance. And that's one of the things that I think would cause us to feel significantly better than we do today.

ESTRIN: Yeah. I mean, predictability would be nice, but how likely is it that the virus would become more predictable?

SLAVITT: You know, we just don't know enough about that - this virus. And when I ask the question to scientists, they continue to say one common thing, which is we are continually surprised. This virus fights for survival, on the one hand. On the other hand, the situations which cause it to multiply so quickly change all the time, and they change in some pretty random ways. So it is not something that I think you could predict today based upon the data. But that doesn't mean that it's not something that is a real possibility.

ESTRIN: The second possibility that you're hoping for is stronger herd immunity. So what do you imagine that looking like? Would people still get COVID, or would the virus just be less deadly?

SLAVITT: Well, really, the second scenario is that the continued strength of vaccines and the multiple occasions when people have had prior infections continue to accumulate to a point where, yes, COVID circulates frequently, but it becomes less and less relevant because the symptoms just get less and less. And this is something that I think some people mistakenly believe is already happening or is destined to happen. You know, I don't think a situation where we have as much disruption as we have today is a great steady-state scenario. But over time, the body and science together could make this much, much more of a non-even. I still think that, like the flu, for people who are in otherwise bad health or frailer, you know, this will represent a threat. But over time, this could look more and more like the other coronavirus that we're familiar with, which is the common cold. And that's the second scenario that I think has some real potential.

ESTRIN: Well, the last idea that you outline in your piece is, quote, "science could win." So what do you mean by science could win?

SLAVITT: Well, look, I think we're - science has had some big wins against COVID-19, no doubt about it. We had millions of people dying, and now we have thousands. Millions of lives have been saved from the vaccine. We've got great therapeutics, monoclonal antibodies, things like Paxlovid. But still, it's not been enough to keep the virus from circulating. And for science to win, I think we're talking about a transformational type of scientific discovery. And the one that I was most fixated on in this piece and what I'm most excited about is a nasal vaccine. The reason I'm excited about a nasal vaccine is because if you can picture a nasal vaccine...

ESTRIN: We're not talking about a needle in the in the nostril, I hope, Andy.

SLAVITT: No, no. We're talking about something you'd inhale...

ESTRIN: Yeah.

SLAVITT: ...In the nose and would create what's called mucosal immunity. And that would actually be a vaccine that could actually prevent the virus from actually infecting you in the first place. And you can imagine a very easy-to-take nasal vaccine that can be easily distributed around the world, low cost. It could make it very difficult for the virus to continue to even infect people. And so that's the type of breakthrough where the virus wouldn't even be able to infect us in the first place that, I think could be in the cards. And when one of those comes on the market. It could be a dramatic alteration of the current course and speed of the pandemic.

ESTRIN: Andy Slavitt, thank you so much for joining us.

SLAVITT: Great to be here.

ESTRIN: Andy Slavitt is a former White House adviser on COVID and the author of "Preventable: The Inside Story Of How Leadership Failures, Politics And Selfishness Doomed The U.S. Coronavirus Response." Transcript provided by NPR, Copyright NPR.