In mid-March 2020, I received a call from Judy Persichilli, the commissioner of the New Jersey Department of Health about the exploding COVID-19 pandemic. The first case in New Jersey had been reported on March 4 and cases were increasing daily. I recently had retired from my executive position at Merck vaccines, and the commissioner, hearing about my retirement, asked me to return to government service as the health department’s COVID-19 medical adviser. I jumped at the opportunity to contribute to the response to the public health emergency. It was one of the better decisions of my career in public health and medicine. 

One of my first responsibilities was to help establish a statewide COVID-19 professional advisory committee (PAC) that would advise the commissioner and Gov. Phil Murphy on how best to address the COVID-19 outbreak. The PAC consisted of former health department commissioners, leaders of major New Jersey health care professional organizations, chief executives of the major hospital systems, clinicians, ethicists and public health professionals. It was my honor to chair that PAC for the 15 months that I was back in government. During that time, the committee provided sound, deliberative advice on numerous policy issues, such as allocation of ventilators and prioritization of those who would get the initial vaccines.  

The PAC ended its tenure two years to the day of the first reported case in New Jersey. On the same day, the governor stopped his regular COVID-19-related press conferences, more than 250 of which he’d held since early 2020. At the same time, he ended the statewide school and daycare mask mandate and lifted the statewide public health emergency while maintaining the general state of emergency.  

These measures reflected the governor’s assessment that the state had achieved a steady state in managing the pandemic that was shifting into an endemic phase. There was a desire to transition from “crisis management to a more normal way of life,” and that large-scale mitigation measures and regular COVID-19 briefings were no longer needed. The governor also promised an after-action report of the state’s response to the pandemic, which is pending.  

At that last briefing, Commissioner Persichilli summarized the enormous progress that had been made since the early days of the pandemic: expansion of testing capacities; development and distribution of vaccines and treatments; improved supply chain for medical supplies; expanded disease surveillance and data analytics capacity; enhanced communication capabilities; public health infrastructure improvement and strengthened public-private sector partnerships.  

What has happened since then?  

From a disease perspective, we have seen waves of surges as new omicron variants have predominated, with cases and hospitalizations in New Jersey now approaching or better than the numbers experienced two years ago. Daily mortality has remained about the same, in the low teens or single digits. 

Vaccination rates 

Primary vaccination rates have improved across all demographics but remain low in the youngest age groups. Racial disparities persist.   

Three booster doses have been authorized and recommended but the percentage of people having received one booster, let alone three, remains far too low.  

Long COVID or post-COVID conditions have become more prevalent, impacting on quality of life and workforce participation with few answers for those affected. Research into the exact mechanism of these complications and possible treatments is ongoing. 

At the federal level, there is a move to a fall annual COVID-19 vaccination schedule with a bivalent vaccine. The Centers for Disease Control and Prevention have now incorporated COVID-19 vaccination into their routine immunization schedules.  

This, too, reflects the normalization of COVID-19 infection. With the impending licensing of an RSV vaccine for seniors, we have the opportunity to prevent the major respiratory pathogens that cause significant morbidity and mortality in our most vulnerable population.  

And it was not that long ago when the word tripledemic seemed to crop up in every article that was written about COVID-19, with concern about a tsunami of respiratory infections that would overwhelm our health care system this winter.  

Guess what: It didn’t happen. 

Dodging a bullet 

Basically, we dodged a bullet. The three viruses that we were concerned about were COVID-19; respiratory syncytial virus, or RSV, and influenza. If the incidence of infection for all three pathogens had peaked at the same time, it could’ve been a déjà vu of  the early days of the COVID-19 pandemic when hospitals were reeling from overflowing beds and intensive care units. 

The good news is that although these three infections had an impact on the burden of disease in the U.S., their peak incidences occurred sequentially as opposed to concurrently. 

Looking at the data on hospitalizations on the CDC website, we can see that the RSV season peaked in late November/early December, the flu season peaked in late December and the COVID-19 surge in the fall peaked in early February. 

New Jersey’s surveillance data parallels the national experience. At this point, the hospitalization rates for all three infections are nearing the lowest point or baseline of what we could expect for those conditions. 

With this in mind, we can understand why the federal government has recently announced that the COVID-19 public health emergency will end in May. 

With the end of the declaration of a public health emergency, the availability of the vaccines and treatments for COVID-19 eventually will shift into the commercial space, something I wrote about in an op-ed last fall.

Some level of immunity 

In addition to the drop in disease incidence, other factors leading to this decision are a high percentage of the population that has some level of immunity, whether through vaccination, infection, or both. And a recognition that the public has, for the most part, returned to a new state of normal: no masking, no social distancing, no limitations in public places, no hesitancy in traveling or eating out.  

Yet, based on my recent experience, most of us know one or more people who have had COVID-19, and even someone who has died recently, despite being up to date in their vaccinations.   

As the fourth year of the scourge of COVID-19 begins, what can we do to continue to protect ourselves? I have no original thoughts on this other than to restate the guidelines the public health community has been emphasizing throughout the pandemic:  

• Wash your hands regularly;  

• Cover your nose and mouth when you cough or sneeze; 
• Stay up to date in your vaccinations; 
• Ensure those you care for are up to date in their vaccinations; 
• Assess your personal disease risk as circumstances change; 
• Monitor what is happening locally and nationally with disease incidence and modify your preventive behavior accordingly; 

• Test yourself and isolate from others when ill;  
• and finally, be a public health advocate by encouraging others to follow these guidelines. 

As anticipated at the governor’s final COVID-19 press briefing last year, we have learned to live with the coronavirus and must continue to do so.