When do we stop?

I got asked the other day what the "endpoint" of anti-covid work was, when we would consider it done and victory achieved. That is a truly excellent question which I could not answer fully off-the-cuff - and so, here is an attempt at putting a synthetic version of that together, which will likely be refined as a proper Activism Resource(TM) later down the line.

Some of those are elements I have discussed previously, notably in What should have been and in the Practical Postscript of I am not the goddamn pope. They have not however been brought together in a manifesto-esque shape, so let's fix that.

Clean the air

First and foremost, clean air needs to become as important as clean water. Good ventilation and air filtration must be enshrined in law, building codes, accessibility guidelines and requirements, architectural practice. Housing, workplaces, public establishments of all kinds, they all need to have clean air by default.

We already see the benefits in places that have implemented clean air measures. Again and again, schools and daycares find that installing air purifiers helps children be sick way, way less.

I'm the wrong kind of engineer to tell you how to do this. I trust that as a society we have the skills needed. It will take effort, money and willpower. So did a push for clean water. It's worth it.

That effort must not be limited to urban centers in the imperial core. Clean water is not yet a given everywhere, far from it, and cities in the global South typically have high population density. The push for clean air must be worldwide and equitable.

Revive public health

Public health needs to take covid seriously. This doesn't mean lockdowns. It however does mean free access to vaccines, free access to high-quality testing (PCR or similar), free access to high quality respirators, outreach campaigns to educate healthcare professionals and the broader public with accessible language.

We learned those lessons the hard way with AIDS. Queer people fought hard and died for those lessons to be learned. They are being un-learned in front of us, by anti-public-health figureheads and activists alike. The tools are similar: prevent, educate, provide free testing and free harm reduction supplies.

I would argue that covid is dangerous enough that we should return to an elimination strategy. Whether that is practical is best left to epidemiologists to argue about. At the very least, I think it should be the ARS (French regional public health agencies) distributing high-quality respirators and pamphlets, not a couple of burned-out disabled queers operating out of a friend's garage.

Find better vaccines

Contrary to what boring people on Bluesky like to say, the overwhelming majority of anti-covid activists is constantly encouraging people to get boosters every six months. We are not anti-vaxxers, we simply recognize the limitations of the current vaccines.

mRNA shots coming together so quickly is nothing short of a miracle of modern medicine. The platform has incredible potential. The covid shots are highly protective. They are just not protective enough to make this all end, as we've seen. They wane. Some people do not tolerate mRNA vaccines and need different options. Recognizing those limitations is a vital part of advocating for vaccines.

We need better vaccines. That research is ongoing: Hilda Bastian has been tracking it for years. Two major avenues of research are "universal vaccines" that would protect us from all coronaviruses and be resilient to mutations, and sterilizing vaccines that would cut spread much more than the currently available formulas.

This is the only item on this list that currently has high odds of coming to pass even without a trajectory change.

Treat post-viral diseases

Long covid is a debilitating condition and there is currently no cure. That too is a sinister echo to the early days of AIDS. The main difference this time is that some people get better. Many don't.

While covid infections are especially likely to trigger chronic diseases, post-viral conditions have long been understudied. They mostly affect people who the medical profession is already biased against, getting a diagnosis typically takes years when it happens at all, and there are no cures.

Long covid patient orgs have specific demands. Those include searching for biomarkers, searching for a cure, better training of healthcare professionals to improve the diagnostic process and avoid harmful recommendations. This is not my main beat and so I am unfamiliar with the details: check out the Patient-Led Research Collaborative, Long COVID Justice, Long Covid SOS, Long Covid Kids or #ApresJ20 for more info.

Frustratingly, some of those organizations are very bad at mentioning or employing the very preventative measures that make covid infections less likely. A single group does not need to do everything; but when long covid advocates fail to take precautions, and when prevention groups do not account for the complexities of post-viral conditions, we all lose.

I deeply believe we can and must work together rather than in parallel or at odds. Preventing HIV infections is just as important as searching for AIDS treatments and vaccines. And I hope that investing in treatments and care for long covid will benefit all post-viral diseases.

Change the culture

Before 2020, I was only aware of particulate respirators as PPE for crafts or construction work. Like many, I'd seen surgical masks worn by medical staff and assumed it was solely about spit droplets. Like many, I'd seen the habit of masking while sick in some East Asian countries and never thought I should probably do the same. This was unquestionably the product of some amount of racism on my part, paired with ableist ignorance of the needs of immunocompromised people.

In 2020 and onwards, I learned better. I changed my own behavior and some of those changes will remain. "Just a cold" will always warrant a test and masking. Conversations about accessibility will now always include concerns about hygiene and disease airborne or not. Sometimes that means everyone needs to mask so someone can be safer.

This must become the norm and be enabled by society. We have technology available for testing, to avoid over-prescribing antibiotics: this must extend to viruses to guide advice and treatment. Free high-quality masks must be available in a variety of sizes and designs to account for access needs.

Social occasions and workplaces need to account for this new awareness, too. Going to work while sick must be discouraged, no-questions-asked paid sick leave must become universal if only as a way to avoid making other people sick. Wearing a mask notably at work must be destigmatized. Friends groups need to have open conversations about disease, in an obvious parallel to safer sex practices.

Conclusion

All of this assumes a world much like the current one. It does not require the abolition of borders, capitalism or States. It does not require a significant shift in our relationship to the natural world to limit the emergence of new-to-humans pathogens. All of those would be good things, do note.

That is maybe the reassuring thing about our win conditions: they do not require a revolution. They are all eminently feasible and worthwhile. While some of the list is covid-specific, the broader infrastructure and culture changes would reduce avoidable disease significantly.

To quote a friend: I just don't like being sick. How about we have less of that?