During the pandemic, UCSF Department of Medicine chair Dr. Bob Wachter emerged as one of the leading voices, both locally and nationally, that people could turn to for clear, concise information on the risks of Covid. On social media and in interviews, Wachter explained the data while humanizing the science by providing a look at his own personal decisions, from mask-wearing to whether to get on an airplane.

On the three-year anniversary of California’s state of emergency declaration due to the spread of Covid-19, Wachter spoke to J. about where we are now. This interview has been edited for length and readability.

J.: The pandemic changed our lives quickly and dramatically. Three years in, people are ready to move on. In regard to long-term impacts, what kinds of changes do you see staying with us? And are they changes for the better — or the worse?

Dr. Bob Wachter: Let me start with the good.

If you think about where the public was three or four years ago, today there’s a much deeper understanding of how viruses work, how epidemiology works, what data means, how research works, the science of everything from mRNAs to aerosols. I think that’s healthy.

In medicine, it opened us up to two main things that I think will be durable changes. It has turbocharged the world of telemedicine and the recognition that we can do a lot of things without you coming to see a doctor in an office. In addition, both in health care and outside of health care, we saw a lot of new tools that gave us data — real-time, beautifully visualized — that helped you understand a phenomenon.

Also, real efforts were made to ensure that the things we’re doing for Covid were equitably distributed. We were thinking hard about how you get vaccines out into poor communities and rural communities. The racial and ethnic and sociodemographic disparities were less profound for Covid than they probably would have been for comparable diseases a decade earlier. We learned some things that will be useful for the way we treat and prevent other diseases.

So those are some positives. What about the negatives?

The negatives are in some ways easier [to answer]. We learned that in today’s information and political ecosystem, the ability to politicize science and to promote misinformation — it’s pretty easy to do, pretty hard to combat. Actually I worry a lot about that, because the progress that those of us who are trying to promote good information have made is less impressive than the progress of those who are trying to promote bad information.

I think when there’s a pandemic next time, the misinformation will start on Day One. And the pushback against anything that relates to public health will be tremendous and make it even harder to fight than it was for this one.

We’re just ending the official state of emergency for Covid in California. Are we already talking about the next infectious diseases?

One of the most striking conversations I’ve had in the last couple of years was when I interviewed Michael Osterholm, who’s one of the world’s pandemic experts. I said, ‘Mike, how does it feel to finally have seen the big one?’ And he looked at me and said, ‘This wasn’t the big one.’

He said, imagine something that is this infectious, or maybe even more so, but is as deadly as Ebola. Not 1 in 100 or 200 people die, but 1 in 5. We got lucky with Covid that it was not that kind of case-fatality rate.

Other than the next big pandemic, what’s on your mind at the moment? How do you see the risks of Covid today?

In March 2020, I was hiding under my kitchen table, pretty scared that I was going to die. That risk does not cross my mind anymore.

But as I think about the three-dimensional chess game of, for example, how do I decide whether I’m going to eat indoors in a restaurant tonight when it’s cold and windy in San Francisco, the risk that I’m mostly worrying about now is the risk of long Covid. It is really tricky.

My carefully calibrated efforts to avoid getting Covid are mostly to avoid Long Covid. As @EricTopol shows in today’s Substack, this isn’t just about symptoms—we should be equally motivated by persuasive evidence that Covid infections raise cardiac risk. https://t.co/AlXL47Pc2x

— Bob Wachter (@Bob_Wachter) March 4, 2023

We’ve seen this in many other viral and infectious illnesses: People recover, most of them do fine, but some of them continue to have lingering symptoms that we don’t understand. And there’s a stigma associated with it, because people sometimes say that it’s psychological.

It’s much less visible than people, you know, crashing and going to the ICU and dying, which is very easy to understand and quite palpable and scary as hell. It’s difficult to measure long Covid. There’s no test for it, and there’s really no treatments that have been proven to be useful.

I think it’s a reasonable take on the literature to say that if we get a case of Covid, there’s somewhere between a 5% and 10% chance of having prolonged symptoms that will disrupt our lives in one way or another. You’re also at a higher risk, long term, of a whole bunch of bad stuff, including heart attacks and strokes and diabetes.

So what’s your strategy?

Much of what I’ve done in the last year or two has been to say, I’m a reasonably informed observer who knows a fair amount about this stuff. I’m keeping my eyes on the literature, and I have the opportunity to speak to some of the world’s experts on this. Based on all of that, here’s what I’m doing and here’s why.

You can make different choices. But at least do it with your eyes open. For many people that’s been helpful, and I’m pleased about that.

Besides keeping in mind the risks that are still associated with Covid, what else do you hope people don’t forget, even as they try to move on and stop worrying?

It’s so easy to forget the fact that over a million people have died. The numbers are so staggering that our brains almost want to push it away. The extent of the tragedy is unfathomable, and I think in our effort to get on with our life, we’ve collectively forgotten that.