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The Surprising Truth About Seasonal Depression

The Atlantic

www.theatlantic.com › family › archive › 2023 › 03 › seasonal-affective-disorder-winter-depression › 673377

Since Sunday’s daylight saving, many of us are feeling new excitement for spring after months of being beaten down by a frigid winter. Right? Or at least that’s the prevailing narrative across a large part of the country—that we suffer through the doldrums of winter and the payoff is a glorious lead-up to summer’s main event. The idea of winter as a season full of dark, depressing, cold days that people barely survive seems ever-present in American culture, bolstered by articles on how to beat the “winter blues,” a billion-dollar light-therapy industry, and even a countdown in the Pacific Northwest (where I live) to what we call “The Big Dark.” But some researchers have long interrogated that notion, calling winter’s psychological effects into question and wondering whether we hear so much about how terrible winter is for our psyches that we’ve come to believe it unequivocally.

The term seasonal affective disorder, or rather its catchy acronym SAD, is so popular that it’s used in casual conversation. Steve LoBello, a psychologist and researcher at Auburn University at Montgomery, set out to do his own assessment of the nationwide scale of SAD—annual depression that follows a strict seasonal cycle, typically occurring in fall and winter and receding in spring and summer. LoBello and his team analyzed data from the CDC’s behavioral risk-factor survey, which asks hundreds of thousands of Americans each year about their health and well-being, including a separate screening for depression and anxiety, to see whether major depression rates followed a seasonal trend. “We expected cases to increase in the wintertime and then for that to subside starting in early spring and so forth, and there was nothing like that in the data,” LoBello told me of the study they published in 2016. “It was just flat as a pancake all the way through the year.” They also found no correlation between major depression and the respondent’s latitude (or hours of daylight). A couple of years later, in 2018, LoBello published another paper that found no correlation between even mild depression and the seasons. Still, the idea that we are all more likely to be sad and depressed in winter has dominated, and LoBello argues that that view is more steeped in folklore than science.

SAD was introduced to the psychology world in a 1984 paper that presented an American study of 29 patients. Those patients had volunteered for the study by responding to a newspaper ad, and were prescreened to include only those who had already been diagnosed with a major affective disorder. Most of them had bipolar affective disorder and reported having experienced, over at least two previous winters, depression that receded in the spring or summer. A “seasonal pattern” specifier was soon added to the Diagnostic and Statistical Manual of Mental Disorders chapter on affective disorders, and the criteria for SAD diagnosis was set: A person must experience major depression during a specific season, that depression must go away during another season, and that pattern must repeat for at least two years. Today, an estimated 4 to 6 percent of the U.S. population experiences SAD during the winter months—a smaller percentage of SAD cases are summer-induced—which is in no way commensurate with the casual way so many Americans apply the term to themselves.

[Read: The secret to loving winter]

As with a lot of psychology research, the question of how seasons affect our brains is complicated, and varies widely. Many studies suggest that there is some connection between the seasons, light exposure, and depressive symptoms for some people. Others challenge these findings, such as a 2008 literature review by a team based in northern Norway that reported that, even in their extreme winter environment, they found “no correlation between depressive symptoms and amount of environmental light.” In Sweden and Britain, too, national health systems have reported that the evidence for light therapy in treating depressive disorders is inconclusive. That isn’t to say no one experiences depressive symptoms in the winter because of the weather, just that a population-wide connection explaining that winter = bad mood is hard to pin down.

What’s certain is that no one’s mood and cognition are affected by the seasons the same way. In fact, while longer, warmer days are commonly thought of as a kind of folk remedy for feeling down, some people who live in climates where the sun always shines report feeling a bit out of sorts by the absence of winter. Kate Sedrowski, a 42-year-old rock climber and writer, grew up in Michigan and went to college in Boston before moving to Los Angeles. “The lack of seasons—particularly winter—just did not feel right to me,” she told me by email. “The chill in the air of winter makes me feel more alive and alert, while summer heat makes me lethargic like a sloth. The shortness of the days in the winter forces me to take advantage of the daylight to get things done before I relax and hibernate when it gets dark.” Sedrowski, who now lives in Golden, Colorado, said she feels the highest energy in the cold, snowy, winter months.

Some folks even discover a different kind of productivity in the winter. Living in Atlanta, Muriel Vega doesn’t experience harsh winters by any means, but she grew up in a tropical country where it was always sunny and warm, and she now finds the cooler, southern winter to be her favorite time of year. Vega likes the break from the heat and the constant social obligations. “Winter is a very special time to stay inside,” the 36-year old product manager told me. The summer tends to be filled with friend hangs, beach days, and park visits, but in the winter she’s able to be productive in other ways, such as spending more time with her family, reading, cleaning her house, and cooking time-intensive recipes.

[Read: How to find joy in your Sisyphean existence]

The question of whether winter actually makes us mentally sluggish is also gaining attention from brain researchers. Timothy Brennen, a University of Oslo psychology professor with a focus on memory and cognition, studies whether seasonal differences produce any changes in cognitive tasks such as memory, attention, or reaction speed. He based his research in Tromsø, Norway; it’s located above the Arctic Circle, and for two months of the year the sun doesn’t rise above its horizon at all, making the city a favorite for this kind of study. “Most tests showed no difference in performance between summer and winter, and, of those that did, four out of five actually suggested a winter advantage,” Brennen wrote in his paper. Even so, many of us frequently attribute sleepiness or a lack of brain productivity to seasonal depression. If we were all truly depressed in winter, Brennen told me, “this would have quite huge effects on society, and it just doesn’t.”

The seasons do affect our lives, Brennen clarified, although a growing body of research shows that major psychological effects such as depression and cognitive slowdown are likely not what most of us are experiencing during winter. Waking up on dark winter mornings can be tougher than waking up in the summer, for instance. “But being groggy when you’re woken up from a deep sleep has nothing to do with depression,” he said. What you may be feeling in those instances are the effects of a disruption to your sleep cycle, or the draw of a cozy, warm bed on a cold morning. We may be uncomfortable in lower temperatures, or feel inconvenienced by hazardous weather such as blizzards, and we may even joke about wanting to hibernate for the entire season. Yet our nervous systems and lives don’t just come to a halt. Some of the busiest travel weekends happen over the winter holidays, and throughout January and February, many people flock to the mountains to ski, snowboard, or sled. Sure, winter can be dark, and navigating it can be a pain, but for the majority of us, the season isn’t necessarily to blame for anything more serious than that.

Vengeance Is Trump’s

The Atlantic

www.theatlantic.com › ideas › archive › 2023 › 03 › donald-trump-cpac-republican-primary-retribution › 673373

At the Conservative Political Action Conference on March 4, Donald Trump gave a speech that my colleague Tom Nichols called “long and deranged,” adding that it was, “even by his delusional standards, dark and violent. Much of it was hallucinatory.” And revealing too—not just of Trump’s worsening state of mind but of the attitudes and temperament of MAGA world which Trump has, for seven years, personified. He remains the GOP’s apotheosis.

That doesn’t mean that Trump is unbeatable in the Republican presidential primary. He’s viewed throughout much of the party as a loser; his presentation is noticeably more lethargic than when he ran in 2016; and his obsessive promotion of lies about the 2020 election is exhausting even some of his loyal supporters. He’s also having trouble drawing large or enthusiastic crowds, which he never had a problem with in the past.

Despite that, at this early stage, Trump and Florida Governor Ron DeSantis are polling as the overwhelming favorites to win the Republican nomination. And although individual surveys are scattered, two recent ones, from Emerson and Fox, show Trump leading DeSantis by 30 and 15 points, respectively. (An Emerson poll from New Hampshire earlier this month showed Trump with a 41-point lead over DeSantis in that early-primary state.) But what the polls can’t measure is just how much the party’s sensibilities have fused with Trump’s, or how many imitators Trump has spawned. His imprint on the Republican Party is almost impossible to overstate. Which is why Trump’s remarks at CPAC are instructive.

[Read: Trump has become the thing he never wanted to be]

One section of the nearly two-hour speech particularly caught my attention, and not mine alone. The New York Times’ Maggie Haberman and Shane Goldmacher devoted an article to the implications of these comments:  

In 2016, I declared, “I am your voice” Today, I add: I am your warrior. I am your justice. And for those who have been wronged and betrayed, I am your retribution. I am your retribution.

“This is the final battle,” America’s 45th president said. “They know it, I know it, you know it, everybody knows it. This is it. Either they win or we win. And if they win, we no longer have a country.”

To understand the modern Republican Party, you must understand the intense sense of fear and grievance that drives so many of its voters, which has in turn given rise to a profound desire for retribution and revenge, for inflicting harm on Democrats, progressives, and other perceived enemies. Those negative emotions existed before Donald Trump ran for the presidency, but he tapped into them with astonishing skill.

In September 2015, I had an email exchange with a person who worked for a theologically conservative church. In the course of sharing thoughts on the early stages of the Republican primary, I described my views and concerns: “I consider Mr. Trump to be in an entirely different category—wrong not just on the issues and philosophically unanchored, but alarmingly erratic … wholly untrustworthy, a flippant misogynist, crude and vulgar, and downright obsessive. As president, he would be unstable and dangerous. As leader of the Republican Party, he would be an embarrassment. As the de facto face of conservatism, he would be a disaster. That’s why I would not vote for him under any conceivable circumstances.”

Although Trump was not this person’s first choice in the primary, his response was instructive. “I am fed up with our side rolling over.” He then said: “I think we have likely slipped past the point of no return as a country and I’m desperately hoping for a leader who can turn us around. I have no hope that one of the establishment guys would do that. That, I believe, is what opens people up to Trump. He’s all the bad things you say, but what has the Republican establishment given me in the past 16 years? First and foremost: [Barack Obama].”

Note the line of argument: My interlocutor agreed with all of the negative things I said about Trump—misogynistic, untrustworthy, erratic, psychologically unstable, and dangerous—but in the end, they didn’t matter. Trump was, to use a word I heard repeatedly to describe him, a fighter. The negative aspects of his character were assumed to be essential to that pugilism. Over time—and it wasn’t much—most of those on the right who had reservations about Trump made their peace with his flaws. Some even quietly celebrated them.

A year later I participated in an event at Stanford University with the sociologist Arlie Hochschild, the author of the acclaimed book Strangers in Their Own Land: Anger and Mourning on the American Right. Hochschild spent five years immersed in a community around Lake Charles, Louisiana, then a Tea Party stronghold. What was important to understand about the rise of Trump, Hochschild told me during one of our offstage conversations, was that it was tied to feelings of being dishonored and humiliated. Trump supporters feel they have been disrespected; Trump is their response, she said, their antidepressant. Hochschild understood the power of emotion in politics, how reason is so often the slave of the passions. And the passions of people who feel unseen, who feel they have been treated with contempt, are destructive and dangerous.

[From the January/February 2019 issue: The real roots of American rage]

Since the Trump era began, we’ve seen a particularly toxic mix of passions on the right: fear and desperation, anger and indignation, feelings of betrayal and victimhood, all of which cry out for vengeance. Whether the nominee is DeSantis—who bills himself as a God-given “protector” and a “fighter”—or Trump, or someone else, the MAGA wing of the Republican Party will demand that the leader of the GOP seek vengeance in its name. Donald Trump has energized a movement and a propaganda infrastructure that will outlast him.

Vengeance is different from justice. The psychologist Leon F. Seltzer puts it this way: Revenge is predominantly emotional, while justice is primarily rational; revenge is, by nature, personal, while justice is impersonal and impartial; revenge is an act of vindictiveness, justice an act of vindication; revenge is about cycles, justice about closure; and revenge is about retaliation, whereas justice is about restoring balance.

“With revenge,” William Mikulas, a professor of psychology at the University of West Florida, told ABC News, “you are coming from an orientation of anger and violence or self-righteousness: ‘I want to get him, I want to hurt them … I want to make them pay.’ You’re coming from a place of violence and anger and that’s never good.”

Revenge creates a cycle of retaliation. It “keeps wounds green, which otherwise would heal,” in the words of Francis Bacon. Vengeance is insatiable, and in any society, over the long term, it can be deeply damaging. The desire for revenge reduces the capacity for legislators to work together across the aisle. It creates conditions in which demagogues can successfully peddle conspiracy theories and call for a “national divorce.” It leads Americans to see members of their opposing party as traitors. And exacting revenge tempts people to employ immoral and illegal methods—street violence, coups, insurrections—they would not otherwise contemplate. (The defamation lawsuit against Fox News by Dominion Voting Systems revealed that a Fox producer texted Maria Bartiromo, a Fox news anchor, saying, “To be honest, our audience doesn’t want to hear about a peaceful transition.”)

White evangelical Christians have been a driving force in creating the politics of retribution and revenge—maybe the driving force. White evangelicals are among the GOP’s most loyal constituencies, and if they declared certain conduct off-limits, candidates and elected officials would comply. But no such signals were ever sent. According to the Pew Research Center, in 2020—after all the lies, misconduct, and deranged conspiracy theories we saw unfold during the Trump presidency—85 percent of white, evangelical Protestant voters who frequently attended religious services voted for Trump. Most of them became more, not less, tolerant of Trump’s misconduct over the course of his tenure.

Human emotions can be dominant and even determinative in distorting and deforming people’s judgments. Individuals who honestly believe that the Bible is authoritative in their lives—who insist that they cherish Jesus’s teachings from the Sermon on the Mount (blessed are the meek, the merciful, the peacemakers, and the pure in heart; turn the other cheek; love your enemies) and Paul’s admonition to put away anger, wrath, slander, and malice and replace them with compassionate hearts, kindness, humility, meekness, patience, a spirit of forgiveness, and, above all, love, “which binds everything together in perfect harmony”—find themselves embracing political figures and a political ethic that are antithetical to these precepts. Many of those who claim in good faith that their Christian conscience required them to get passionately involved in politics have, upon doing so, discredited their Christian witness. Jesus has become a “hood ornament,” in the words of the theologian Russell Moore, in this case placed atop tribal and “culture war” politics.

[From the June 2022 issue: How politics poisoned the evangelical Church]

One recent example: Jenna Ellis, a former attorney for Donald Trump who has made much of her Christian faith and worked for several different evangelical associations. “My mission is Truth, my God is the Lord Jesus Christ, and my client is the President of the United States,” she tweeted in 2020. But last week she admitted in a sworn statement that she had knowingly misrepresented the facts in several of her public claims that widespread voting fraud led to Trump’s defeat—and she posted a video on Twitter mocking an injury from a fall that sent 81-year-old Senator Mitch McConnell to the hospital. (McConnell, although a Republican, has been a critic of Trump, earning the enmity of MAGA world.)

The antidote to the politics of retribution is the politics of forbearance. Forbearance is something of a neglected virtue; it is generally understood to mean patience and endurance, a willingness to show mercy and tolerance, making allowances for the faults of others, even forgiving those who offend you. Forbearance doesn’t mean avoiding or artificially minimizing disagreements; it means dealing with them with integrity and a measure of grace, free of vituperation.

None of us can perfectly personify forbearance, but all of us can do a little better, reflect a bit more on what kind of human beings and citizens we want to be, and take small steps toward greater integrity. We can ask ourselves: What, in this moment, is most needed from me and those in my political community, and perhaps even my faith community? Do we need more retribution and vengeance in our politics, or more reconciliation, greater understanding, and more fidelity to truth?

The greatest embodiment of the politics of forbearance was Abraham Lincoln. With a Civil War looming, he was still able to say, in his first inaugural address, “We are not enemies, but friends. We must not be enemies. Though passion may have been strained, it must not break our bonds of affection.”

Those bonds were broken; the war came. By the time it ended, more than 700,000 lives had been lost in a nation of 31 million. But the war was necessary; Lincoln preserved the Union and freed enslaved people. And somehow, through the entire ordeal, Lincoln was free of malice. He never allowed his heart to be corroded by enmity or detestation.   

In his 1917 biography of Lincoln, Lord Charnwood wrote, “This most unrelenting enemy to the project of the Confederacy was the one man who had quite purged his heart and mind from hatred or even anger towards his fellow-countrymen of the South.”

Another Lincoln biographer, William Lee Miller, said of America’s 16th president, “He did not mark down the names of those who had not supported him, or nurse grudges, or hold resentments, or retaliate against ‘enemies’—indeed, he tried not to have enemies, not to ‘plant thorns.’” Lincoln’s previous failures did not leave scars or resentments, Miller says; he was an unusually generous human being, lacking in ruthlessness, disinclined to make himself feared, explicit in disavowing vengeance. Some believed he was too sympathetic to be a great leader. He turned out to be our greatest leader.

Lincoln was unique; we will never see his kind again. But the contrast between America’s first Republican president and its most recent Republican president is almost beyond comprehension. Each is the inverse of the other. One cannot revere Lincoln and embrace the political ethic of Trump, his many imitators, and the MAGA movement.

Sensibilities and dispositions can be shaped and reshaped; the “ancient trinity” of truth, beauty, and goodness can still inspire the human heart, even among cynics. The burning question for each of us is what we aspire to, for ourselves and for our leaders, and the kind of political culture we will help build. We are citizens, not subjects, and so it is within our power to write magnificent new chapters in the American story. But that requires letting go of hatred and vengeance and to be again touched, as we surely can be, by the better angels of our nature.

The COVID Question That Will Take Decades to Answer

The Atlantic

www.theatlantic.com › health › archive › 2023 › 03 › kids-babies-getting-covid-exposure-vaccines › 673368

To be a newborn in the year 2023—and, almost certainly, every year that follows—means emerging into a world where the coronavirus is ubiquitous. Babies might not meet the virus in the first week or month of life, but soon enough, SARS-CoV-2 will find them. “For anyone born into this world, it’s not going to take a lot of time for them to become infected,” maybe a year, maybe two, says Katia Koelle, a virologist and infectious-disease modeler at Emory University. Beyond a shadow of a doubt, this virus will be one of the very first serious pathogens that today’s infants—and all future infants—meet.


Three years into the coronavirus pandemic, these babies are on the leading edge of a generational turnover that will define the rest of our relationship with SARS-CoV-2. They and their slightly older peers are slated to be the first humans who may still be alive when COVID-19 truly hits a new turning point: when almost everyone on Earth has acquired a degree of immunity to the virus as a very young child.

[Read: Is COVID a common cold yet?]

That future crossroads might not sound all that different from where the world is currently. With vaccines now common in most countries and the virus so transmissible, a significant majority of people have some degree of immunity. And in recent months, the world has begun to witness the consequences of that shift. The flux of COVID cases and hospitalizations in most countries seems to be stabilizing into a seasonal-ish sine wave; disease has gotten, on average, less severe, and long COVID seems to be somewhat less likely among those who have recently gotten shots. Even the virus’s evolution seems to be plodding, making minor tweaks to its genetic code, rather than major changes that require another Greek-letter name.

But today’s status quo may be more of a layover than a final destination in our journey toward COVID’s final form. Against SARS-CoV-2, most little kids have fared reasonably well. And as more babies have been born into a SARS-CoV-2-ridden world, the average age of first exposure to this coronavirus has been steadily dropping—a trend that could continue to massage COVID-19 into a milder disease. Eventually, the expectation is that the illness will reach a stable nadir, at which point it may truly be “another common cold,” says Rustom Antia, an infectious-disease modeler at Emory.

The full outcome of this living experiment, though, won’t be clear for decades—well after the billions of people who encountered the coronavirus for the first time in adulthood are long gone. The experiences that today’s youngest children have with the virus are only just beginning to shape what it will mean to have COVID throughout a lifetime, when we all coexist with it from birth to death as a matter of course.

At the beginning of SARS-CoV-2’s global tear, the coronavirus was eager to infect all of us, and we had no immunity to rebuff its attempts. But vulnerability wasn’t just about immune defenses: Age, too, has turned out to be key to resilience. Much of the horror of the disease could be traced to having not only a large population that lacked protection against the virus—but a large adult population that lacked protection against the virus. Had the entire world been made up of grade-schoolers when the pandemic arrived, “I don’t think it would have been nearly as severe,” says Juliet Pulliam, an infectious-disease modeler at Stellenbosch University, in South Africa.

Across several viral diseases—polio, chicken pox, mumps, SARS, measles, and more—getting sick as an adult is notably more dangerous than as a kid, a trend that’s typically exacerbated when people don’t have any vaccinations or infections to those pathogens in their rearview. The manageable infections that strike toddlers and grade-schoolers may turn serious when they first manifest at older ages, landing people in the hospital with pneumonia, brain swelling, even blindness, and eventually killing some. When scientists plot mortality data by age, many curves bend into “a pretty striking J shape,” says Dylan Morris, an infectious-disease modeler at UCLA.

The reason for that age differential isn’t always clear. Some of kids’ resilience probably comes from having a young, spry body, far less likely to be burdened with chronic medical conditions that raise severe disease risk. But the quick-wittedness of the young immune system is also likely playing a role. Several studies have found that children are much better at marshaling hordes of interferon—an immune molecule that armors cells against viruses—and may harbor larger, more efficient cavalries of infected-cell-annihilating T cells. That performance peaks sometime around grade school or middle school, says Janet Chou, a pediatrician at Boston Children’s Hospital. After that, our molecular defenses begin a rapid tumble, growing progressively creakier, clumsier, sluggish, and likelier to launch misguided attacks against the tissues that house them. By the time we’re deep into adulthood, our immune systems are no longer sprightly, or terribly well calibrated. When we get sick, our bodies end up rife with inflammation. And our immune cells, weary and depleted, are far less unable to fight off the pathogens they once so easily trounced.

Whatever the explanations, children are far less likely to experience serious symptoms, or to end up in the hospital or the ICU after being infected with SARS-CoV-2. Long COVID, too, seems to be less prevalent in younger cohorts, says Alexandra Yonts, a pediatrician at Children’s National Hospital. And although some children still develop MIS-C, a rare and dangerous inflammatory condition that can appear weeks after they catch the virus, the condition “seems to have dissipated” as the pandemic has worn on, says Betsy Herold, the chief of pediatric infectious disease at the Children’s Hospital at Montefiore, in the Bronx.

Should those patterns hold, and as the age of first exposure continues to fall, COVID is likely to become less intense. The relative mildness of childhood encounters with the virus could mean that almost everyone’s first infection—which tends, on average, to be more severe than the ones that immediately follow—could rank low in intensity, setting a sort of ceiling for subsequent bouts. That might make concentrating first encounters “in the younger age group actually a good thing,” says Ruian Ke, an infectious-disease modeler at Los Alamos National Laboratory.

COVID will likely remain capable of killing, hospitalizing, and chronically debilitating a subset of adults and kids alike. But the hope, experts told me, is that the proportion of individuals who face the worst outcomes will continue to drop. That may be what happened in the aftermath of the 1918 flu pandemic, Antia, of Emory, told me: That strain of the virus stuck around, but never caused the same devastation again. Some researchers suspect that something similar may have even played out with another human coronavirus, OC43: After sparking a devastating pandemic in the 19th century, it’s possible that the virus no longer managed to wreak much more havoc than a common cold in a population that had almost universally encountered it early in life.

Such a fate for COVID, though, isn’t a guarantee. The virus’s propensity to linger in the body’s nooks and crannies, sometimes causing symptoms that last many months or years, could make it an outlier among its coronaviral kin, says Melody Zeng, an immunologist at Cornell University. And even if the disease is likely to get better than what it is now, that is not a very high bar to clear.

Some small subset of the population will always be naive to the virus—and it’s not exactly a comfort that in the future, that cohort will almost exclusively be composed of our kids. Pediatric immune systems are robust, UCLA’s Morris told me. But “robust is not the same as infallible.” Since the start of the pandemic, more than 2,000 Americans under the age of 18 have died from COVID—a small fraction of total deaths, but enough to make the disease a leading cause of death for children in the U.S. MIS-C and long COVID may not be common, but their consequences are no less devastating for the children who experience them. Some risks are especially concentrated among our youngest kids, under the age 5, whose immune defenses are still revving up, making them more vulnerable than their slightly older peers. There’s especially little to safeguard newborns just under six months, who aren’t yet eligible for most vaccines—including COVID shots—and who are rapidly losing the antibody-based protection passed down from their mothers while they were in the womb.

A younger average age of first infection will also probably increase the total number of exposures people have to SARS-CoV-2 in a typical lifetime—each instance carrying some risk of severe or chronic disease. Ke worries the cumulative toll that this repetition could exact: Studies have shown that each subsequent tussle with the virus has the potential to further erode the functioning or structural integrity of organs throughout the body, raising the chances of chronic damage. There’s no telling how many encounters might push an individual past a healthy tipping point.

Racking up exposures also won’t always bode well for the later chapters of these children’s lives. Decades from now, nearly everyone will have banked plenty of encounters with SARS-CoV-2 by the time they reach advanced age, Chou, from Boston Children’s Hospital, told me. But the virus will also continue to change its appearance, and occasionally escape the immunity that some people built up as kids. Even absent those evasions, as their immune systems wither, many older people may not be able to leverage past experiences with the disease to much benefit. The American experience with influenza is telling. Despite a lifetime of infections and available vaccines, tens of thousands of people typically die annually of the disease in the United States alone, says Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital. So even with the expected COVID softening, “I don’t think we’re going to reach a point where it’s, Oh well, tra-la-la,” Levy told me. And the protection that immunity offers can have caveats: Decades of research with influenza suggest that immune systems can get a bit hung up on the first versions of a virus that they see, biasing them against mounting strong attacks against other strains; SARS-CoV-2 now seems to be following that pattern. Depending on the coronavirus variants that kids encounter first, their responses and vulnerability to future bouts of illness may vary, says Scott Hensley, an immunologist at the University of Pennsylvania.

[Read: Are our immune systems stuck in 2020?]

Early vaccinations—that ideally target multiple versions of SARS-CoV-2—could make a big difference in reducing just about every bad outcome the virus threatens. Severe disease, long COVID, and transmission to other children and vulnerable adults all would likely be “reduced, prevented, and avoided,” Chou told me. But that’s only if very young kids are taking those shots, which, right now, isn’t at all the case. Nor are they necessarily getting protection passed down during gestation or early life from their mothers, because many adults are not up to date on COVID shots.

Some of these issues could, in theory, end up moot. A hundred or so years from now, COVID could simply be another common cold, indistinguishable in practice from any other. But Morris points out that this reality, too, wouldn’t fully spare us. “When we bother to look at the burden of the other human coronaviruses, the ones who have been with us for ages? In the elderly, it’s real,” he told me. One study found that a nursing-home outbreak of OC43—the purported former pandemic coronavirus—carried an 8 percent fatality rate; another, caused by NL63, killed three out of the 20 people who caught it in a long-term-care facility in 2017. These and other “mild” respiratory viruses also continue to pose a threat to people of any age who are immunocompromised.

SARS-CoV-2 doesn’t need to follow in those footsteps. It’s the only human coronavirus against which we have vaccines—which makes the true best-case scenario one in which it ends up even milder than a common cold, because we proactively protect against it. Disease would not need to be as inevitable; the vaccine, rather than the virus, could be the first bit of intel on the disease that kids receive. Tomorrow’s children probably won’t live in a COVID-free world. But they could at least be spared many of the burdens we’re carrying now.