As covid becomes endemic, can people drop masks, other precautions?

New coronavirus variants are making headlines. Photos of positive test results are popping up on social media feeds. Hospitalizations are increasing.

Far from the start of a sensational new chapter in the pandemic, experts say this uptick is the new normal in a world with covid as an endemic disease. Now, with some level of immunity nearly ubiquitous across the country, many people are wondering when — or if — we can stop treating the coronavirus differently from other common respiratory ailments.

Experts say the answer will vary, depending on people’s individual tolerance for risk and the changing landscape of variants and boosters.

Covid is still a leading cause of death. Doctors have little to offer people who are stricken by the constellation of lingering symptoms known as long covid. Vigilance is still required to protect high-risk people, including those who are older or who have compromised immune systems.

For some, covid will never stop being special, and worries mount as they watch more people drop the precautions that help keep vulnerable individuals safe.

“The newer people [just diagnosed] with long covid are really angry,” said Hannah Davis, a co-founder of the Patient-Led Research Collaborative, who has long covid. “Everyone’s been told the pandemic is basically over, the risk is basically over if you are vaccinated.”

But many public health experts also point out that there is a middle ground between living in fear of the virus and ignoring its existence.

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Covid was exceptional in 2020 when it was a new and deadly illness that tore into an unprepared human population. In 2023, widespread immunity — alongside tools such as masks, testing, treatments, updated boosters and improved ventilation — can empower people to protect themselves and others while resuming most normal activities.

“I’m less worried than I was last year, and I was less worried last year than I was the year before,” said Jennifer Nuzzo, an epidemiologist at Brown University School of Public Health. “But I’m aware, and I’m looking and trying to make sure nothing changes.”

Many public health experts also hope that our concept of normalcy will shift, and that habits people learned to guard against covid — such as staying home when sick and putting on a mask in high-risk situations — will become muscle memory. Covid is special in part because we have so many tools to prevent suffering and death, as well as routine disruptions such as school closings. So why stop using them when the virus spikes?

“I don’t want to get sick. I don’t want to get anyone else sick,” said Gregg Gonsalves, an epidemiologist at Yale School of Public Health. “Is that so bad to say?”

The emergency phase of the pandemic officially ended in May, and federal policies that had made covid markedly different from other diseases — such as the government footing the bill to buy vaccines, tests and treatments for everyone — ended.

Data updates on the virus became less frequent and less detailed as reporting requirements changed, and that’s made cases harder to track. In addition, at-home test results aren’t reported, and some people aren’t testing at all. So experts are keeping their eyes on other metrics, such as wastewater, which can show indirectly where the virus is spiking.

Covid is increasing as the U.S. heads into fall — but so far, this uptick doesn’t look like past surges.

The Centers for Disease Control and Prevention tracks hospitalizations due to covid, and there were 18,871 in the past week, a 25 percent increase over the previous two weeks, according to CDC data. That’s a big leap. But over the summer, hospitalizations had dropped to be among the lowest levels seen during the pandemic. That means even with the current spike, the overall numbers remain relatively low — a little more than half that from around the same time last year.

In eastern Kentucky, there is a lot of covid going around, though it’s hard to get a handle on the numbers, said Scott Lockard, health director for the Kentucky River District Health Department, which serves seven counties.

Lockard said he’s seen a jump in business owners calling him for guidance when an employee tests positive. The Lee County School District made the decision to shut for a few days in August because they were seeing so many absences due to respiratory illness. It’s even hitting Lockard’s own staff.

“Pretty much my message is: If you’re in a mass gathering, you’re likely to come in contact with someone who has covid right now in our area,” Lockard said. “So protect yourself accordingly.”

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That doesn’t mean people need to hide in their homes. He recommends eligible people get a booster shot, and he advises people to stay home when sick and test when they have symptoms. Lockard acknowledges “a great reluctance” to use masks, but he wants to remind people that they work — and said he has seen more of them in the grocery store lately.

“We’re in a very different place than we were in 2020 and 2021, so we’re treating it very differently than we did then,” Lockard said. “For the most part, coming down with covid is not as severe as it once was. That being said … there’s just so much that we have yet to learn about the long-term impacts of covid.”

Long covid can happen after even a mild case, but the threat is greatest after severe illness, and vaccination may decrease the risk of developing it, so some experts think new surges will not bring the same level of long-term suffering. Still, they point out, the search for treatments for long covid is just beginning.

Guidance evolves along with the virus

Even as health experts urge people to stay calm but alert, many argue that we need to continue to treat covid differently from seasonal flu or the common cold for a few reasons.

For one thing, four years with a new virus is a relative blink of an eye, and its novelty factor and rapid evolution mean experts still aren’t sure what sort of long-term pattern to expect. Will the virus evolve in small steps to evade our immunity, similar to the flu, or will it continue to make big jumps, like the emergence of the omicron variant?

“I don’t think we’re in a place to absolutely know for certain” that the virus will evolve to be less dangerous, said Barbara Ferrer, director of the Los Angeles County Department of Public Health. “That means we’re going to treat it differently while we figure out with more certainty what we can expect from this virus and the implications it has for our response.”

Even more than before, though, people are navigating the virus largely based on their own judgment. Some people are still testing with every symptom or wearing a mask after a covid exposure, but many aren’t. Official guidance is increasingly out of sync with how people are behaving, and even those rules are evolving in a piecemeal manner.

In Oregon, health authorities made the decision after the national public health emergency ended to change their guidance for people who test positive for covid. Instead of requiring five days of isolation, they told people to stay home until they recovered — similar to other respiratory illnesses — while avoiding vulnerable people for 10 days and wearing a mask around others.

“Our approach is reflective of the situation we’re in,” said Dean Sidelinger, state epidemiologist for the Oregon Public Health Division.

That approach makes sense to some experts. Shira Doron, chief infection control officer for Tufts Medicine in Boston, anticipates a more strategic use of testing in the future. For those at high risk who could benefit from taking the antiviral Paxlovid, testing is important. But does a healthy younger person who lives alone and develops the sniffles need to buy a test?

“There is a disconnect between the fact there isn’t widespread availability of testing anymore while we still expect everyone to test,” Doron said.

Others argue that covid’s at-home testing empowered people, and it would be reversing course to stop using a tool that can help people understand their own health — and the risk they might pose to others.

“People want more control over their health,” said infectious-disease specialist Céline Gounder, editor at large for public health at KFF’s Health News.

People are also primed to expect surprises from the virus, and each new variant brings with it unknowns: Will this one upend our lives again? But viruses are expected to evolve, and the scientific steps to understanding the threat are becoming routine.

The emergence of BA.2.86, a heavily mutated coronavirus variant, caused a flurry of headlines and alarm. However, evidence from laboratory experiments suggests that BA.2.86 doesn’t pose an omicron-level threat, and that the booster being rolled out now should bolster antibodies that can fend off the new variant.

BA.2.86 won’t be the last ominous variant to pop up, and what worries some experts is that news about covid and punditry about each new variant has begun to feel so incessant people might not respond if the alarm bells need to ring again.

“My worry,” said Justin Lessler, an epidemiologist at the University of North Carolina Gillings School of Global Public Health, “is our barometer of [knowing] when it is time to really respond in earnest is broken.”

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