William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville, cares for a family member of his undergoing chemotherapy. Because his relative is immunocompromised, Schaffner remains cautious. He and his wife wear N95 masks anytime they enter a public, indoor space. They also haven’t returned to restaurants or movie theaters.
“We’re pretty much homebodies still,” he says.
As we enter year three of the pandemic, few people are taking the same level of precautions as Schaffner’s family. CDC, state, and local guidelines on how to best protect yourself and others have changed a lot through the past 24 months (and counting), from mask mandates and vaccine passports to no restrictions at all. Amid the shifts and fluxes in case counts and policies, it can be difficult to know how to behave, or whether it’s important to remain cautious at all, as some elected officials seem to be declaring the end of the pandemic.
Unfortunately, most public health experts don’t agree. Just in the past couple of weeks, the tides have begun to turn from a celebration of the end of the U.S. Omicron wave to cautious reports of a new possible uptick in cases based on wastewater data and rapidly rising infection rates in Europe. In other words: The pandemic is far from over, and another wave is likely, Rupali Limaye, a public health and epidemiology expert at Johns Hopkins University in Baltimore, tells Inverse. “I do think it’s probably imminent,” she says. With the mask mandate rules and vaccine requirements constantly in flux, and the virus still circulating at high levels internationally, “I find it hard to think, No, it’s gonna be different this time.”
Until the whole world is vaccinated or otherwise has some immunity to the coronavirus, new, more contagious variants will keep popping up, says Limaye. So does that mean anyone who hasn’t gotten the virus yet should just throw in the towel? Limaye and others argue no. Infection isn’t inevitable, especially if you’re vaccinated. If you’ve managed to avoid Covid-19 this long, there are a few key reasons to keep avoiding it for even longer.
Treatments will only keep getting better
For one thing, previously young and healthy people with Covid-19 can end up severely ill, and there’s no way to know for sure how your body will react, Limaye says. Getting vaccinated and boosted makes the worst consequences much less likely, but it doesn’t eliminate all risk.
There’s still a lot we don’t know about the virus, Sonia Villapol, a neuroscientist researching the effects of long Covid at Houston Methodist Research Institute in Texas, tells Inverse. “Especially with long Covid, that is a huge unknown,” she says. Recent research has suggested which groups are most at risk of long Covid, but the list is long. Diabetes, previous Epstein-Barr virus (i.e. mono) infection, and even just being a woman all seem to increase a person’s chance of lasting symptoms.
The longer you go without getting sick, the higher chance there is that, if you do fall ill — even with long Covid — there will be better treatments or improved vaccines. We know much more now than we did at the onset of the pandemic, Villapol points out, and patient outcomes have improved accordingly. The vaccines we currently have greatly reduce the risk of severe infection, even for Omicron and its BA.2 subvariant. For instance, two shots of the Pfizer mRNA vaccine are 70 to 80 percent effective at preventing hospitalizations in people who catch Covid, and a booster shot bumps that protection up to 90 percent according to a recent preprint study done in Qatar. For high-risk patients who still become sick, there’s now Paxlovid, a recently approved antiviral pill that can reduce the severity of an infection, helping to further prevent hospitalization and death. If a person is hospitalized with Covid, they’re more likely to survive it now than in March 2020. In the first year of the pandemic alone, the death rate among critically ill, hospitalized Covid-19 patients went from almost half (44 percent) to less than 20 percent even after controlling for factors like patient age and pre-existing conditions, according to one study of Pennsylvania hospitals. The researchers hypothesized that the improvement came from medical providers learning and using better treatment strategies like avoiding intubation and ventilators when possible, and positioning patients to help them breathe more easily. Two years in, and we’re all safer from Covid-19 than we were when the pandemic started. Ongoing research and the drive to develop even more effective vaccines and treatments are likely to keep that trend going. Chances are, the longer you go without getting Covid, the more likely it will be that when or if you do get it, treatments will be better than they are now.
It is not just about you
As has been true for the entire pandemic, taking precautions isn’t just about protecting yourself. If you live with others or have frequent contact with vulnerable people through your work, getting sick puts others at risk, too.
Vanderbilt’s William Shafer knows this well. To enter the Schaffners’ home, visitors need to be vaccinated, boosted, test negative ahead of time, and agree to wear a mask. To many, this might seem extreme, especially as current cases in the U.S. are at a low point. But to him and his family, all the precautions are well worth it when the potential consequences of infection are so high.
About three percent of the total U.S. population is immunocompromised. This group is statistically more likely to experience worse consequences from a Covid infection and unlikely to fully benefit from the vaccines. For instance, almost half of organ transplant patients, who depend on potent immunosuppressive drugs to survive, develop no antibody response to two doses of a Covid-19 vaccine, leaving them unprotected from infection. And if infected and hospitalized, immunocompromised patients face a higher risk of dying.
In one Korean study, immunocompromised, hospitalized patients had a mortality rate three times higher than others. Continuing to wear masks in places like public transit and grocery stores — effectively continuing to avoid getting Covid — provides immunocompromised people safer access to basic needs, while imposing minimal inconvenience on everyone else.
Balance is key
This is essentially what pandemic behavioral decisions should be about: balancing risk, inconvenience, and well-being. “Every person has their level of risk and also has the level of importance of different activities,” says Anna Bershteyn, a population health researcher at New York University’s Grossman School of Medicine.
Pandemic fatigue is real and being cautious doesn’t have to mean remaining in perpetual lockdown. Bershteyn encourages people to strategically choose when to do certain activities. “If there are things you need to be doing for your well-being, whether it’s your physical or mental well-being, now’s a good time to be doing them because transmission is low,” she says.
Bershteyn recently attended an indoor, interactive museum exhibit. “That was really nice, and I did mask in that context,” she says, because it didn’t affect her enjoyment and was an easy precaution to take. And, although she regularly interacts with elderly relatives, Bershteyn chooses to also engage in outdoor dining, and has begun inviting friends over.
On top of getting vaccinated and boosted, simple measures like masking where possible in public can still make a big difference for your health and others. And monitoring your local case counts via the CDC’s dashboard or elsewhere can help you make informed decisions based on current transmission and vaccination rates in your area. “Everybody has to do their homework. We have to keep up,” says Vanderbilt’s Schaffner.
As Covid-19 waves continue to ebb and flow, official guidelines will keep changing as well. “The key thing here is being flexible,” says Limaye, the Johns Hopkins epidemiologist. And Schaffner agrees. “We’re moving from pandemic to endemic,” he says, but the journey there is a marathon, not a sprint. “We’ll still have to remain alert and conscious of the fact that Covid will be with us in the future.” Ultimately, considering the health risks of our day-to-day actions should stick around just as long.
