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My hospital just reinstituted mask mandates for all staff working with patients. They also advise patients to wear masks while in the hospital, but have not made it a requirement. I still have a stash of N95 masks so it was easy, and all too familiar, for me to comply, but I admit it created an unpleasant flash-back. All things considered, I would rather not have to wear a mask at work all day. But that is now part of the job, like washing your hands, wearing gloves, occasionally having to gown, and keeping up to date with your vaccines.

It seems that collectively, as a society, we all have a bit of COVID-19 PTSD. I get it. ln a way, we were all innocent pre-pandemic, thinking we lived in a world where modern medicine meant we did not have to live in fear of infectious illness, or alter our lives around minimizing spread of disease. We knew this existed, but it was more an afterthought, and an occasional nuisance when we or people close to us caught a cold or flu. We also knew there were vulnerable people who needed to be protected. The COVID pandemic made us all feel vulnerable. It changed the world we live in.

So it’s likely that no one wants to be reminded that COVID is still with us, and some of the pandemic-era precautions are still necessary, although to a lesser degree. Pretty much as predicted, COVID has gone from an acute pandemic infection to a persistent background infection, one of many that we have to track and take precautions for.

The reason for the mask recommendations is because it’s respiratory virus season in the Northern hemisphere, including COVID, flu, and RSV (respiratory syncytial virus). Together these viruses represent a significant health risk that need to be managed. There are several things to consider – the risk of getting infected, the likely severity of infection, the risk of hospitalization, and the risk of death or long-term morbidity (like long-COVID).

Risk of hospitalization is important because, as we saw, hospital resources can get easily overwhelmed by a surge of illness. This is why hospitals remain acute aware of such illnesses. The CDC reports “from October 1 through November 30, 2024, there have been between 64,000 and 110,000 hospitalizations due to COVID-19.” This is still significant, even if COVID has mostly faded from our collective consciousness.

Experts also continue to track SARS-Cov-2 as it evolves. The Omicron variant and its subtypes remain dominant. However, there is now an XEC variant which emerged likely from a cross between two strains. This is now the dominant strain. Researchers were initially very worried because the strain has a novel spike protein and can evade existing immunity. However, in the wild the strain appears to cause more mild illness. In fact, many people who have it may think they just have a cold, or their infection may even be subclinical. This is just luck more than anything else.

One way to track the spread of these viruses and their strains is through wastewater. We can track the DNA/RNA (SARS-Cov-2 is a single-stranded RNA virus) of organisms that gets into waste water through excretions. This is a powerful tool to measure spread and track strains.

What does the XEC variant teach us? A few things. First, these viruses will continue to evolve. This means that we must keep on top of them to minimize spread. Vaccines need to be updated, and people should continue to get vaccine boosters to keep their immunity up to date. Again as predicted, an annual flu and COVID vaccine should just be standard practice for most people. Despite this, COVID vaccine rates have significantly dropped off. According to the CDC:

“The percent of the population reporting receipt of the updated 2024─25 COVID-19 vaccine is 11.0% (10.0-12.0) for children and 22.8% (21.7-24.0) for adults age 18+, including 46.4% (42.2-50.7) among adults age 65+.”

This is unfortunate, because vaccines are a major reason that the COVID illness is becoming more mild over time. This is also due to the fact that most people have caught the virus one or more times. Vaccines plus natural exposure leads to robust immunity, so we can fight off the virus before it has a chance to cause more serious illness or chronic symptoms. But as the virus evolves, the best way to keep ahead of it is with keeping up on the vaccines.

Another lesson is that these viruses will continue to change in unpredictable ways. COVID is evolving to be more of an upper respiratory virus than a pneumonia causing virus, which is a good thing, but this is not inevitable or predictable. It is also possible that coronaviruses like SARS-CoV-2 could evolve into an enterovirus, spreading through the GI system. A new variant can emerge that is really good at evading existing immunity (like XEC), or that causes more severe illness.

This is simply the world we now live in. There are over 8 billion people on the planet, and we are connected through a robust global network. We have made ourselves, in short, a tempting target for any bug that wants to infect us. We live with a constant background of such germs, with new one popping up, old ones evolving, and surges occasionally happening. This will never be over.

Of course we rely heavily on our immune systems to protect us. But we also have lots of tools to increase that protection and minimize death, morbidity, and overwhelming our healthcare infrastructure. It would be nice if we could use those methods based on the best scientific evidence available with a rational risk and cost vs benefit analysis, free of politics, ideology, and wasteful nonsense. But that is also not the world we live in.

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  • Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.

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Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.