The COVID emergency has officially ended. The CDC, WHO, and most governments have ended any emergency designations for the COVID pandemic. Does that mean the pandemic is over? Not really, it just means we are entering another phase. We might think of this as the tail end of the pandemic, or we can think of it as a transition to endemic COVID.
Meanwhile, the CDC is talking about a possible late summer wave of COVID. There has definitely been an uptick in COVID infections and hospitalizations. There has been a 17% increase in hospitalizations between June and July nationwide, and while August numbers are not in yet, the trend seems to be continuing. The reason for the increase is likely several things. Summer heat waves are forcing people to spend more time indoors. Summer vacation travel is also a good way to spread the virus around. But perhaps most importantly, people have largely returned to their pre-pandemic behavior. For example, in July my hospital ended their mask-wearing mandate. Now, very few people are masking.
But we also need to keep this summer wave in perspective. The numbers are still far lower than they were a year ago, or anytime during the pandemic. This is because the population is generally much more resistant to the virus now. Most people have either been vaccinated, or they have had COVID at least once, or both.
On the other hand, the virus is still mutating, degrading the protective effect of prior immunity. The dominant strain circulating right now is EG.5, but dominant means only 20% of cases. There are many strains circulating. Experts have also detected a new strain of interest – BA.2.86. This one is of interest because it has more than 35 mutations on the spike proteins. This makes this virus as different from prior strains as Omicron was from the original virus. The spike proteins are the business end of the virus that allow it to enter human cells. So far there are only a few detected cases, but in many countries, including the US.
The reason the many mutations are of interest is because this suggests the virus may be good at evading existing immunity. This may be the new phase we are in, similar to the ongoing flu pandemic but not as seasonal. We may be in an endless arms race between immunity and viral mutations to evade immunity.
So what does all this mean practically? It’s important to recognize that even if the state of emergency is over, even if we consider the pandemic to be over, we are not living in a prepandemic world. We are now living in a world with endemic COVID. This means we can’t go back to our prepandemic behavior, but nor do we need to maintain our pandemic precautions. So what’s the new normal?
First – keep up to date on your COVID vaccines and boosters. The FDA has approved new versions of the Pfizer and Moderna vaccines that cover new variants of the virus, dubbed XBB1.5. It appear these vaccines will cover the EG.5 variant well. So the easiest and best thing you can do to protect yourself going forward is to get an updated booster. This will not only increase your immunity, it will target the newer variants. This new vaccine is coming out in a few weeks, so if you are due for a booster it is best to wait for the new one. Only people who have a specific reason to get a booster now should do so, like travel or other activity that will put them at high risk.
Universal mask wearing is not necessary. However, that does not mean you should never wear a mask. Targeted mask wearing should become the new normal. It is reasonable to mask up if you are having what might be early symptoms of a respiratory infection. Masks will protect against the flu and cold viruses too, not just COVID. So when you get the sniffles, or feel achy like you might have a virus, wear a mask if you have to be in public. Or work from home, if that is an option. Going out in public unprotected when you might be sick and contagious is simply no longer acceptable.
You may also wish to wear a mask when you are going to be in a large crowd. If you are going to be in a sea of people at a concert, convention, busy airport, or other similar situation, the probability of getting infected with a virus is statistically high. These are nexus points for disease spread. Protecting yourself with a mask is a reasonable standard precaution, like washing your hands after going to the bathroom.
The bottom line is that we are living in a world awash in infectious diseases, because there are 8 billion people on the planet and we have robust international travel. Basic hygiene includes taking common sense precautions against getting exposed to and spreading infectious diseases. This means keeping up to date on your vaccines, staying home when you are sick, washing your hands, and wearing a mask in targeted situations of high risk.
