Cases, deaths, and hospitalizations have plummeted – but transmission remains high across the nation

As some US companies begin asking people to return to the office and governors lift mask mandates, talk has emerged of life after the Covid-19 pandemic in America.

But infectious disease experts aren’t quite ready to declare that it’s safe for individuals, rather than governments and health officials, to determine whether precautions such as masking indoors are necessary.

“I think it’s probably reasonable not to get too cocky at this point,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security. “I welcome the decline in cases that we are seeing in the US and a number of other countries, and I think you can both celebrate the sunshine while also keeping an umbrella close by for the possibility that rain could occur.”

The numbers of Covid cases and hospitalizations in the United States have decreased by 67% and 38% over the last two weeks, according to data from the New York Times.

Amid that decline, Democratic governors in Massachusetts, Illinois, New York, Rhode Island, California, Connecticut, Delaware, New Jersey and Oregon have recently lifted at least some parts of the masking mandates.

California governor Gavin Newsom on Thursday announced a plan based on the idea that we are entering an endemic stage, meaning the virus is no longer a significant threat in some areas, rather than a pandemic, meaning a global outbreak.

That new approach includes a focus on countering misinformation and disinformation and mass testing to spot new variants and surges, according to the Associated Press.

US companies, most notably, Microsoft, have also announced plans to reopen their facilities and asked employees to return. And Amazon, where many people already worked in person, announced that it would not require fully vaccinated employees to wear masks, according to the Wall Street Journal.

“While the world has changed, our dedication to the safety and wellbeing of our employees has remained constant,” Microsoft said in a blogpost about the reopening. “As we navigate this new phase of work, we’ll continue to take a data-driven approach to decision making that follows the guidance of public health authorities.”

But Justin Lessler, an epidemiology professor at the University of North Carolina, says that while the numbers of Covid cases, deaths and hospitalizations have recently plummeted, the fact that the Omicron spike was so much higher than previous waves has misled people into thinking that they no longer need to wear masks or avoid mass gatherings. The US daily average of cases and hospitalizations on 16 February were about 124,000 and 81,000, according to the Times.

Before removing precautions, Lessler said he would like to see Covid levels like late June 2021 – before the Delta wave – when the daily averages of new cases and hospitalizations were about 12,000 and 16,000.

Modeling shows the US could achieve that around late March, he said.

“In most of the country, cases, deaths and hospitalizations are still extremely high, and I certainly hope that’s not the new normal, and I don’t believe it’s the new normal,” Lessler said. “I worry that the perception that we are already there is going to lead people to act in ways that is going to draw this out longer than it needs to be drawn out.”

William Schaffner, an infectious diseases expert at Vanderbilt University School of Medicine, also thinks that we cannot yet treat the virus as though it is endemic.Advertisement

“Some governors think we are almost there are already – they are dropping mask mandates – and my response is: good luck to you,” said Schaffner. “My fingers are crossed on your behalf.”

Almost the entire country remains at what the Centers for Disease Control and Prevention defines as high transmission of the virus, meaning a seven-day daily average of more than 100 new Covid cases per 100,000 residents.

Anna Bershteyn, assistant professor in the department of population health at New York University, thinks more companies will ask employees to return once their surrounding county drops at least to a level of “substantial transmission,” meaning less than 100 new cases per 100,000 residents. Companies will also consider the vaccination levels of their workforce and the severity of a new variant, among other factors, Bershteyn said.

She recommends employers use a framework of “always measures,” such as increasing clean air exchanges in indoor spaces; and ensuring that workers are fully vaccinated and stay home when sick; “sometimes measures,” when case numbers are higher, such as mandating masks and proof of vaccination to be on the premises; and “rarely measures,” such as temporarily closing a business.

Also, “people can reduce their risk in the long term for Covid-19 by improving general health, so taking the opportunity when transmission is low to catch up on any health care that has been missed … staying on top of weight, exercise and diet; and recovering economic losses and educational losses; and really importantly, restoring some of the social connections and those activities that are really important to a person’s wellbeing,” said Bershteyn.

Nuzzo, the Johns Hopkins epidemiologist, also thinks that the country needs to end its binary thinking on precautions, “that we either care about the virus and are trying to do something about it – or we’re not,” she said.

“The option not to care is not an option, but how we try to address the virus can and should change with the data,” she said. “That may include shifting from mandatory measures to recommended measures … It may mean that we put masks at the front of the entrance to the coffee shop for people to take if they so choose, but we don’t have the poor barista have to yell at somebody and call the police if somebody is not wearing a mask.”

Nuzzo and other epidemiologists also do not take it as a given that a new variant won’t emerge that overcomes the population’s immunity against the virus.

“It’s not like you are going down on a rollercoaster and are just going to keep on cruising. We could see the cases go up again, and I think we have to be mentally and socially prepared that if we are experiencing another surge, we may have to dust off some measures that we got to take a break from,” she said.

Dr Celine Gounder, an infectious disease specialist and epidemiologist at New York University, also thinks the pandemic will be shaped by individuals’ risk tolerance and how well we protect demographics such as low-income populations and residents of long-term care facilities. That means, for example, ensuring that everyone at a nursing home is vaccinated and boosted.

“Instead of having top-down recommendations for everyone, we are entering a phase soon where what we need to be doing is arming people with the information and tools to protect themselves and their loved ones,” she said. “And as opposed to blanket recommendations for the whole population, we need to really focus our public health efforts on the most vulnerable.”

The Guardian