Tag: COVID-19

For all of 2020, Alex, a 28-year-old living in New York, followed the U.S. Centers for Disease Control and Prevention’s (CDC) COVID-19 guidance “religiously.” Then, in 2021, something began to shift. That spring, the CDC said it was okay for vaccinated people to ditch their masks in most places. But people were clearly still getting sick—including Alex, who got COVID-19 for the first time in late 2021 and later developed Long COVID symptoms.

“There was this reckoning moment where it was like, ‘Maybe the CDC is not being totally honest with us about the situation,’” he says. “‘Maybe they’re trying to present it like we can go back to normal when we can’t.’”

For Alex, who asked to use only his first name to protect his privacy, that feeling has only deepened. The virus killed roughly 1,000 people in the U.S. during the week ending March 2 and has left about 7% of U.S. adults with Long COVID—but despite its continuing toll, real-time data on infections are limited, most mask mandates are gone, and isolation guidance has been scaled back.

The officials making those policies say they are justified, given that almost all of the U.S. population has some immunity to COVID-19, death and hospitalization rates are far lower than they were a few years ago, and tools like rapid tests, antivirals, and updated vaccines are widely available. “We are out of the emergency phase,” CDC Director Dr. Mandy Cohen said in a March interview with TIME. Updated guidelines, such as the end of five-day isolation periods, “reflect that progress,” Cohen said.

But to Alex, it feels less like progress than an attempt to “wrap [the pandemic] up in a pretty bow” and pretend everything is fine. Today, he feels there are “very few” experts he can trust—a sentiment that reflects a growing rift between America’s scientists and the COVID-cautious community, which includes people who are immunocompromised, coping with Long COVID, or simply trying to avoid the virus.

Read More: Experts Can’t Agree If We’re Still In a Pandemic

For much of the pandemic, the scientific establishment and the COVID-cautious public were largely aligned in their desires to contain COVID-19. But as many officials argue for a more moderate approach to living with the virus, COVID-cautious individuals are increasingly the loudest voices calling for continued precautions—and, sometimes, lashing out at the scientists they feel have abandoned the cause.

People who “are still taking COVID precautions seriously have every right to be angry about being abandoned by public-health officials and experts,” says Lucky Tran, a science communicator at Columbia University. “The very real pain that many people are experiencing has not been sufficiently acknowledged.”

Some experts, however, feel they’re in a lose-lose situation, accused of fear mongering one moment and abandoning America’s most vulnerable the next. Experts “feel attacked from all sides,” says Katelyn Jetelina, who writes the popular Your Local Epidemiologist newsletter—and as a result, she fears some will stop trying to communicate at all, further fracturing the already strained relationship between scientists and the public.

Though it may not feel like it, a significant portion of U.S. adults still care about COVID-19. In a KFF survey from late 2023, 26% of respondents said they were “somewhat” or “very” worried about catching the virus, and about half said they planned to take at least one precaution during the winter season, such as wearing a mask or avoiding large gatherings.

Briana Mills, a 31-year-old in California, continues to take many precautions. She has muscular dystrophy and severely decreased lung capacity, which means even a cold could land her in the hospital. With COVID-19 still a threat and with most mitigation measures gone, Mills rarely sees anyone in person except her live-in boyfriend. She ventures out once a month for a park meetup with a group of similarly COVID-cautious people, testing beforehand and wearing a respirator the whole time, but mostly she stays at home.

Mills says she feels abandoned by federal health officials, most recently when they relaxed their COVID-19 isolation guidance in March, even while people like her continue to live in near-total seclusion. “They’re supposed to take care of the people,” she says. “The fact that they’re letting not just disabled people, but people in general, either become disabled or pass away from this virus is very negligent.”

Read More: Long COVID Doesn’t Always Look Like You Think It Does

In certain segments of the population, disappointment with the CDC has been simmering for a long time, to the point that a volunteer group of scientists, health-care workers, public-health experts, educators, and advocates founded a group called People’s CDC to serve as a watchdog and alternate source of information. But federal officials aren’t the only ones drawing ire from those who still take the virus seriously. COVID-cautious Americans are increasingly turning their backs on some of the doctors, epidemiologists, and researchers who built their reputations on helping the public through the pandemic, and are now advocating for more relaxed measures.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, amassed a dedicated following to his podcast, Osterholm Update, by dissecting COVID-19 policy and talking about his personal precautions throughout the pandemic. Recently, though, Osterholm has loosened up. He no longer wears an N95 mask anytime he goes out in public, since, he says, he’s up-to-date on vaccinations and has access to Paxlovid if he gets sick. And he supports the CDC’s shortened isolation guidelines, arguing they will not meaningfully increase transmission and are more realistic for the average person.

Some listeners have felt betrayed by his loosened stance. “I can no longer, in good faith, be part of this family,” one listener wrote in a note Osterholm read during the podcast’s March 7 episode. “I am so saddened that you are willing to make a mockery of public health and throw a 50-plus-year career down the toilet just to be beholden to the capitalist enterprise.”

Read More: What Happened When a Man Got 217 COVID-19 Shots

Osterholm isn’t overly bothered by the criticism. Listening to and validating people’s feelings is a crucial part of being in public health, he says—and right now, it’s clear that “those who are reluctant to accept the current status of recommendations really do that out of a very real and legitimate personal fear.” The criticism, he thinks, is “less about whatever you say; it’s about whatever they’re feeling.”

Still, while Osterholm is empathetic to those fears, he thinks it’s reasonable and justifiable for COVID-19 policy to change as the virus’ impact on society does. “This is not about abandoning ship,” Osterholm says. “This is about the reality we’re in right now.”

Jetelina, who advises the CDC in addition to writing her newsletter, says she has also struggled to convey that her approach to COVID-19 is evolving with the data, not because she’s stopped caring. She continues to recommend precautions like masking during surges and staying up-to-date on vaccines—but she also argues it’s appropriate to relax a bit now that “we don’t have overwhelmed morgues and we’re not losing 3,500 people a day.”

That message sometimes chafes with longtime readers. In March, Jetelina turned over an edition of her newsletter to someone who has criticized COVID-19 mitigation measures, in an effort to better understand why some people lost trust in public health during the pandemic. Afterward, she got angry emails from followers who felt she was giving a platform to a COVID-19 minimizer. Jetelina has also been accused of downplaying ongoing risks like Long COVID.

It can feel surreal, she says, to get critical messages—and even death threats—from people who feel she isn’t being strict enough in her COVID-19 guidance when, a couple years ago, she was getting bashed for the opposite reason. The never-ending criticism sometimes makes her hesitant to keep publishing the newsletter at all. She recently took several weeks off because she was experiencing stress-related heart issues, and fears other science communicators will give up completely. “A lot of people are just kind of throwing up their hands and moving on, because it’s just not worth it,” she says. “That’s a huge concern of mine.”

Read More: Why Zero Stress Shouldn’t Be Your Goal

Dr. Lara Jirmanus, a clinical instructor at Harvard Medical School and a member of the People’s CDC, has the same fear—that the public will no longer have access to science-backed information—but for a different reason. In her view, many experts have given into “peer pressure” to start moving on from COVID-19, glossing over continued risks like Long COVID; societal inequities that leave some people without reliable access to tests, vaccines, and treatments; and the reality that not everyone is “25 and healthy.”

While there are policy measures that could help make society safer for everyone, such as ventilation standards for public buildings and sick leave policies that allow everyone to stay home when they’re unwell, Jirmanus says independent scientists still have an important role to play. If all experts communicated clearly about the continued risks of the virus, Jirmanus thinks people might be more open to precautions like masking, staying home when sick, and getting vaccinated.

Officials sometimes argue that “public-health guidance is limited by what people are willing to do,” Jirmanus says. “But what people are willing to do is shaped by what experts tell them.”

Data and communication are all Lindy Greer, a 45-year-old in Washington State, wants these days. Greer has taken COVID-19 seriously since the very beginning, both because she previously had long-term symptoms after a non-COVID viral illness and because she works as an esthetician, putting her in close contact with others. She still wears an N95 every day and uses a HEPA air purifier in her work studio, because she still feels COVID-19 is a major threat.

It’s frustrating, Greer says, that many experts, including those she looked up to earlier in the pandemic, don’t seem to feel that way anymore. When even the experts have moved on, she says, it becomes harder for everyone to figure out how to stay safe—and causes people who remain COVID-cautious, like her, to wonder if they’re “crazy” for still caring.

“People in our community are pegged as wanting lockdowns again, and that’s not the case at all,” she says. “All I ever want is for people to have the right information.”

Today marks four years since I said the global outbreak of COVID-19 could be characterized as a pandemic.

My decision to use the “p-word” was not one I took lightly. Pandemic is a powerful word, evoking fear linked to plagues and pandemics throughout history that have claimed millions of lives and caused severe disruption to societies and economies—as COVID-19 did.

Many of WHO’s critics have pointed to my use of “pandemic” on March 11, 2020 as evidence that WHO was “late” in taking the threat of COVID-19 seriously. By that stage, more than 118,000 cases had been reported in 114 countries, and more than 4,000 deaths. The horse had bolted.

However, the far more significant date was January 30, 2020, six weeks earlier, when I declared a public health emergency of international concern (PHEIC)—the highest level of alarm under the International Health Regulations (IHR), an instrument of international law designed to govern the response to global health emergencies. At that time, fewer than 100 cases, and no deaths, had been reported outside China.

A PHEIC has legal and technical meaning; “pandemic” does not—it’s a descriptor, rather than a technical designation.

I declared an end to COVID-19 as a PHEIC on May 5 of last year. Although the crisis has passed, the threat has not. The virus is still circulating, still changing, and still killing.

As countries learn to manage COVID-19 alongside other disease threats, and continue to grapple with the complications of Long COVID, they must also learn the painful lessons of COVID-19, and take corrective action to address deficiencies in the IHR and gaps in global health security that the pandemic exposed.

History teaches us that the next pandemic is not a matter of if, but when. It may be in our lifetime; it may not come for another 100 years or more. But it will come. And as things stand, the world remains unprepared.

Read More: Experts Can’t Agree Whether We’re Still in a Pandemic

That’s not to say nothing has been done. In the past two years, WHO, our Member States, and partners have established several initiatives to detect outbreaks earlier, strengthen sharing of biological samples and sequences, expand regional manufacturing of vaccines and other tools, improve equitable access to medical countermeasures, and strengthen financing of national preparedness and response capacities, especially in lower-income countries.

But there is still one key missing ingredient: an agreed framework between countries on how they will work together to counter the threat of a future pandemic.

The lack of coordination and cooperation between countries was one of the greatest failings of the global response to COVID-19. Countries became competitors, rather than cooperators, especially in seeking access to vaccines.

While the development of multiple safe and effective vaccines in such rapid time was an unprecedented triumph of science, before a single jab reached an arm, high-income countries had used their financial muscle to pre-order most of the world’s supply—often ordering more than they might ever need—leaving lower-income countries behind, waiting for scraps.

Of course, every sovereign government is responsible for protecting its people. But in a pandemic, no country can truly protect itself without working with other countries—especially those with the least financial, technical, or political capital—to ensure they too are protected. A global threat demands a global coordinated response.

Countries have recognized that, which is why they decided to strengthen the IHR and, in December 2021, to develop an international agreement on pandemic preparedness and response—a legally-binding generational pact to work together to keep themselves and each other safe.

They set themselves a deadline of completing the agreement and the IHR amendments in time for adoption at the World Health Assembly in May 2024. That’s now just 10 weeks away.

Read More: Is There a ‘COVID’ Season Yet?

Countries are making good progress, and have agreed on significant elements of the draft agreement, although there are still some issues which require further negotiation. I remain confident they can and will find common ground.

A more pernicious problem is the avalanche of lies, fake news, and conspiracy theories about the pandemic agreement that are propagating on social and traditional media.

Just as the response to the pandemic itself was hampered by mis- and disinformation, so the agreement’s negotiators are operating amid a frenzy of falsehoods: That the agreement is a power grab by WHO; that it will give WHO power to impose lockdowns or vaccine mandates on countries; or that it’s an attack on freedom.

These claims are completely false. WHO does not have, and has never had, the power to impose anything on anyone. We don’t want that power, and we’re not trying to get it.

The agreement is being written by countries, for countries, and will be implemented in countries in accordance with their own national laws. No country will be signing away its sovereignty to WHO. Why would it?

Legally-binding international agreements are not new. They are a tool that countries have used often since the end of the Second World War to meet common threats with a common response: the Geneva Conventions; the UN Charter; the Nuclear Non-Proliferation Treaty; the Paris Agreement; the WHO Framework Convention on Tobacco Control; and the WHO Constitution, to name a few.

All are binding agreements in international law, and none give UN staff, including me, power to dictate to sovereign states.

In his classic novel La Peste, Albert Camus wrote, “There have been as many plagues as wars in history, yet always plagues and wars take people equally by surprise.”

As the generation that lived through the COVID-19 crisis, we have a collective responsibility to protect future generations from the suffering we endured.

Because pathogens have no regard for the lines humans draw on maps, nor for the color of our politics, the size of our economies, or the strength of our militaries.

For everything that makes us different, we are one humanity, the same species, sharing the same DNA and the same planet.

We have no future but a common future.

Older adults should get the COVID-19 vaccine more frequently than previously recommended, according to new guidance from the U.S. Centers for Disease Control and Prevention (CDC). Health officials are urging people ages 65 and older to receive another vaccine dose in the spring, or at least four months after their most recent dose.

CDC director Dr. Mandy Cohen announced the decision after a CDC advisory committee, which is made up of independent vaccine and infectious disease experts, voted 11-1 to make the change. “An additional vaccine dose can provide added protection that may have decreased over time for those at highest risk,” she said in a statement.

The decision is based on data presented by CDC scientists that showed current hospitalization rates for COVID-19 are highest among seniors, with the biggest spikes occurring among those 75 years and older. People 65 and older account for 67% of hospitalizations due to COVID-19. (The CDC previously recommended that most people get a COVID-19 vaccine once a year. )

The committee reviewed new data showing that the current COVID-19 shot is effective against currently circulating variants including JN.1 , even though it targets XBB. People who were vaccinated with the latest shot made fewer trips to urgent care and emergency rooms for COVID-19-related symptoms, and were less likely to be hospitalized than those who did not receive the shot. But vaccine protection wanes over time, so getting another dose will help prevent serious outcomes in the most vulnerable.

Read More: Why It’s So Hard to Get Kids Vaccinated Against COVID-19

“I was convinced by the data that there is significant protection with an additional dose at this time,” says Dr. Wilbur Chen, professor of medicine at the University of Maryland School of Medicine and a member of the committee. “This recommendation isn’t for the entire population, but for high-risk segments of the population. We are trying to improve their protection as much as possible and wanted to afford those over 65 years the opportunity to get a second dose.”

One challenge to achieving that, however, is that uptake of the newest COVID-19 vaccine has been low. Though about 40% of seniors have gotten it so far—the highest rate out of any age group—it still means more than half of a very vulnerable group are not up to date. The low demand is fueling decreased access, says Chen, since more doctors’ offices are deciding not to provide the shot because their patients aren’t asking for it. Now that the government is no longer providing the vaccines for free, many people who are under- or uninsured are not getting immunized.

Chen says the committee members hope that older adults and health care providers alike receive the strong message behind the recommendation and take it seriously. “As we enter the warmer months, while we usually see flu and RSV disappear, in previous summers we still saw 500 deaths a month,” he says. “That’s a lot of deaths, and we need to act on that.”

Since 2021, people with COVID-19 have been told to isolate themselves for at least five days to avoid spreading the disease. But that practice may soon join most mask mandates as relics of the peak pandemic era.

The U.S. Centers for Disease Control and Prevention (CDC) is said to be weighing a new, symptom-based approach to isolation for the general public, the Washington Post reported on Feb. 13. Under that potential approach, which may be rolled out for public feedback this spring, people could leave home when their symptoms are mild and improving and they’ve been fever-free for at least 24 hours without medication, according to the Post.

That possible shift, which echoes similar moves in California and Oregon, would bring the CDC’s recommendations for COVID-19 in closer step with its guidance on the flu. When people are sick with the flu, the CDC recommends they stay home until at least 24 hours after their fever has broken naturally, or until other symptoms clear—which the agency says can take up to five days.

A CDC representative did not confirm or deny the Post’s report when asked by TIME. The agency has “no updates to COVID guidelines to announce at this time,” the representative wrote in an email. “We will continue to make decisions based on the best evidence and science to keep communities healthy and safe.”

While the shift is not yet official, experts have previously predicted that 2024 will bring a further relaxation of COVID-19 policy. “The guidance becomes lighter and lighter over time, and that actually makes sense as people build up more immunity,” Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration’s former COVID-19 response coordinator, said in a January interview with TIME. “I do expect that some of those guidances will dissipate.”

Read More: We’re In a Major COVID-19 Surge. It’s Our New Normal

The virus itself has not evolved to become less contagious. But people’s tolerance for public-health precautions has plummeted. Many people in the U.S. haven’t paid attention to COVID-19 guidance in a long time, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You have to face reality,” he says.

Meeting people where they are may encourage them to take at least some precautions, he says. Some people who are unwilling or unable to isolate for five full days might be open to staying home for a shorter period of time when they’re acutely ill, for example.

Not all experts are as optimistic. Lucky Tran, a science communicator at Columbia University, called the potential end of five-day isolation periods “a reckless anti-public-health policy that goes against science, encourages disease spread, and puts everyone at risk. The bare minimum we should have learned from this devastating pandemic that has killed and disabled millions is that we should stay home when sick.” The rumored adjustment “would completely ignore the continued suffering” of people who are immunocompromised, chronically ill, disabled, or otherwise at heightened risk of severe COVID-19, Tran adds.

Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, says it would be “really strange” for the CDC to relax its current guidance, given that even a five-day isolation period isn’t always long enough to stop the spread. Studies have shown that a significant portion of people who catch COVID-19 test positive, and thus potentially remain contagious, for longer than five days. (The CDC currently recommends that people with COVID-19 wear a high-quality mask, such as an N95 or KN95, around others for at least 10 days after getting sick; it’s not clear whether that suggestion would remain in place if the guidelines change this spring.)

The absence of symptoms also isn’t a guarantee that someone is no longer infectious, Murray says. Research has long suggested that pre-symptomatic or asymptomatic people can spread the virus, although they may not be as contagious as people who are sicker. At-home tests aren’t a perfect measure either, although they can provide some information about potential contagiousness.

Even still, Dr. Tara Bouton, an assistant professor at the Boston University Chobanian and Avedisian School of Medicine who has researched COVID-19 isolation periods, feels it’s reasonable to loosen isolation guidance at this stage of the pandemic, when fewer people who get infected die or become hospitalized. That’s in large part because lengthy isolation periods disproportionately penalize people whose income depends on working in person, Bouton says. “The ability to isolate is a privilege,” Bouton says, and public-health policy needs to balance the costs and benefits of asking people to do it.

Murray, however, fears that relaxing isolation guidance will make it easier for businesses to deny their employees time off to recover. If the CDC removes its current guidance—which, Murray notes, is a recommendation rather than a mandate—it would be “providing information that is not evidence-based and is not going to help people make informed decisions, but will probably be used to limit paid leave.”

So what would the experts do if they got sick with COVID-19?

Even though Bouton feels that a blanket five-day isolation recommendation is no longer necessary, she says she would stay home around that long because she’s able to—and because working as an infectious-disease doctor puts her in contact with lots of immunocompromised patients, who remain at increased risk of severe disease if they get infected.

Murray says she would stay home until her symptoms cleared up and wait until she’d gotten two consecutive negative test results, spaced out by at least a day, before exiting isolation. (Often, that approach requires more than five days of isolation, since people can test positive on at-home rapid tests for more than a week.)

Tran says he’d go even further: he’d stay home for 10 days, self-test multiple times before ending isolation, and wear a mask—as he usually does anyway—upon returning to public spaces.

Osterholm, too, says he’d stay home for five days and continue to wear an N95 in the immediate aftermath of his illness. Efforts like those are important, he says—but they’re also not everything. He’d like the public-health community to devote more attention to encouraging vaccination among vulnerable older adults, many of whom have not gotten the latest shot, and streamlining Paxlovid access for high-risk patients.

Those efforts, Osterholm says, could save lives at a time when most COVID-19 deaths occur among people who are elderly or otherwise at high risk—and at a time when Americans are moving on from COVID-19, whether official guidance tells them to or not.

COVID-19 doesn’t always affect people the same way. If someone gets sick, for example, not everyone in that person’s close social circle will get infected—even if they recently spent time together. But why? In a paper recently published in Nature Communications, researchers delve into the different factors at play, from genetics to public health interventions, all of which affect how a virus spreads from one person to another.

They found that at the beginning of the pandemic, environmental factors like social distancing, isolation, hand washing, mask wearing, and vaccination played a bigger role in whether people got infected, while over time, genetic factors have become more important. Now, genetics may account for anywhere from 30% to 70% of one’s chance of getting COVID-19, they concluded.

To reach that estimate, the researchers studied the health records from more than 12,000 people (who came from about 5,600 families total) who tested positive for COVID-19 at a large New York City hospital from Feb. 2020 to Oct. 2021. To capture the role that non-genetic factors, such as a person’s environment, play in their chance of getting infected with the virus or how severely ill they got if they were infected, they also categorized each person’s potential exposure by weighing factors like who lived in their household, contact with their extended family, and what kind of housing they had.

Read More: When Will We Get New COVID-19 Drugs?

At the beginning of the study, the researchers estimated that genetics accounted for about 33% of a person’s likelihood of getting infected, while by the end, genetics accounted for 70%. That’s a huge jump from previous studies, which estimated that a person’s genes only explained about 1% of their likelihood of infection. This indicates that more genes are likely contributing than previously thought.

“We don’t know what the specific genetic variants are yet, but we do know there are other genetic variants that confer some sort of susceptibility, which might explain why some people are reinfected multiple times and others seem resistant even if they are family members living together,” says Nicholas Tatonetti, associate professor of computational biomedicine at Cedars-Sinai and senior author of the paper.

Why did genetics gain a bigger role as the pandemic progressed? At the beginning of the outbreak, public health measures such as mask mandates, lockdowns, and isolation practices had a bigger influence on who got infected, since nearly everyone was encountering SARS-CoV-2 for the first time and had little immunity to fend off the virus. But as people became infected and vaccinated, those environmental factors became more homogenized, and genetic factors related to people’s different immune responses began to emerge as the more prominent driver of who got infected and to what extent.

It’s not an exact science, but Tatonetti says this type of modeling can help public health experts understand when interventions like masks are most impactful. And it seems to be at the start of outbreaks. “These results show that public health practices really do matter, and they worked,” he says. That’s important to remember, since genetic factors are out of our control—while behavior changes can help us tip the balance, at least somewhat, in our favor.