Tag: COVID-19

If you’ve been to a hospital lately, you might have noticed: masks are back. The rising number of COVID-19 hospitalizations is prompting many health care systems—including those at the University of Pennsylvania, Johns Hopkins, and all public health hospitals in New York City—to require them once again.

Does wearing a mask still matter—and do the new mandates mean that other restrictions are on the horizon? Here’s what experts say.

Masks still make sense in these settings

Hospitals are full of people who are most vulnerable to COVID-19’s complications, such as those with weakened immune systems, older people, and those battling multiple health problems. “They represent areas where more people could potentially suffer very severe results from their infection,” says Andrew Pekosz, professor of molecular microbiology at the Johns Hopkins Bloomberg School of Public Health, so masking there is a good idea.

Masks aren’t perfect, and some are more effective than others, but studies show that they do reduce transmission on the whole. In the latest analysis, published in Clinical Infectious Diseases in January, researchers led by Dr. Francesca Torriani at University of California San Diego report that almost no infections were transmitted within that health facility (where there was a mask mandate) in the early days of the Omicron wave. In fact, they found that the only areas where transmission occurred were in break areas or during gatherings when people removed their masks to eat.

“Masks work,” says Dr. Robert Murphy, professor of medicine at Northwestern Feinberg School of Medicine. “If you’re interested in public health, requiring masks in places like hospitals is what we need to do. If everybody is wearing a mask, it works even better to prevent transmission of disease.”

Hospitals aren’t the only places vulnerable people gather, so Murphy suggests mask mandates could be extended to long-term care facilities and assisted living spaces. He also believes mask requirements in these settings should become a regular feature every year during respiratory season. “It’s probably a very good idea, from a public health standpoint, to say that this is something that happens every winter from December to February,” he says. “It just makes common sense. If universal masking is never going to be accepted at this point, let’s protect the most vulnerable, and hospitals are places where there are a lot of vulnerable people.”

Don’t bet on a return to restrictions

Murphy is also aware that “people in the U.S. are very nervous about getting into wider mask mandates.” While masks make sense in the health care setting, public health experts aren’t naïve enough to believe that they will return to other public places. “People are fed up,” says Torriani. “And we have to ask, ‘What’s the bang for the buck?’” In settings where there might not be as many vulnerable people, the payback for the inconvenience of wearing a mask is likely much lower. Plus, people have built up immunity from a combination of vaccines and infections over the past four years. “Now that the virus is less virulent, I really think we don’t need to be as drastic as we were at the beginning,” says Torriani.

Read More: How Long Does It Take to Get COVID-19?

She and other experts predict that COVID-19 measures in general will get looser, not tighter. In January, California’s public health relaxed recommendations on how long people need to isolate after testing positive, advising people to only stay home if they are positive and have symptoms like a cough or fever. If they are positive but don’t have symptoms, they no longer need to isolate. Torriani believes that the U.S. Centers for Disease Control and Prevention (CDC) might soon shorten their own guidelines—which currently advise positive people to isolate for at least five days after testing positive, and sometimes more, depending on their symptoms—as well.

Don’t forget your vaccine

There’s another important way to protect against COVID-19—getting the updated vaccine, which works quite well against the newer circulating variants. But now that vaccine mandates are a thing of the past, just over 20% of eligible people in the U.S. have received the latest shot. That’s because there are too many barriers to getting vaccinated now that the government is no longer providing free shots at convenient mass vaccination sites, Murphy says. “If you go to a pharmacy and say ‘I want the COVID vaccine,’ the first thing they will do is see if you have insurance that can pay for it,” he says. “The U.S. system is set up for public health failure.”

That places more of the burden of shielding against diseases like COVID-19 up to each individual. “COVID-19 is still killing more people than flu or RSV in the U.S.,” says Pekosz. “It’s still something we need to pay attention to and actively utilize the tools we have to minimize infections.”

With COVID-19 spreading as widely as it is right now, you run the risk of meeting an infected person every time you go into a public place. But every trip to the pharmacy or meal in a restaurant doesn’t lead to a case of COVID-19. So what makes some exposures more harmful than others?

The length of time you spend around a person with COVID-19 seems to heavily influence your likelihood of getting sick, according to a recent Nature study that has been peer-reviewed but not fully edited. Most exposures that result in transmission last at least an hour, if not much longer, the researchers say.

Previous studies have shown that people who spend long bouts of time with someone who has COVID-19 are at increased risk of getting infected, particularly if the encounter happens in a small, enclosed space. The U.S. Centers for Disease Control and Prevention also warns that longer COVID-19 exposures are riskier than shorter ones—but the agency has typically said 15 minutes of exposure is the threshold after which there’s a meaningful chance of getting sick. The new study, however, suggests it usually takes even longer for the virus to spread.

The researchers analyzed data from a COVID-19 tracking app that millions of people in England and Wales used to report positive test results and get notifications if they came into contact with someone who tested positive. The authors used data from 7 million of those notifications, which all happened from April 2021 to February 2022, to assess which exposures led to additional infections.

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There are some limitations to this approach. Data collection ended shortly after the peak of the first Omicron wave, so none of the newer variants, which have continued to evolve for increased contagiousness, are reflected. It’s also possible that some people who got infected after an exposure either did not get tested or did not report their test results in the app, and are therefore not included in the data.

It’s an imperfect measure. Nonetheless, users reported 240,000 positive test results following the 7 million exposure notifications. In around 80% of these cases, the person who tested positive had previously been around someone with COVID-19 for an hour or longer, says co-author Christophe Fraser, a professor of infectious disease epidemiology at the University of Oxford’s Pandemic Sciences Institute (PSI). Transmission was particularly likely within households, where people tend to spend long stretches of time together. These encounters were responsible for 41% of recorded transmissions, according to the study.

“That doesn’t mean some people haven’t been infected during short exposures,” Fraser says, but these incidents were relatively rare in the study group.

Co-author Luca Ferretti, a fellow at PSI who researches the behavior of viruses, says the study suggests you have about a 2% chance of getting infected if you spend an hour with someone who has COVID-19, with the risk continuing to accumulate the longer you spend together.

That’s a much more optimistic conclusion than other scientists have reached. In one modeling study published in 2021, researchers calculated that, in a worst-case scenario, chances of infection could rise as high as 90% during just a few minutes of conversation with a sick, unmasked person. (If either or both people wore a mask, the researchers found, that number fell significantly.) Another modeling study, this one published in 2023, found that someone could inhale an infectious amount of virus after six to 37 minutes in a room with someone who has COVID-19.

What happens in the real world, however, is sometimes different from the theoretical conditions used in studies. The authors of the new Nature study found that “fleeting” exposures of 30 minutes or less caused only 10% of documented illnesses in the study group.

Of course, even 10% of recorded transmission equals thousands of illnesses—so, clearly, people do get sick after even brief brushes with the virus. If you’re seated on the subway next to someone who is sick with COVID-19 and actively coughing, your proximity may be more important than the length of your trip. And having lots of short exposures in a row can amount to a significant risk. Data show, for example, that bus drivers are at increased risk of COVID-19. They probably don’t spend a ton of time with any one passenger, Fraser says, “but if they’re meeting hundreds of passengers per day, it adds up.”

Still, Fraser says people tend to overestimate the “stranger danger” of getting COVID-19 from a random encounter, when in fact transmission often happens in places where they spend a lot of time, like their home or workplace.

Given the study’s findings, Ferretti recommends being extra careful if you know you’ll be spending a lot of time with someone who could be infected. If you’re staying overnight at a relative’s house, for example, you may both want to test beforehand.

And, he says, it’s better to take precautions late than never at all, since it can take a long time to get infected. Lots of people assume that if they’ve already been exposed to someone who has COVID-19, it’s too late to do anything. But the research suggests it could take hours or even days for someone to pass on the illness. So even if, say, you slept next to your spouse the night before they tested positive, it’s still worth masking or isolating moving forward.

You probably know a lot of sick people right now. Most parts of the U.S. are getting pummeled by respiratory illness, with 7% of all outpatient health care visits recorded during the week ending Dec. 30 related to these sicknesses, according to the U.S. Centers for Disease Control and Prevention (CDC).

Many people are sick with flu, while others have RSV or other routine winter viruses. But COVID-19 is also tearing through the population, thanks largely to the highly contagious JN.1 variant. Just like every year since 2021, this one is starting with a COVID-19 surge—and Americans are getting a good glimpse of what their “new normal” may look like, says Katelyn Jetelina, the epidemiologist who writes the Your Local Epidemiologist newsletter.

“Unfortunately,” she says, “signs are pointing to this [being] the level of disruption and disease we’re going to be faced with in years to come.”

The CDC no longer tracks COVID-19 case counts, which makes it harder than it once was to say exactly how widely the virus is spreading. Monitoring the amount of virus detected in wastewater, while not a perfect proxy for case counts, is probably the best real-time signal currently available—and right now, that signal is a screaming red siren. According to some analyses, wastewater data suggest the current surge is second in size only to the monstrous first wave of Omicron, which peaked in early 2022. By some estimates, more than a million people in the U.S. may be newly infected every single day at the peak of this wave.

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Wastewater isn’t the only sign that things are bad. Almost 35,000 people in the U.S. were hospitalized with COVID-19 during the week ending Dec. 30—far fewer than were admitted at the height of the first Omicron wave, but a 20% increase over the prior week in 2023. Deaths tend to lag a few weeks behind hospitalizations, but already, about 1,000 people in the U.S. are dying each week from COVID-19.

Yet even as the trends veer in the wrong direction, people are still working in offices, going to school, eating in restaurants, and sitting shoulder-to-shoulder in movie theaters, largely unmasked. It can be hard to know how to feel about that reality. Viewed through a 2020 lens, many people would consider it catastrophically concerning that people are living normally even as COVID-19 sickens the equivalent of an entire city’s population every single day. But is it as worrisome in 2024, when the pandemic is over on paper, if not in practice?

Not according to Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration’s former COVID-19 response coordinator. Almost all of the U.S. population has some immunity from previous infections or vaccinations; treatments like the antiviral Paxlovid are available for people at risk of severe disease; and most people know the basics of masking, testing, and other mitigation measures. All of these factors, Jha says, mean COVID-19 is becoming less of a threat over time. Some groups of people, including the elderly and immunocompromised, are still at greater risk than others, and Long COVID—the name for potentially debilitating chronic symptoms that sometimes follow a case of COVID-19—remains a possibility for everyone. But Jha maintains that vaccines and treatments should make everyone feel safer.

“The straight facts are: COVID is not gone, it’s not irrelevant, but it’s not the risk it was four years ago, or even two years ago,” Jha says. “It’s totally reasonable for people to go back to living their lives.”

The big challenge now, says Dr. Robert Wachter, chair of medicine at the University of California, San Francisco, is wrapping our heads around that change. “We’ve got to somehow reprogram our minds to think about this as a threat that is just not as profound as it was for a couple years,” Wachter says. “When your minds have been pickled in terror for a couple of years, it’s very hard to do.”

How to assess COVID-19 risk in 2024

In the earlier days of the pandemic, Wachter closely watched the COVID-19 data and used exact numbers and percentages to decide what he felt comfortable doing. Now, with fewer of those precise numbers and more disease-fighting tools available, he goes by trends.

During COVID-19 lulls, “I’m living my life about as normally as I did in 2019,” Wachter says. Once indicators like COVID-19 hospitalizations and wastewater surveillance data start to suggest the virus is on the upswing, he wears a KN95 mask in crowded places like airports and theaters, where there’s little downside to masking. And in a full-blown surge, like now, Wachter masks almost everywhere and avoids some places he can’t, such as restaurants.

Those decisions feel right to Wachter, based on his personal risk tolerance and vulnerability to severe disease. He’s up-to-date on vaccines, which slashes his chances of being hospitalized or dying if he gets infected—but, at 66, those outcomes are still likelier for him than for his 30-year-old children. “Other people might make different choices,” Wachter says. “And there are going to be people who say, ‘This is a lot of mental energy…screw it.’”

With hard numbers scarcer than they once were and lots of people no longer willing or able to make detailed risk assessments, Jetelina instead recommends letting your objectives shape your behavior. Want to avoid infecting your grandmother before a visit? Maybe skip having dinner in a crowded restaurant a few days before and test before you go to her house. Want to minimize your risk of getting very sick if you do get infected? Stay up-to-date on boosters—as far too few people do, says Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development.

“The biggest failing right now in our response to COVID,” Hotez says, is that only about 20% of U.S. adults got the latest vaccine, which was updated to target newer viral variants. “That should be the number-one priority,” he says, since vaccination is the best way to prevent complications like hospitalization, death, and, to some degree, Long COVID.

The risks that don’t go away

Even with boosters, Jetelina says Long COVID is a hard risk to plan around. The only tried-and-true way to avoid it is to avoid infection entirely; staying up-to-date on vaccines reduces the risk by up to 70%, according to recent research, but people can and do develop it even if they’re healthy, fully vaccinated, and have had previous infections without incident. With variants as contagious as JN.1 running rampant, doing almost anything in public opens up the possibility of getting sick.

But there are plenty of choices between ignoring the virus entirely and completely locking down at home, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID. She recommends wearing good-quality masks in public, socializing outside or using open windows and air filters to improve ventilation inside, asking people to test before gatherings, and avoiding especially crowded places during surges. “I wish more of those were normalized, because they do at least decrease the chance of getting infected and causing long-term harm and disability to yourself or other people,” she says.

But, Davis says, all responsibility shouldn’t fall on individuals. She says it’s a “huge injustice” that the government hasn’t done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues. She also feels the data support policy measures like ventilation requirements for public places and mask mandates on public transportation.

The unclear future of COVID-19

Some mask mandates in health care facilities and nursing homes have been reinstated during this surge. But Jha says widespread mandates are unlikely to come back—and in his view, they shouldn’t. “There was a role for mandates in the early days of the pandemic…when we had no other tools, no way of protecting people,” he says. “Mandates four years in, when we have plenty of tests, plenty of vaccines, plenty of treatments, plenty of masks,” are not as crucial, he says.

Jetelina says she wouldn’t be surprised if 2024 brings a further relaxation of COVID-19 guidance rather than increased mitigation measures. She speculates that the CDC may change its isolation guidelines, for example.

“The threat [of COVID-19] will get baked into the other threats people have in their background that aren’t front of mind,” Wachter predicts, similar to the ever-present risk of getting sick with other illnesses or getting into a car accident. And, “as long as the virus doesn’t shape-shift its way into laughing at our immune status,” he says that’s not such a bad thing. People will continue to reach different conclusions about the level of risk-taking they can stomach and behave accordingly, just as they do in other areas of life.

It’s natural for guidance and behavior to change once a public-health menace begins to transition from emergency to endemic, Jha says. But that doesn’t mean we should turn a blind eye toward COVID-19 or the numerous other pathogens swirling around.

“For a lot of people it’s been about, ‘How do we go back to 2019, to life before the pandemic?’” he says. But, in his view, that’s not the right goal: “We actually want to look forward.”

Jha says he’s hopeful that lessons learned during the COVID-19 pandemic will spark a reimagining of how we deal with respiratory diseases in general. Such an approach wouldn’t necessarily single out COVID-19, as much of the public-health messaging has done since 2020. Instead, Jha says, it could standardize and broaden guidance around all infectious diseases, hammering home the importance of things like vaccines, masks, ventilation, and sick-leave policies that allow people to stay home when they have any disease—not just the one that has dominated our collective consciousness for the past four years.

GENEVA — The head of the U.N. health agency said Wednesday holiday gatherings and the spread of the most prominent variant globally led to increased transmission of COVID-19 last month.

Tedros Adhanom Ghebreyesus said nearly 10,000 deaths were reported in December, while hospital admissions during the month jumped 42% in nearly 50 countries—mostly in Europe and the Americas—that shared such trend information.

“Although 10,000 deaths a month is far less than the peak of the pandemic, this level of preventable deaths is not acceptable,” the World Health Organization director-general told reporters from its headquarters in Geneva.

He said it was “certain” that cases were on the rise in other places that haven’t been reporting, calling on governments to keep up surveillance and provide continued access to treatments and vaccines.

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Tedros said the JN.1 variant was now the most prominent in the world. It is an Omicron variant, so current vaccines should still provide some protection.

Maria Van Kerkhove, technical lead at WHO for COVID-19, cited an increase in respiratory diseases across the globe due to the coronavirus but also flu, rhinovirus and pneumonia.

“We expect those trends to continue into January through the winter months in the northern hemisphere,” she said, while noting increases in COVID-19 in the southern hemisphere—where it’s now summer.

While bouts of coughs, sniffling, fever, and fatigue in the winter are nothing new, Van Kerkhove said this year in particular, “we are seeing co-circulation of many different types of pathogens.”

WHO officials recommend that people get vaccinated when possible, wear masks, and make sure indoor areas are well ventilated.

“The vaccines may not stop you being infected, but the vaccines are certainly reducing significantly your chance of being hospitalized or dying,” said Dr. Michael Ryan, head of emergencies at WHO.

Getting COVID-19 today is much less scary and more common than it was three years ago. By now, many people have had it not just once, but two, three, or even more times. Most of the time, repeat infections aren’t as severe as they were the first time, leading to a sense of complacency about getting COVID-19 over and over.

But reinfections aren’t harmless. As cases continue to rise and more variants arrive on the scene, infectious-disease experts are warning that repeat infections could have cumulative, lasting effects.

“There is some early evidence starting to show that if you had COVID-19, there can be all sorts of problems after getting infected” and reinfected, says Dr. Robert Murphy, professor of medicine and executive director of the Havey Institute for Global Health at Northwestern’s Feinberg School of Medicine. “We are just at the beginning of learning about them.”

A higher risk of Long COVID

Dr. Ziyad Al-Aly, assistant professor of medicine at Washington University School of Medicine in St. Louis and director of the clinical epidemiology center at the VA St. Louis Health Care System, studies Long COVID: a condition marked by health effects that linger after infection. “Reinfection remains consequential,” he says.

In a paper published in Nature Medicine in 2022, he found that people who had gotten COVID-19 at least twice experienced higher rates of short- and long-term health effects, including heart, lung, and brain issues, compared to those who were only infected once.

But why? Dr. Davey Smith, a virologist and head of infectious diseases at University of California San Diego, says that certain characteristics—such as older age—may make people more vulnerable to complications after repeat bouts. “The older you get, the worse you do with viruses in general, but specifically with SARS-CoV-2,” he says. “Every time you get COVID-19 again and again, you increase the likelihood of having a worse infection just based on age.”

Underlying health conditions that people may not necessarily be aware of—like prediabetes or increased inflammation—could also put them at higher risk after each infection. “For somebody who is already on the edge of developing diabetes and then gets COVID-19, that could damage the pancreas and the endocrine system enough to change things,” Smith says. Similarly, having high rates of inflammation before COVID-19 could raise the risk of heart events such as stroke or a heart attack after an infection.

Regardless of a person’s health status, each COVID-19 infection can raise the risk of developing blood clots, which can travel to the brain or lungs. That’s why Smith believes anyone who is eligible for antiviral drugs such as Paxlovid should take them, since controlling the virus as quickly as possible can reduce any potential long-term or lingering effects an infection can have on the body.

COVID-19 may alter the immune response

At this point, many people view COVID-19 as relatively benign. But even if you’ve already recovered from a mild case, there’s no guarantee that next time will go as smoothly. “Just because you did okay with it last year doesn’t mean you’ll do okay with it this year,” Smith says.

“There is a mischaracterization in the public understanding that you can get an acute infection with fever, cough, malaise, and fatigue, get over it after a few days or a week or so, then bounce back, and it’s gone,” says Al-Aly. “The data are showing that [some] people still display increased risk of problems even two years after an infection.”

That’s what he found in his study. People who had multiple infections were three times more likely to be hospitalized for their infection up to six months later than those who only got COVID-19 once, and were also more likely to have problems with clotting, gastrointestinal disorders, kidney, and mental-health symptoms. The risks appeared to increase the more infections people experienced.

Understanding why SARS-CoV-2 has a uniquely lasting effect on the body remains a challenge. Historically, when the immune system meets a new pathogen like a virus, it generates novel defenses and remembers the intruder, so it has a head start if the virus returns. That’s certainly the case with SARS-CoV-2—which is why vaccines work, and why getting reinfected generally leads to milder symptoms.

But there is also growing evidence that in some people, getting COVID-19 the first time may compromise the immune response in a way that makes the body less likely to respond effectively the next time it sees the virus. That could leave certain organs and body systems, such as the brain, weaker for months after infection—and subsequent ones. “It’s the balance of these two opposing forces—the immune system learning from the past and knowing how to deal with a virus and do a better job the second and third time around, and the idea that a first encounter with a virus might alter the immune system in some way that it becomes less efficient—that could explain why some people get Long COVID,” says Al-Aly.

Data also continue to show that even vaccinated people can get Long COVID—although the risk may be lower—since the protection provided by vaccines wanes over time, just as it does from infections. Vaccines are therefore a strong but not absolute barrier to the virus.

Preventing reinfections

“Each time you get hit, it does impact your body, so let’s try not to get it too many times,” says Smith. That’s easier said than done, since after three years, people are tired of taking precautions such as wearing masks and avoiding crowded public spaces. “We’ve lost the public-health battle; there is no appetite for public masking or stringent public health measures,” says Al-Aly.

That means other strategies need to become available, including universal vaccines that can protect against multiple variants and nasal spray vaccines that stand guard at the nose, which is where SARS-CoV-2 generally enters. Researchers are currently testing these next generation shots, so while “the good news is that these technologies do exist, they need to be accelerated and brought to market as soon as possible to protect the public,” says Al-Aly.

In the meantime, Smith says it’s important for people to understand that they still need to do everything they can to avoid getting COVID-19. That means staying up to date with vaccinations and taking some basic precautions, such as wearing high-quality masks indoors when cases are high, especially in crowded places and on public transportation.

“I wish we lived in a world where getting repeat infections doesn’t matter,” says Al-Aly, “but the reality is that‘s not the case.”