As COVID-19 cases continue to fluctuate around the country, it has become clear that the coronavirus that causes the disease is unlikely to disappear.
But navigating the risks can be difficult when conditions differ dramatically between cities, counties and states—from the rate of infection in each area, to local recommendations on masking and other policies.
Assoc. Prof. Emily Landon says learning to live with COVID-19 means learning to accept our vulnerability to infectious diseases—and taking the right steps going forward to protect our health and the health of others. An infectious diseases specialist and hospital epidemiologist, Landon answers questions about mask-wearing, the continued importance of vaccines, and risks to children.
What worries you at this stage of the COVID-19 pandemic?
As we switch to a COVID-19 prevention model where individuals are responsible for taking care of themselves, I’m not 100% convinced we've gotten all of the information out. People don’t necessarily realize they’re at high risk for getting a bad case of COVID-19.
Those at obvious high-risk—older individuals, the immunocompromised, the unvaccinated—know. But as protection from our vaccines weaken, there are a lot of people who are at high risk for COVID-19 and other conditions because they have illnesses like heart disease, high blood pressure or diabetes. These may be well-controlled in your day-to-day life, but they still make you more vulnerable for severe COVID-19.
Can I quit wearing a mask?
Until coronavirus transmission is much lower, we need to keep masks on in places like trains, planes and buses.
Japan uses the three C’s to remind people where risk of COVID-19 is highest: closed spaces (places with limited ventilation); crowds; and close contact settings. These are the places where masks offer the best benefit and individuals should decide whether or not to use a mask based on their risk and the current amount of COVID-19 in the community.
Immunocompromised folks may want to keep wearing masks in most of these settings until COVID-19 rates are very low, whereas healthy, vaccinated people may want to forgo a mask. In a setting where masks aren’t required anymore, it’s important to choose a really protective mask (like a close-fitting KN95, KF94 or N95 mask) to provide the best protection. When cases are really high in an area, indoor mask mandates provide the best protection and can help save lives. On the other hand, when we get to a point where there’s almost no COVID-19 circulating, there’s no reason to be wearing masks unless you’re at very high risk.
What mask should I use in the future?
Choose the mask based on the situation and your risk factors. For instance, if you're a low-risk individual going to an event where everybody's wearing masks, people don't need to all be in N95s. Even a well-fitting fabric mask will offer some protection; a poorly fitting surgical mask probably isn’t any better. That said, a tight-fitting mask, like a well-fitted surgical mask with adjusted straps, such as KN95s and KF94s, would be a real step up. A fitted N95 mask is best.
How often should I be washing or sanitizing my hands?
For colds that are spread on surfaces, washing your hands is critical; for other colds, you're only going to pick them up from coughs and sneezes in the air. But you're not going to know what type of cold someone has when you're around them. Any time I switch settings or change buildings, I like to wash my hands. For example, when I go from work to home, I’m touching a lot of stuff along the way, so I wash my hands when I get home. Also make sure to wash your hands before preparing food, eating and after using the washroom.
During the pandemic, the flu all but disappeared. Should I bother with a flu vaccine?
I didn't think that if we asked everybody to wear a mask, it would completely end influenza. But in a normal year, tens of thousands of Americans die of influenza. We tend to underappreciate influenza and other respiratory viruses, because when we’re young and healthy, they just seem like bad, nuisance colds. But they can be life-threatening for some people, including kids and even some healthy adults. The flu vaccine is helpful in preventing bad outcomes like hospitalization, pneumonia and even death. Still, you shouldn’t rely on the vaccine to be your only layer of protection. You also need to wash your hands and stay home when you’re sick. And if you’re high-risk, make sure you have access to medications like Tamiflu.
How should people who are older and/or immunocompromised navigate the next few months?
High-risk individuals may need to take more precautions because others are no longer wearing masks to help shield them. For instance, in closed spaces with other people, the highest-risk individuals may need to wear both an N95 and face shield to protect their eyes from large COVID-19 droplets. Highest-risk people probably also need to avoid crowds altogether, even outside, if they can’t keep 6 feet of distance from the unmasked. Because vaccines aren’t as effective for this group, make sure to keep up with vaccination recommendations and pay attention to the COVID-19 situation. Your physician should be able to say whether new recommendations apply to you.
At this point, why bother getting vaccinated against COVID-19?
Everyone needs to be vaccinated for COVID-19 and it’s wise to keep up with boosters as well. Individuals who are unvaccinated are 10 times more likely to die of COVID-19 than the vaccinated. The current recommendations that it’s safe to be unmasked and "get back to normal" is meant for vaccinated people. Even healthy unvaccinated people are at high risk of a bad outcome after having COVID-19. More doses of these vaccines have been given than almost any other vaccine and vaccinated people are doing beautifully. We are not seeing people die or have medical problems related to the vaccine. Unvaccinated COVID-19 infection, on the other hand, has killed hundreds of thousands of Americans and caused millions of cases of long COVID, strokes, heart attacks, kidney failure, heart failure, lung damage, blood clots… the list goes on and on.
Why should I get my kids vaccinated when the Pfizer vaccine was found to be less effective for 5- to 11-year-olds?
Just because it’s less effective doesn’t mean it’s not effective. Your child may get a breakthrough infection, but it’s still extremely protective in keeping them well and out of the hospital. Multiorgan inflammatory syndrome in children (MIS-C) can be devastating for a child even if they survive, and kids can get long COVID, leading to difficulties in school. Furthermore, the risk of developing diabetes is much higher in kids who were unvaccinated and had COVID-19. As a parent, I worry a lot about my child’s physical health, education and social development. I’ve done a lot of things to ensure my child’s success. COVID-19 vaccination is just another step I can take to help my child be as successful as possible.
—A version of this story was first published by the University of Chicago Medicine.