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Pandemic Lessons: What to know as the Covid-19 emergency ends

Buffalo News - 5/16/2023

May 16—It's essentially over, but we are hardly done.

In the last several days, the U.S. government and the World Health Organization have lifted emergency status declarations for the Covid-19 pandemic. Three years after the no-longer-novel coronavirus first surfaced, we can safely stop calling this a pandemic.

But it doesn't mean we're done with Covid. Because Covid is absolutely not done with us.

"The pandemic is probably over," says Dr. Nancy Nielsen, senior associate dean for health policy at the University at Buffalo. "But it is now going to be a virus that we live with periodically. It's going to be here for sure. Covid is not going anywhere."

The pandemic is done, but Covid-19 is here to stay. How do we make sense of that? We spoke with a series of experts to find out.

So we can breathe a sigh of relief?

Well ... yes. But don't get complacent.

"The answer is mostly," says Dr. Thomas Russo, the chief of infectious disease at UB's Jacobs School of Medicine and Biomedical Sciences. He adds a caveat: One of the reasons we're likely in a particularly good spot now is the time of year. Mid-spring has us far enough from the much-higher winter transmission rates, and still distant from the hottest days of summer, when people in some states — particularly southern ones — tend to gather in the air-conditioned indoors.

When we do hit those spots on the calendar, we are still well-equipped to handle increased viral circulation. "We've got a pretty good immunity wall," Russo said, noting that some of his fellow infectious disease experts estimate that only a tiny percent of the population — perhaps as low as 1% to 2% — have no immunity through vaccination or infection.

OK, let's ask again: Is the pandemic REALLY over?

"I think that's an easy one," Russo says. "If most people define the pandemic as across the globe there's a large number of cases, hospitalizations and deaths, by that definition, the pandemic is over. We're really at the lowest number of cases, hospitalizations and deaths that we've been virtually at any time in this pandemic."

The World Health Organization's Covid-19 dashboard has a pair of charts that illustrate Russo's point. The confirmed cases graph, which depicts surges and lulls of virus spread over the last three years, is ticking at a level so low that it resembles early March 2020, before the first major Covid-19 explosion.

The same is true for the second chart: Deaths, by week. A total of 290 deaths were reported globally in the week preceding May 8. Contrast that to mid-January 2021, when global deaths exceeded 100,000 weekly.

But the totals on those charts are harrowing: The world has seen nearly 766 million cases — a number that is likely underreported, since many people either don't take tests, or use at-home kits and don't report the results.

The global death count is nearing 7 million people. That's the equivalent of the Buffalo Bills'Highmark Stadium filled to capacity nearly 100 times.

Those numbers may stabilize low — the virus "is going to be more predictable and less dangerous," Nielsen says — but they likely won't hit or stay at zero.

"I can't stress this enough," Russo says. "'The pandemic is over' does not mean that we're done with Covid. Covid is still out there. Covid is still causing infections. Covid is still killing individuals. It's just doing it at low numbers compared to what it was doing earlier."

How are we doing locally and regionally?

The same as above. On a visit in March to Millard Fillmore Suburban Hospital, we saw one Covid-19 patient in an intensive care unit that, earlier in the pandemic, had been over capacity with people fighting the virus for their lives.

"It's not gone," said Dr. Lucy Campbell, a critical care specialist who oversees the ICU. "But it's become one of the other things that people come into the hospital with: Bad influenza, bad whatever."

Statewide and regional numbers are reflecting the downward trend. In early January, data released by New York State cited about 21 Covid-19 cases per 100,000 people statewide, with Western New York seeing approximately 13 cases per 100,000 people.

As of last week, New York reported less than three cases per 100,000 people statewide. The same figure for Western New York was below two as of May 10.

In a sure sign that the pandemic has wrapped, Gov. Kathy Hochul's office also announced that it will no longer be issuing its regular Covid-19 data public statements. For most of the last three-plus years, it had been a regular — and often daily — delivery in journalists' email inboxes.

But now, with the lifting of the federal emergency declaration, which in turn curtails some of the detailed data reporting that has happened since 2020, the latest information will be available on the state's Covid-19 online tracker.

Could more variants be on the way?

Coronaviruses are constantly mutating, but those evolutions tend to become faster and more problematic when the virus is spreading fast, and when it stays inside its hosts — the infected people — for longer periods of time.

Less spread means less likelihood of highly contagious and dangerous variants. But the chance of that happening is still very real, and nowhere near zero. A panel of infectious disease experts recently consulted by the White House predicted the chances of it happening as 10% to 20%.

Russo, who wasn't among those physicians, said, "People just have to keep in mind that there is a small but finite chance that we could have a significant resurgence that sends us backwards in terms of all the gains we've made over these last three years."

In the meantime, if you get Covid-19 now, what do you do?

No dramatic changes here. If you test positive for Covid-19, the Centers for Disease Control and Prevention still advises isolating at home for five days from either the onset of symptoms. (If you don't have symptoms, your five-day clock starts with the negative test.)

After five days, if you're starting to feel better and you're fever free for 24 hours, you can head back into the world, but with a "high-quality" (meaning N-95 or similar) mask. You should avoid dining in groups, or other situations where you share air without a mask, through day 10.

The CDC also offers a way out of masking: If you test negative on two at-home rapid tests taken at least 48 hours apart, you're free to drop the mask.

These are guidance, not laws. As Covid-19 normalizes in our society, we'll likely see people simply fit these guidelines to how they are feeling — which could include extending beyond five days.

"Frankly, think about it," said Nielsen, who is a former president of the American Medical Association. "Is that what you would tell somebody who had influenza? Is that what you would tell somebody who had a really bad cold that couldn't stop sneezing and coughing? It would be 'stay at home until you feel better.' These are pretty common sense."

What precautions should we still be taking?

That's mostly individual. One consistently delivered bit of advice from doctors, especially for people at potential risk, is to keep up to date on vaccinations and boosters. "It's important for people to recognize their own situation," Nielsen says. "For example, if you're over 50, you really need to be aware of this virus in a way that you take certain precautions. If you haven't been vaccinated, you should be."

People who are older, have high risk factors or who are immunocompromised may still opt to mask more often, or avoid certain crowded situations, especially indoors. If you do contract Covid-19, it's still vital to talk to your doctor quickly. They may advise you to take a therapeutic such as Paxlovid, which often helps clear symptoms more quickly and keep people out of hospitals.

"We have therapeutics that are good," said Dr. Katherine Mullin, an infectious disease specialist at Roswell Park Comprehensive Cancer Center. "We see people who are able to utilize those therapeutics and do well."

That includes many of Roswell's patients whose medical conditions and treatments have weakened their immune systems. The intense focus on developing Covid-19 therapeutics has helped keep many of them safe. "Frankly, at this point in the pandemic, we have more tools to give our immunocompromised patients and help them fight Covid than we do for some other viruses, like RSV," Mullin said.

The risk going forward likely won't include just Covid-19. RSV, influenza and other viruses will all be part of our decision making on masking, vaccination and socialization, for our own self-benefit and for the people around us.

"That first winter we had almost no flu," Nielsen said. "Why? Because nobody was going out, and if you did go out, you wore a mask. We learned some things — maybe not the lessons we intended — but this virus is going to be there."

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