Category: Education

The New York Times

On the COVID ‘Off-Ramp’: No Tests, Isolation or Masks

Emily Baumgaertner – August 27, 2024

Jason Moyer was days away from a family road trip to visit his parents when his 10-year-old son woke up with a fever and cough.

COVID-19?

The prospect threatened to upend the family’s plans.

“Six months ago, we would have tested for COVID,” said Moyer, 41, of Ohio. This time they did not.

Instead, they checked to make sure the boy’s cough was improving and his fever was gone — and then set off for New Jersey, not bothering to tell the grandparents about the incident.

In the fifth summer of COVID, cases are surging, and the Centers for Disease Control and Prevention has reported “high” or “very high” levels of the virus in wastewater in almost every state. The rate of hospitalizations with COVID is nearly twice what it was at this time last summer, and deaths — despite being down almost 75% from what they were at the worst of the pandemic — are still double what they were this spring.

As children return to schools and Labor Day weekend travel swells, the potential for further spread abounds. But for many like Moyer, COVID has become so normalized that they no longer see it as a reason to disrupt social, work or travel routines. Test kit sales have plummeted. Isolation after an exposure is increasingly rare. Masks — once a ubiquitous symbol of a COVID surge — are sparse, even in crowded airports, train stations and subways.

Human behavior is, of course, the reason that infections are soaring. But at some point, many reason, we need to live.

“I no longer even know what the rules and recommendations are,” said Andrew Hoffman, 68, of Mission Viejo, California, who came down with respiratory symptoms a few weeks ago after his wife had tested positive for COVID. He skipped synagogue, but still went to the grocery store.

“And since I don’t test, I can’t follow them,” he said.

Epidemiologists said in interviews that they do not endorse a lackadaisical approach, particularly for those spending time around older people and those who are immunocompromised. They still recommend staying home for a couple of days after an exposure and getting the newly authorized boosters soon to become available (despite the poor turnout during last year’s round).

But they said that some elements of this newfound laissez faire attitude were warranted. While COVID cases are high, fewer hospitalizations and deaths during the surges are signs of increasing immunity — evidence that a combination of mild infections and vaccine boosters are ushering in a new era: not a post-COVID world, but a postcrisis one.

Epidemiologists have long predicted that COVID would eventually become an endemic disease, rather than a pandemic. “If you ask six epidemiologists what ‘endemic’ means, exactly, you’ll probably get about 12 answers,” said Bill Hanage, associate director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health. “But it certainly has a sort of social definition — a virus that’s around us all the time — and if you want to take that one, then we’re definitely there.”

Certain threats remain clear. For vulnerable groups, the coronavirus will always present a heightened risk of serious infection and even death. Long COVID, a multifaceted syndrome, has afflicted at least 400 million people worldwide, researchers recently estimated, and most of those who have suffered from it have said they still have not recovered.

But the CDC director, Dr. Mandy Cohen, called the disease endemic last week, and the agency decided this year to retire its five-day COVID isolation guidelines and instead include COVID in its guidance for other respiratory infections, instructing people with symptoms of COVID, RSV or the flu to stay home for 24 hours after their fever lifts. The updated guidelines were an indicator that, for most people, the landscape had changed.

Hanage defended the hard-line mandates from the early years of the pandemic as “not just appropriate, but absolutely necessary.”

“But,” he said, “it is just as important to help people onto an off-ramp — to be clear when we are no longer tied to the train tracks, staring at the headlights barreling down.”

The absence of stringent guidelines has left people to manage their own risks.

“I don’t bother testing myself or our kids for COVID,” said Sarah Bernath, 46, a librarian on Prince Edward Island in Canada. “My husband doesn’t test himself either. Knowing if it’s COVID wouldn’t change whether I stay home or not.”

In some social circles, diverging choices can make for uncomfortable dynamics.

Debra Cornelius, 73, of Carlisle, Pennsylvania, stayed home from a recent indoor party because she learned that several other guests — a family of five — had returned from vacation and tested positive for COVID three days before the gathering, but still planned to attend.

“They said, ‘Oh, it’s like a bad cold, we wouldn’t stay home for a cold,’” she said. “I think people’s attitudes have changed considerably.”

But for countless others, attitudes haven’t changed at all. Diane Deacon, 71, of Saginaw, Michigan, said she tested positive for COVID three days into a trip to Portugal with her two adult daughters. She isolated herself for five days before flying home wearing a mask.

“A number of people asked me, ‘Why did you test? You could have carried on with your vacation,’” she said.

For Deacon, it was about remembering the refrigerated morgue trucks of 2020 and anticipating the vulnerable people she might see on her flight home — people in wheelchairs, or people on oxygen, she said.

“I’m trying to avoid a moral judgment of people who make other choices,” she said. “To me, it was inconvenient and it was unfortunate, but it was not a tragedy.”

In a Gallup poll this spring, about 59% of respondents said they believed the pandemic was “over” in the United States, and the proportion of people who said they felt concerned about catching COVID has been generally declining for two years. Among people who rated their own health positively, almost 9 in 10 said they were not worried about getting infected.

That could be, at least partly, a result of personal experience: About 70% of people said they had been through a COVID infection already, suggesting that they believed they had some immunity or at least that they could muscle through it again if need be.

If the Olympics were any barometer, the rest of the world seems to have exhaled as well. In Tokyo in 2021, there were daily saliva samples, plexiglass dividers between cafeteria seats and absolutely no live spectators; the arenas were so empty that coaches’ voices echoed. In Beijing in 2022, under China’s zero-tolerance policy, conditions were much the same.

But in Paris last month, the organizing committee for the 2024 Olympics offered no testing requirements or processes for reporting infections, and so few countries issued rules to their athletes that the ones that did made news.

There were high-fives, group hugs, throngs of crowds and plenty of transmission to show for it. At least 40 athletes tested positive for the virus, including several who earned medals despite it — as well as an unknowable number of spectators, since French health officials (who had once enforced an eight-month-long nightly COVID curfew) did not even count.

In the United States, about 57% of people said their lives had not returned to prepandemic “normal” — and the majority said they believed it never would. But the current backdrop of American life tells a different story.

The years-old social-distancing signage is faded and peeling from the floors of an indoor market in Los Angeles. Hand-sanitizer dispensers at amusement parks have dried up. The summer camp hosted by Chicago’s Lincoln Park Zoo requires children to bring a face covering — not to protect other children, but the animals.

Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the newfound complacency can as much be attributed to confusion as to fatigue. The virus remains remarkably unpredictable: COVID variants are still evolving much faster than influenza variants, and officials who want to “pigeonhole” COVID into having a well-defined seasonality will be unnerved to discover that the 10 surges in the United States so far have been evenly distributed throughout all four seasons, he said.

Those factors, combined with waning immunity, point to a virus that still evades our collective understanding — in the context of a collective psychology that is ready to move on. Even at a meeting of 200 infectious disease experts in Washington this month — a number of whom were older than 65 and had not been vaccinated in four to six months — hardly anybody donned a mask.

“We’ve decided, ‘Well, the risk is OK.’ But nobody has defined ‘risk,’ and nobody has defined ‘OK,’” Osterholm said. “You can’t get much more informed than this group.”

Asked about how the perception of risk has evolved over time, Osterholm laughed.