Coronavirus FAQ: 'Emergency' over! Do we unmask and grin? Or adjust our worries?

Last Friday, the World Health Organization ended the Public Health Emergency of International Concern that it announced three years ago when the virus that causes COVID-19 became a global threat. And the Centers for Disease Control and Prevention ended its public health emergency, effective May 11.

The FAQ series published in the Goats and Soda blog was a cornerstone of NPR pandemic coverage, touching on everything from transmission via pets (possible but unlikely) to whether a glass of wine after a vaccine is advisable (seems ok). As the world enters a new phase of the pandemic, we talked to public health gurus about how to move forward since the disease appears to be here to stay even as the emergency is lifted. Dear readers, if you have questions about this new phase of the pandemic, write us at goatsandsoda@npr.org and put "FAQ" in the subject line. Please include your name and location. We'll be answering a sampling of questions in a follow-up FAQ.

So remind me, what was the purpose of the emergency state?

Thomas Bollyky, senior fellow for global health, economics and development at the Council on Foreign Relations, says that a public health emergency is "really designed to spur international cooperation around a public health event that is serious, sudden, unexpected and requires immediate attention."

And what makes this an appropriate time to end the emergency state?

Last week when the World Health Organization ended its 3-plus year Public Health Emergency of International Concern, the emergency committee advising the WHO's Director General said it was time to do so because of "the decreasing trend in COVID-19 deaths, the decline in COVID-19 related hospitalizations and intensive care unit admissions, and the high levels of population immunity to SARS-CoV-2 [the virus that causes COVID-19]."

In the U.S., the Centers for Disease Control and Prevention said the U.S. Public Health Emergency was ending because "as a nation, we now find ourselves at a different point in the pandemic – with more tools and resources than ever before to better protect ourselves and our communities."

Did those agencies do a good job explaining themselves?

Well, the quotes from the CDC and WHO are clear.

But Bollyky says articulating the targets and goals for the ending the pandemic all along — such as how low the case and death counts would need to be to lift mask mandates or school closures — would have helped the public understand why the agencies felt that May 2023 was the right time to conclude the public health emergency. "If the public can't see progress, it will be harder to convince them next time that these emergency measures are necessary," says Bollyky.

And how big of a threat is COVID now?

The announcement that the emergency is over doesn't mean the virus been vanquished, says Dr. Wafa El-Sadr, director of the Global Health Initiative at the Mailman School of Public Health at Columbia University. It's still infecting thousands – and killing thousands – each week.

Then again, so are diseases like malaria and cholera.

And just as we take those diseases seriously, we should take COVID-19 seriously, say the experts.

"HIV doesn't have a public health emergency declaration, tetanus doesn't have a public health emergency declaration, and yet people stay up to date with vaccinations and treatments," says Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, "People don't need a public health emergency to take something seriously."

Nonetheless, the reassuring message from CDC and WHO is that you're less likely to catch COVID-19 because case counts have dropped due to vigilance and treatments.

"WHO now sees COVID-19 as a threat in our regular repertoire of things-trying-to-kill-us," says epidemiologist Katelyn Jetelina. a health policy epidemiologist with the Meadows Mental Health Policy Institute in Dallas, who writes the blog Your Local Epidemiologist. And the truth is that the world now has better tools and treatments for COVID than for some age-old diseases: from the readily available self-tests to vaccines and boosters to the paxlovid pill to lessen severity for higher-risk patients.

So is it ok to just blithely dismiss a case of COVID?

Even if you're an individual with no health risks and you catch the virus, there are things to worry about: just plain feeling awful is possible even if you're not high-risk. You might have to miss work. You run a risk of long COVID. And then there's the possibility you could transmit the virus to others at risk of severe COVID and death from the virus.

And what if you test positive and have risks: say, you're older, immunocompromised or have underlying health conditions such as obesity, heart disease, a compromised immune system or diabetes. Don't just figure you can beat it on your own. Reach out to your doctor right away, says Dr. Aaron Glatt, chair of medicine at Mount Sinai South Nassau in Oceanside, N.Y. "There are effective treatments available for high-risk infected individuals that are underutilized. You may be a candidate, which could reduce your possibility of progressing to severe disease."

For example, there's the COVID antiviral drug paxlovid — which has been proven to help. A review of federal data in JAMA Internal Medicine found that the risk of long-term health problems, hospitalization and death after a COVID-19 infection diminishes among those who take the medication within five days after testing positive. That's according to an analysis of federal health data by researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care system.

So then ... is it wise to keep maybe some precautions?

Many physicians interviewed for this story tell us they still take precautions they think warranted. "Professionally, I still wear a mask for most patient care in the clinic and the hospital," says Dr. Luis Ostrosky-Zeichner, chief epidemiology officer at the Memorial Hermann Healthcare System in Dallas.

"In my personal life," he adds, "I still have A Purell dispenser in my car and carry a small bottle when I travel. I wear a mask in the airport and until the plane takes off — since I'm less exposed in my own seat and [because of] the plane's ventilation system — and then put it on again and wear it until I get to my hotel room. And yes, I still have tests at home and travel with a pair of them."

And while many many people are glad to doff masks forever and plunge back into the madding crowds in transportation hubs, concert arena and sports venues, others are understandably ... nervous.

If you don't have underlying conditions that put you at risk and feel uncertain about how to proceed, have an honest converation with your doctor or health-care provider, suggests Dr. Preeti Malani, a professor of medicine in the Divisions of Infectious Diseases and Geriatric Medicine at the University of Michigan. Ask how to gauge your personal risk.

Malani does believe that too much worry is not good for you: Fear of COVID or severe anxiety out of proportion to risk can lead to depression and other mental health concerns, says Malani.

So she's a champion of being realistic rather than fatalistic.

"We have the tools to mitigate and manage risk so that we can do all the things that are important to us," says Malani. She notes that people should keep in mind that masks work well especially when they are worn, if needed, and you are fully vaccinated. And it may be reassuring to have a plan for testing and treatment if needed.

So the idea is, to mask or not to mask ... it's up to me?

You are the keeper of your own health and the best authority on your own risk factor.

It is worth noting that even though masks were often deemed ineffective in the U.S. in the early days of the pandemic, global evidence shows that N-95s and KN-95s worn properly do reduce your risk of contracting COVID (not to mention the flu and other respiratory ailments). And the U.S. did eventually embrace masks.

You may still need to mask up in certain places, like health-care faciliites – although rules are changing, with many hospitals and doctors offices ending the requirement for staff and patients. But that doesn't mean you have to take yours off. And if you're concerned you can ask maskless staff that interact with you to put one on. (And if you see a carelessly worn mask, you can muster up your best public-health voice and remark a mask should go above the nose.)

And ... keep getting those boosters, right? Or maybe not so necessary if it's not an emergency?

The rapid development of effective COVID vaccines around the world has been a medical marvel. There will be periodic new boosters available. But don't necessarily expect to be prodded on your cellphone – one NPR reporter just got a message that his vaccine reminders will cease.

So with the emergency state over, you may have to pay attention to your own vaccine schedule rather than hearing calls from the government to go get your booster.

And public health specialists note that you shouldn't just focus on COVID when it comes to vaccines. "Learn about and stay up to date on all vaccines," says Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases. The first-ever vaccine for adults to prevent respiratory syncytial virus (RSV) is expected to be available by September in the U.S.. Then there are easonal flu shots and likely a new COVID booster. "Adults will want to talk to their doctors this fall about all the vaccines they need," he says.

Are there any surprising lessons from this emergency?

Loneliness sucks more than you can imagine. Yeah, well maybe that's not a big surprise — but the pandemic reinforced the toll that a lack of social contacts can take on mental health.

Dr. Malani is the lead researcher on a January 2023 survey of more than 2,500 people ages 50 to 80 conducted by the University of Michigan Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine. The survey found that one in three people between the ages of 50 and 80 say they sometimes or often experience loneliness.

That's down from about half of older adults in June 2020, when remaining at home was advocated in order to help prevent contracting COVID-19. But it's still noteworthy, says Malani: "If anything, the pandemic has shown us just how important social interaction is for overall mental and physical health and how much more attention we need to pay to this from a clinical, policy and personal perspective."

She says that even for people at risk of severe disease from COVID-19 there are precautions to take to help avoid isolation including online conversations, meeting outdoors where risk of transmission is lower, continued masking and especially talking to your doctor to get a clear sense of your risk of severe disease.

"Some people who were treated for cancer years ago continue to worry that they are at high risk," says Malani. "A talk with your doctor can help you determine risk and precautions to help you engage with people and activities you enjoy." On a personal note, she says she masks when caring for patients but otherwise generally does not mask in meetings or even while traveling these days. "I pay attention to how I feel and am careful about not exposing anyone if I have any symptoms at all, even if mild," she says.

And when should I test for COVID in this post-emergency era?

Consider testing if you have been exposed to someone with the virus or have symptoms that could be COVID-19, especially if you fall into a high risk group, say the doctors we interviewed. And hang onto those masks. You'll want one if someone in your home tests positive so you can protect yourself — and protect others if you test positive.

So can you sum it all up for me?

The end of the national emergency around COVID-19 means that there will be certain bureaucratic changes in the way COVID is handled, says Dr. Leana Wen, an emergency physician and professor of health policy and management at George Washington University. For example, she says, there will be less collection and posting of COVID data and fewer requirements for local public health departments to check in with the CDC.

But we're going to be living with COVID-19 for ... a while. Wen, who gave birth to her second child during the pandemic, says "it has become clear that this coronavirus will be with us for the foreseeable future and is an infectious disease that must be prevented, treated, and managed, like other serious conditions. The focus should shift from population-wide measures to safeguarding the most vulnerable and investing in better vaccines and treatments to help those at highest risk from severe outcomes due to COVID-19."

Editor's note: To all the medical professionals who have kindly shared their time and insights to answer questions for the coronavirus FAQ series — even as many of them put themselves at risk of infection while caring for patients — we offer our heartfelt gratitude.

[Copyright 2023 NPR]