Conflicts mount on easing COVID-19 restrictions amid autumn case spikes

An uptick in COVID-19 cases as winter approaches is setting off a debate about if a new era of living with the virus has arrived or whether heightened restrictions and caution are still needed.

Cases in the U.S. have risen to more than 80,000 per day as the weather in much of the country gets colder. There are about 1,000 people dying every day from the virus, according to Centers for Disease Control and Prevention (CDC) figures, largely among the unvaccinated. 

At the same time, the widespread availability of vaccines and booster shots has made the individual risk for many people far lower. 

The result is a sometimes-confusing picture where individuals and localities are trying to figure out what level of risk to accept. 

Washington, D.C., for example, on Tuesday announced it is lifting its mask mandate. 

“We are learning to live with COVID,” said LaQuandra Nesbitt, director of D.C.’s health department. She said the virus is becoming “endemic,” meaning it is fading into a fact of life in the background. “It’s really my way of trying to stress to people that we’ve moved away from this goal of getting to zero cases,” she said.

Other experts, though, worried the move was premature heading into the winter and with cases and deaths still at a high level. 

“The way I view it is this is the last part of the crisis phase,” said Walid Gellad, professor of medicine at the University of Pittsburgh. He said it would make sense to wait a few more weeks to allow more children under 12 to be vaccinated and to give time for powerful new antiviral treatments from Pfizer and Merck to be authorized. 

D.C.’s move, he said, could be like taking “your foot off the gas right before you’re over the finish line.”

Many experts, though, said it is warranted to at least somewhat change thinking about the virus given the strong protection from vaccines, especially once people get their booster shots, and the fact that the virus is not going to be completely eliminated anytime soon. 

“I am now approaching it as if now is a reasonable version of what the future is likely to look like,” said Bob Wachter, chair of the department of medicine at the University of California, San Francisco. 

He said if someone is unwilling to do a certain activity now because of COVID-19, one is “making a statement you’re not going to do it next year or the year after.”

“It’s no longer a short-term sprint,” he said, while noting it still could be prudent to wear masks in crowded public areas where it is unclear whether everyone is vaccinated. 

Ashish Jha, dean of the Brown University School of Public Health, said it is “reasonable to start thinking about lifting mask mandates.”

But, he said, “if you can hold off on lifting these restrictions until early January I think that’s better.” That would give time to get through any holiday spike and for more children to get vaccinated. 

Jha said a similar timeline could work for school mask mandates, which have been a major source of controversy. 

“I would keep those masks on probably through the holiday season,” he said. “Once every school-age child has had a chance to get vaccinated I think it’s totally reasonable to lift mandates.”

Of course, many parts of the country abolished their mask mandates months ago. 

Jha said that for people who are vaccinated and have gotten a booster, the risk of severe illness from COVID-19 is generally on par with the risk from the flu. 

Biden administration health officials are not ready yet to give the green light to relaxing restrictions and entering a new phase of dealing with the virus. 

CDC Director Rochelle Walensky told reporters Wednesday her agency still recommends that localities be in low levels of COVID-19 transmission for several weeks “before releasing mask requirements.” 

She noted that over 85 percent of counties in the U.S. are still in “substantial” or “high” transmission, meaning the CDC recommends masking indoors in public. 

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, likewise said cases and deaths are not yet low enough to accept the virus as “endemic” and a fact of life. 

“We want control, and I think the confusion is at what level of control are you going to accept it in its endemicity,” he told reporters. “And as far as we’re concerned, we don’t know really what that number is, but we will know it when we get there; it certainly is far, far lower than 80,000 new infections per day and it’s far, far lower than 1,000 deaths per day, and tens of thousands of hospitalizations.”

Another consideration for even vaccinated people is that there is still a chance of getting lingering “long” COVID-19 symptoms from a breakthrough infection, though that risk is substantially less than for unvaccinated people. 

Wachter said there are not fully precise figures but estimated that the chance of long COVID-19 is about half as much for vaccinated people who get breakthrough cases compared to unvaccinated people, and could be about 1 in 10 breakthrough cases. 

“That’s enough of a risk that if you told me I had COVID now even though I’m fully vaccinated, I’d say at least I’m not going to die, but I’d still be pretty unhappy,” he said. 

But as the overall COVID-19 situation improves, with vaccines, boosters and now new antiviral treatments coming, the proper level of precaution is becoming more of a situation where, he said, “reasonable people could disagree.”