Emergence of a Deadly Coronavirus

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That actually might be very true. I wore an N95 mask during the initial years of the COVID pandemic when the virus was very deadly. I never got COVID, nor did my family who I gave masks to.

The early advice was also incorrect. They said you were safe if you wore mask 6 feet away from someone who was infected. That was false. It was 50 feet away in indoor environments. The 3 foot or 6 foot distance was just something someone made up. It was false and an early study showed it was transmittable 50 foot from an infected person indoors. [The study is identified in this thread but you will have to go to somewhere around page 200 to find it.]

Generally the virus was an indoor threat, not an outdoor threat. I wore an N95 masks when I was going to stores, movies, the YMCA, generally when I was up and about. I only ate outdoors at restaurants. You cannot wear an N95 mask when you are eating, therefore to be safe, one had to eat outdoors.

I knew by the end of March 2020 that N95 masks were required but the main problem at the time was that you could not buy one if your life depended on it. And it really did.

But I had a box of 12 stored away in my garage. You can wear the same mask over and over again, provided you purified it using UVC light to purify it between uses. I wore the same mask for up to 3 months before I had to throw them away.

I wear masks in public indoor spaces during surges that includes the current one.

The wave of COVID-19 cases this summer came earlier and impacted more people than in previous years, Long Island experts said Friday.

On a positive note, most people infected with the current variant of COVID-19 are recovering after experiencing mild or moderate symptoms and not becoming severely ill, according to health officials.

Across the country and on Long Island, visits to the emergency department, hospitalizations and even wastewater surveillance show a steady increase in COVID-19 infections since early June.

Hospitalizations for COVID-19 in Nassau and Suffolk counties were 1,180 as of Thursday — more than double the number since early June. Wastewater surveillance for the State of New York is currently showing a moderate level of the virus. This time last year, that level was low.

It is difficult to compare positive COVID-19 test results from this year with last year because they account for only a small number of tests that are administered. Many people use over the counter test kits that are not reported.

But the seven-day average of positive cases on June 30, 2023, was 3.6%. A year later on June 30, the seven-day average was 10.3%.

“In June, I started to notice we were getting a bunch of COVID cases coming in after several months without cases,” said Dr. Marc Lashley, a pediatrician with Allied Physicians Group who sees patients in Valley Stream and Rockaway.

While the symptoms for COVID-19 range from fever and chills to cough, fatigue and body aches, Lashley said their young patients are coming in mostly with sore throats.

“That can be problematic because a lot of things cause sore throats including strep throat,” he said. “And there are other viruses circulating, so we have the PCR test, which is very accurate.”

The summer wave is clearly larger than most people anticipated, said Dr. Bruce Farber, chief of public health and epidemiology at Northwell Health. The KP variant of the SARS-Co-V2 virus that causes COVID-19 accounts for more than 50% of cases currently circulating, according to the state Health Department.

Farber said the variants are very different from the ones around last year or in the winter when people received their updated COVID-19 vaccine or developed natural immunity from an infection.

“Immunity doesn't last that long,” Farber said. “So now we're seeing this. I anticipated that it would happen more when people went indoors, and I suspect that it'll grow when that happens.”

Farber encouraged people to get the updated COVID-19 vaccine, which is expected to be available in September, pointing out it will better match the latest circling variants and provide more protection.

He’s concerned that not enough people will get the updated vaccine, which could impact people who are more prone to serious illness from COVID-19 because of existing medical conditions or are immunocompromised. The Centers for Disease Control and Prevention recommend the vaccine for everyone over the age of 6 months.

Only 22.5% of adults reported receiving the updated vaccine between Sept. 14, 2023, and May 11 of this year, according to the CDC. The number for children 17 years of age and younger was even smaller at 14.4%.

“Even if COVID isn’t hospitalizing or killing a lot of people, there is a very vulnerable part of our population and this can tip them over,” Farber said. “There’s a simple measure everyone can take to avoid COVID, make sure immunity stays up to limit the number of people missing school and work and that’s taking the vaccine that is coming out in September.”

The Food and Drug Administration on Thursday approved the new Covid vaccine from Pfizer and Moderna.

It’s the third time the vaccines have been updated to match circulating strains since the original series. The shots should be available within days. The agency hasn't yet approved a third vaccine, from drugmaker Novavax.

The timing of the new vaccines — last year's rollout was in mid-September — is significant, since most of the U.S. is still caught in the summer wave of Covid illness. As of Monday, the Centers for Disease Control and Prevention reported that the number of people testing positive for Covid keeps rising and that emergency room visits for Covid have been increasing since mid-May. Hospitalizations are rising, too.

How are the new Covid vaccines different?
The new shots from Pfizer and Moderna are designed to target the KP.2 strain, a descendant of the highly contagious JN.1 variant that began circulating widely in the U.S. last winter. The drugmakers started making the new doses in June after the FDA advised them to freshen the formulas to match the version of the virus that was gaining ground in the U.S.

A third vaccine, from drugmaker Novavax, has been updated to target the JN.1 strain. JN.1 and KP.2 have largely faded from circulation, according to the CDC.

As of Saturday, a sister strain called KP.3.1.1 accounts for about 36% of all new Covid cases, while another sister strain, KP.3, accounts for about 17%.

It’s unclear exactly how effective the vaccines will be against the newer strains, but experts expect that they will protect against severe illness.

A spokesperson from Pfizer told NBC News that data submitted to the FDA shows that its vaccine generates a “substantially improved” immune response against multiple currently circulating variants, including KP.3, compared to earlier versions of the vaccine.

There are “very minor sequence differences” between the variants, said John Moore, a professor of microbiology and immunology at Weill Cornell Medical College.

A paper published this month in the journal Infectious Diseases found that KP.3.1.1 shares similarities with JN.1 and KP.2, although it has a few additional mutations that may help it spread more easily.

“All these changes are incremental. They do not change the overall big picture,” Moore said. “ KP.3.1.1 is just another step in the road that the overall Omicron lineage is taking towards greater transmissibility.”

Who should get the new Covid vaccine?
In an earlier interview, Dr. Ashish Jha, dean of the Brown University School of Public Health and a former White House Covid-19 response coordinator, said Covid is likely endemic in the U.S., meaning the virus is following “a relatively predictable pattern that will last a very long time.”

That means we’ll be getting a yearly, updated Covid vaccine to protect against mutations and waning immunity, just like annual flu shots.

But Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto, said it’s challenging to make a one-size-fits-all recommendation on who should get the vaccine, especially for healthy, young adults.

“It’s fair to say that the vaccines are still helpful, certainly at an individual level, and to some extent at a community level,” he said.

It’s critically important that people at the highest risk of a severe Covid infection — including people over 65, or with weakened immune systems or underlying health conditions, such as heart disease or obesity — get the vaccine, Bogoch said.

When should I get the new Covid vaccine?
Millions of Americans have had Covid within the last few weeks and months. An advantage of the summer wave is that people who have recently recovered have an immune boost to fight off future infections.

Because the vaccines will be available earlier this year than last, the question of timing for the most protection through the winter is more urgent. According to CDC guidance, if you’ve recently had Covid, “you may consider delaying your vaccine dose by 3 months.”

For people at high risk of severe illness, experts say get the vaccine when it becomes available. That's because infection may not provide as much protection as vaccination, Dr. Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital, said.

Protection from infection can vary based on the severity of infection, the strain, as well as a person’s age and health.

For the young and healthy, it may not be as beneficial to get the vaccine so close to recovery from infection, said Akiko Iwasaki, professor of immunology at the Yale School of Medicine. High levels of antibodies present from recent infection may prevent the vaccine from stimulating new immune cells.

“If there’s a lot of antibodies already circulating, those antibodies are going to block the [vaccine] from doing its job,” she said. “That’s one reason why it’s not recommended to get the vaccine immediately after you’ve had Covid.”

Dr. Paul Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston, said there’s no harm in getting the vaccine now, although it may make more sense to wait since Covid cases tend to pick up around November.

“Assuming that’s the case again this year, I would say sometime in October when people get their flu shot would be perfect,” Sax said.

There’s not a risk to getting it right away, but the initial protection from the vaccine may not last through an expected winter wave, Sax said.

“The good thing is that all of us with our immunity from prior vaccines or getting Covid or both don’t have as much of a risk of severe disease,” he said. “But if you want to really completely avoid getting infected it’s that antibody spike after the vaccine that happens one to three weeks after that’s most protective.”

Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health, said that people who recently had Covid can wait a few months before they get their updated vaccine.

“Immunity does wane from having had Covid or getting the vaccine,” Juthani said Wednesday during a media briefing with the Association of State and Territorial Health Officials ahead of the winter respiratory virus season. “If you don’t feel strongly about getting the vaccine right away, then waiting about three months from when you had Covid, and particularly, so that as we’re approaching the holidays, that you get that shot before the big holidays and when you may be gathering with people.”

“If you feel strongly that you really want to get the shot as soon as it’s available, even if you had Covid this summer, then of course you can get that,” she added. “There’s nothing to say that you can’t in September or October.”

Data from prior Covid vaccines suggests that the initial protection against infection peaks about a month after the shot and starts to wane over the next several months, even when the vaccine is well matched to the circulating strains.

Fortunately protection against severe disease remains robust for much longer, Iwasaki said.

Ultimately you never know when you may become infected with the virus, she said.

“It’s kind of a risky calculation because waves just means that there is a large number of infections in the population, but at the individual level you can get infected tomorrow,” she said. “So it’s very difficult to predict what is the best time to get it.”

Iwasaki plans to get the vaccine herself sooner rather than later since she has not been infected or had a booster in some time.

What are side effects of the new Covid vaccines?
Like other versions of the Covid vaccines and similar to flu shots, the most common reaction is some pain at the injection site. Other side effects include:

Tiredness
Headache
Muscle pain
Chills
Fever
Nausea
The CDC says the side effects typically resolve after a few days. Serious side effects, such as the life-threatening allergic reaction called anaphylaxis, are rare.

Pfizer and Moderna’s vaccines have been associated with a small but increased risk of myocarditis, the inflammation of the heart muscle, mostly in young men. Most people make a full recovery.

How much will it cost?
Pfizer, Moderna and Novavax are charging up to $150 per dose for a Covid vaccine, according to data from the Centers for Medicare and Medicaid Services.

The vast majority of people with public and private health insurance should pay nothing out of pocket for the updated Covid vaccines —as long as they stick with an in-network provider, said Jennifer Kates, director of the Global Health & HIV Policy Program.

Medicare and Medicaid require that the vaccines are free for patients. The Affordable Care Act, also known as Obamacare, requires private insurers to cover all vaccines that are recommended by the CDC’s vaccine committee and director.

However, Kates added that the ACA’s requirement does not apply to grandfathered plans — plans that existed before the ACA was signed into law — and short-term health plans.

“People enrolled in these plans may face cost sharing for the Covid vaccine, or the vaccine may not be covered at all,” she said.

Children without insurance can get free vaccines through the government-run Vaccines for Children Program.

For adults without health insurance, the situation is a bit different. The CDC’s Bridge Access Program — which has been paying for shots for uninsured adults — is expected to shut down in August because of a lack of funding.

Once the funding runs out, uninsured individuals may be able to access free Covid vaccines through community health centers and other safety net providers that participate in the Section 317 vaccine program for adults, Kates said. Section 317 is a federal initiative that gives funding to states to provide vaccines for uninsured and underinsured adults.

“Some state and local health departments may also have a limited supply for people without insurance, but any supply will be very limited,” Kates said.

Millions of U.S. children have had long Covid, estimates suggest, but less is known about their symptoms than those of adults.

A large, national study offers new insights into what the post-viral illness looks like in kids and teens, suggesting that they experience a markedly different set of symptoms from adults. Although Covid itself has historically been milder in kids, the results indicate that many have debilitating, long-term side effects that make it difficult to attend school, participate in extracurriculars or spend time with family or friends.

“This is a public health crisis for children,” said Dr. Rachel Gross, the study’s lead author and an associate professor of pediatrics at the New York University Grossman School of Medicine.

“Experiences of chronic illness affect them as they grow, and it impacts the health of the adults that they become,” she said.

The study is part of the RECOVER initiative, one of the world’s largest investigations into long Covid, which is funded by the National Institutes of Health.

The researchers behind the new study, published Wednesday in the journal JAMA, asked the caregivers of more than 3,800 children about their kids’ symptoms at least 90 days after Covid. They also surveyed the caregivers of around 1,500 children without a history of Covid and compared the responses.

The results showed that among children ages 6 to 11, headache, trouble with memory or focus, trouble sleeping and stomach pain were most commonly associated with long Covid.

Adolescents’ common symptoms were more similar to those in adults, which previous RECOVER findings identified as post-exertional malaise (worsening symptoms after exercise), fatigue, brain fog, dizziness, gastrointestinal issues and heart palpitations. The new research showed that those ages 12 to 17 were more likely than young kids to experience daytime sleepiness or low energy, and body, muscle or joint pain.

Headaches and trouble with memory or focus were still common in this age group. A change or loss in the sense of taste or smell — another characteristic symptom of long Covid in adults — was also prominent in adolescents but not in young kids.

“We have to look for these differences,” Gross said. “Otherwise, we may be missing children who are experiencing long Covid.”

Long Covid overall seems to be less common in children than in adults, but a February review in the journal Pediatrics estimated that 10% to 20% of children who got Covid developed post-viral symptoms within six months.

The spectrum of symptoms in children and teens is wide, according to the new study. In total, 14 symptoms were more prevalent in children with a history of Covid than those without.

The study has a few limitations, however: Since caregivers reported their children’s symptoms, it’s possible they missed some or overestimated others. The caregivers also reported their children’s Covid infections — they weren’t confirmed by tests. The researchers did, however, test to make sure the uninfected group didn’t have Covid antibodies.

The findings align with what doctors are observing in long Covid clinics, said Dr. Amy Edwards, director of the pediatric Covid recovery clinic at UH Rainbow Babies and Children’s Hospital, who wasn’t involved in the new research.

Edwards said some kids in her clinic “have dropped out of school, dropped out of all their extracurricular activities and are barely functioning.” For others, she added, “it’s not so bad that they can’t go to school, but their grades are slipping. They may have used to be A, B students, and now they’re really struggling to pass.”

The new research validates these experiences, she said — especially for some of her pediatric patients who faced skepticism from adults when they reported their symptoms.

“School nurses were mocking them for faking it,” Edwards said. “These are teenagers and kids, and people are telling them to their face that there’s nothing wrong with them”.

Knowing that a symptom may be related to long Covid could help kids find appropriate treatments, said Christine Koterba, a pediatric neuropsychologist at Nationwide Children’s Hospital, who also wasn’t part of the study.

There’s no broadly effective treatment for long Covid, but many clinical trials are underway. In the meantime, Koterba said, doctors have turned to interventions used for other long-lasting illnesses like post-concussion syndrome, which is similarly characterized by headaches and memory or concentration problems.

“There’s a lot that we can draw on from other, similar populations to help kids get back to functioning,” she said.

Edwards said that for many kids with long Covid, she recommends sleep and a healthy diet consisting of anti-inflammatory foods, as well as managing other conditions like allergies that can further aggravate the immune system.

Anecdotally at least, young kids tend to recover more quickly from long Covid than teens or adults, she said.

Thank you for posting this AsPartOfMe. Where I live, children and young people have had no recognition in the narratives of Long Covid at all, other than a scapegoat narrative that they exposed school teachers to high rates of infection. Nor have we had any long covid clinics, now or during any stage in the pandemic. The medical assumption was that children were resilient and nothing severe would happen to them, so they were cast only as spreaders, and no effort was made to detect the severity of their infection rates nor sequalae. Schools were closed for a while.

It is impossible to know the impact on children here as deaths from Covid have been (and still are) reported here daily though the statistics are merely numbers, mentioning no details of age groups affected. Cognitive damage from Covid IS now well recognised, but it is still framed only as an issue affecting some adults, so affected children have no recognition nor treatment centres. Tragic.

A summer COVID-19 surge has killed thousands of Americans and sent many more to hospitals, yet experts say some of those people would still be alive if they had taken a medication that studies show dramatically reduces the chances of severe disease.

Paxlovid, available since December 2021, reduced the COVID-19 death rate in high-risk patients by 73%, according to a study National Institutes of Health researchers released last year.

Yet uptake has been low. Only 9.7% of those eligible for Paxlovid took it, the study found. Researchers estimated that if half of people with COVID-19 who had been eligible for Paxlovid had taken it, 48,000 lives would have been saved between December 2021 and February 2023.

That study also found that Paxlovid reduced hospitalizations by 26% — with other studies finding even greater hospitalization declines, such as 51% and 65%.

xperts say misperceptions and misunderstandings about Paxlovid among patients and health care providers are among the reasons so few people have taken the medication.

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In addition, many are repelled by drugmaker Pfizer's list price of $1,390 for 30 pills to be taken over five days, but are unaware that many people can get the drug for free or at a deep discount.

There’s also the clock that begins ticking when people get sick: Treatment with Paxlovid must begin within five days of symptom onset, before the virus can potentially cause severe damage, according to the Centers for Disease Control and Prevention guidelines. During that time, a patient must get an appointment with a provider and then pick up a prescription.

"It's very hard for people to get the drug in hand within five days of symptom onset, because of all of these hoops and hurdles," said Denis Nash, a professor of epidemiology at CUNY School of Public Health in Manhattan. "By the time you get through all these steps, you’re beyond the window of where it could potentially help you."

Although the number of COVID-19 deaths has plummeted since the early years of the pandemic, thousands still die of the disease — more than 76,000 in 2023, according to a CDC report released this month. About 30,000 Americans have died of COVID-19 so far this year, incomplete and provisional CDC data shows.

Up to 234 people a day were hospitalized with COVID-19 on Long Island this month, three times May's peak, although lower than in the early winter, state data shows. More than 300 people have died of the disease on Long Island this year, according to state Department of Health statistics that do not include deaths outside health care facilities.

Dr. Kawsar Talaat, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, bemoans that much of the suffering and dying could have been prevented by 30 small pink and white tablets.

"Some of those people did not have education [about Paxlovid] or access to lifesaving treatment," she said.

Treatment must begin right away
Doctors and other providers should consider Paxlovid for any adult — or child 12 and older weighing at least 88 pounds — with at least one risk factor for severe COVID-19, the CDC advises.

That includes anyone 50 and older, and those with certain medical conditions, including obesity, asthma, cancer or diabetes, and behaviors such as smoking.

A study released in June that Nash co-authored found only 18.5% of people who fit the CDC criteria believe they are at risk for severe COVID-19.

"There’s a big disconnect between what people perceive as their risk and what their actual risk is," Nash said.

Even when people want Paxlovid, their doctors may not always prescribe it, he said.

“People call me all the time asking, ‘How can I get Paxlovid? My father's physician won’t prescribe it because he doesn't think his symptoms are severe enough,’ ” Nash said. "These are 80- and 90-year-old people."

Yet treatment must begin when symptoms are mild or moderate, the CDC says.

"If you wait until they get sicker, then it’s too late to give it, and it’s not going to work," Talaat said.

Doctors worry about potentially dangerous interactions with other medications — although in some cases, use of other drugs can be suspended while using Paxlovid, she said. In other cases, the patient cannot take Paxlovid, but there are alternative treatments.

A small percentage of people who took Paxlovid had a "rebound" of symptoms within a few days of initially improving, but the same thing can happen in people who don’t take the medication, multiple studies show.

Delainne Bond, a Florida nurse who founded the 112,000-member COVID-19 Long Haulers Support Facebook page and a long-COVID support and education group, said that even when physicians recommend Paxlovid, some patients balk. They’ve read online misinformation that Paxlovid is "poison" and are afraid to take it, she said.

Risk of losing money on drug
The federal government had provided Paxlovid for free until December 2023.

Nidhin Mohan, owner of New Island Pharmacy in Deer Park, said the current $1,390 list price and poor insurance reimbursement rates means he loses money on each Paxlovid prescription for about half of insurance plans. Other pharmacists don’t stock the drug for that reason, he said.

Customers, in turn, sometimes get sticker shock when they see a charge of more than $1,000 and they leave without the pills.

Mohan said he tells customers they typically can obtain a big discount or free medication if they fill out a form, but some say, “I’m too sick. Forget it. I don’t want to deal with this.”

The federal government will provide Paxlovid for free for Medicare and Medicaid recipients until the end of the year, and for uninsured people through 2028, with Pfizer paying administrative costs, the Department of Health and Human Services said in a statement. Pfizer also administers a program offering free or deeply discounted Paxlovid for those with private insurance. Enrollment forms for both programs are at paxlovid.com/paxcess.

But a huge bill could result if the online forms are not filled out. Even if Paxlovid is free, patients may get charged for an office visit, said Jennifer Kates, a senior vice president at KFF, a San Francisco-based health policy, research and news group.

Many are unaware of the online forms and worry about paying hundreds of dollars, she said.

"You might hear that it might cost you something, or there might be other charges, and you say, ‘You know what, I'm just going to forgo this.’ And in some cases, that could actually have real medical consequences, since Paxlovid is so effective," Kates said.

Nash said the extra steps to obtain free or low-cost Paxlovid are "totally unnecessary."

Pfizer said in a statement that 93% of health insurers cover Paxlovid. Yet some policyholders may face pricey copays.

Many uninsured people don't seek Paxlovid because they are unaware it can be free, said Dr. Grace Ting, interim chief medical officer of Nassau University Medical Center in East Meadow. Ting didn't know the drug was free for uninsured people until she spoke with Newsday.

"They haven’t publicized it," she said of Pfizer and the federal government.

A summer COVID-19 surge has killed thousands of Americans and sent many more to hospitals, yet experts say some of those people would still be alive if they had taken a medication that studies show dramatically reduces the chances of severe disease.
Paxlovid, available since December 2021, reduced the COVID-19 death rate in high-risk patients by 73%, according to a study National Institutes of Health researchers released last year.

I have never used Paxlovid. But it might be an effective treatment for this condition.

Is there anyone on this site that used this drug treatment when they went through a bout of COVID.

If so, WAS IT EFFECTIVE for your recovery?

I think my younger sister used it along with their husband when they contracted the virus and it seemed to help them recover.

In mid-2022 we both tested positive for COVID-19. We went to our medical care provider and got Paxlovid...because we were old enough to be at greater risk for problems from COVID-19.
No problems. I don't know whether that was due to the Paxlovid, or not.

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.

n 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.

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.

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.

“Lewis Carroll once said something like, ‘If you don’t know where you’re going, any road will take you there,’” he said. “I feel in many ways, that’s where we’re at.”