Experts say we need creative strategies to live with the virus long term

That means we are going to have to learn to “dance” with the virus — a safe co-existence — without constantly stepping on each other’s toes.

Dancing with Covid-19

Like with other diseases, this requires tight control — giving the virus as little freedom as possible so as not to set the stage for the surge of sickness and death we experienced last winter.

It also means finding a balance between the extremes — on the one hand, lockdowns that trigger economic and personal chaos, and on the other, putting the rights of individuals above the good of society as a whole — and moving toward the middle. That way we can more safely enjoy all of life’s pleasures — family gatherings, live sports and arts events, travel, indoor dining — with only minor inconveniences, like vaccines and masks, during times of substantial viral spread.

“Let’s be creative with making adjustments to life, rather than saying it’s all or none, because that was kind of the feeling last year,” said Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School.

So, what can and should we be doing now and into the fall to make sure we follow the path to living well with the virus? Over the past couple weeks, we spoke to experts in the world of pandemic preparedness, infectious diseases and virology to try and get guidance on how to best and most safely live our lives going into the fall. Many of these experts live with the same concerns as everyone else, including managing the safety of unvaccinated children, and balancing the risk, given the Delta variant, with a deep desire to live a more normal life.

While nearly everyone is reluctant to make predictions nowadays, there was agreement on five strategies to be put in place. I have included our conversations, their specific reasoning, and the evidence to bolster the claims.

First thing first: Vaccinations

At the top of the list for all our experts: vaccinations.

Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota and an epidemiologist, echoed the sentiment.

“The first thing is, we need to continue our programs of vaccination,” he said, adding that the current surge we are experiencing won’t be impacted by those efforts since it takes four to six weeks to develop full immunity. “But having said that, it is absolutely critical to get people vaccinated now, because … it’s very likely that we will see additional surges, whether this fall or this winter. And the way to minimize those is, in fact, get people vaccinated. So please do that.”

Keep masks around, like an umbrella

“We need universal masking again. Because that … reduces the amount of virus that’s in the air around us [and] helps protect you individually from breathing virus in the air around you,” said Marr. “People can be spreading virus without any symptoms. So, we need this really until we can get the number of cases down.”

Right now, most of the country is being “showered” with virus, and masks, like an umbrella, can help protect us from getting drenched. When viral transmission is lower, it will be a lot safer to set aside our masks. Marr added we may not need to mask all the time. “We might want to use them in certain areas at certain times of year when there are outbreaks of colds and flus caused by respiratory viruses,” she added.

Osterholm called the controversy surrounding masking “terribly unfortunate.”

“Because the vaccines won’t have an immediate effect for those that are not vaccinated yet, we have to continue to emphasize protection …” he said.

Masks + ventilation = Safer schools

Worrying public health experts is the fact that this fourth surge of coronavirus infections is coinciding with the reopening of schools and colleges throughout the country, causing parents, teachers, politicians and municipalities to clash in some states over basic public health measures, specifically vaccine and mask mandates.

“Anybody who tries to tell you, ‘Well, don’t worry about the kids; the virus won’t really bother them,’ — that’s not the evidence. And especially with Delta being so contagious, kids are very seriously at risk and it’s up to all of us to do everything we can to protect them,” Dr. Francis Collins, director of the National Institutes of Health, said Sunday on Fox.

“I know some states have said ‘No,’ but we do need masks during the Delta variant. And then, I believe we need off-ramps for when those masks can come off for kids, because not everyone wants their children masked, and I think that’s fair. But we need off-ramps when the community transmission rate is low,” said Gandhi.

“Things seem really scary right now, because cases are increasing rapidly. But this will not continue forever,” Osterholm predicted. “Things will settle down eventually.”

He said we can expect to see an uptick in cases as schools go back in session, with larger outbreaks in schools where they do not require masks — but we shouldn’t be surprised by some cases even in schools where appropriate precautions are being taken.

“We need to hang on and not freak out … After a few weeks, those will kind of [taper] off and then hopefully things will settle into a manageable pattern, in terms of cases in schools,” he said.

And don’t forget about ventilation, stressed Marr.

Even if classrooms don’t have windows, Marr said filtration can improve air quality fairly inexpensively. “There’s funding [provided by the federal American Rescue Plan] available to schools now … and a good way to spend that would be to invest in a portable HEPA air cleaner, which you can put one or two of these in a classroom and it can help reduce levels of virus that might be in the air, reducing everyone’s exposure and making a safer environment for everyone,” she said.

Passing the test

More rapid testing is something Faust would like to see.

“We should be integrating rapid testing into our daily lives — a lot more routinely,” he said. Faust is not talking about PCR tests, which are used for diagnosing, but antigen tests for the purpose of screening people. While a PCR test is the gold standard for detecting the presence of virus, the antigen tests can be quite useful in determining if an asymptomatic person is contagious. Anyone who is symptomatic should stay home regardless, but the antigen tests can be useful for someone who feels fine but wants to make sure they are not a silent spreader.

Faust said the Delta variant makes it particularly important. “That’s how I got scared about this: I started hearing about people testing positive on rapid [antigen tests] who were vaccinated, and I was, like ‘Whoa! That means not just that are they infected; they’re contagious potentially.'”

As a vaccinated person, Faust said he doesn’t want to inadvertently spread it to his child, who is unvaccinated, or an immunocompromised person who may not have mounted an adequate immune response.

“So Delta changes the equation in terms of, before I would have advocated [testing] for everyone who was unvaccinated. But now I’m advocating it for everybody,” he said.

“People said that the statistics show that they miss a lot of cases. But that’s actually a misunderstanding of how these tests work. The rapid tests don’t diagnose whether you just got infected or whether you had an infection a week ago — which, by the way, the other tests do. The rapid test only tells you when you’re contagious,” he said.

Osterholm agreed more “surveillance testing” needs to be done. “Obviously, knowing whether or not you’re positive, whether you’re infected, is so important in minimizing the risk to others by taking responsible actions on your part to limit the contact you have with others,” he said.

Marr also put testing on her top five list. “[Testing] is also important because it can catch people … who are infected — and maybe they don’t know it — and help isolate them and keep them from spreading the disease around to other people,” she said.

Reassess exposure risk

Faust said, given the dominance of the Delta variant, it’s time for Americans to reassess and adjust their risk of exposure if necessary, especially if they eased up on measures in the late spring and early summer.

“Delta has changed my risk calculator for myself — and I think it’s good for others [to do],” he said.

By way of example, Faust said he took “two completely frivolous trips” to New York City in June. “And I did indoor dining, because the case counts were low and I was vaccinated and regular infections weren’t really happening,” he said.

But, given the situation today, he said he would not do the same thing. “Now, my recommendation on travel is to only do travel when it’s really necessary,” he said.

That same mindset should be applied to all “risky” activities, from attending weddings and concerts and sporting events, to dining out and travel. And what’s “necessary” will vary from person to person.

“I mean, what’s actually really, really important to you — ask yourself: is it worth the risk? Really prioritize,” Faust recommends. There is no doubt we have more knowledge and tools now than this time last year, and with testing, masks and vaccinations, gatherings can be much safer. It comes down to a balance between the importance of the gathering and the tolerance of risk.

Osterholm said he, too, is reassessing and prioritizing. “I happen to be a grandparent of five wonderful young kids, none of them are vaccinated. And this has reoriented my thinking to how close contact I have with them,” he explained.

He said he doesn’t want to get them sick, so he has scaled back on activities like indoor gatherings with them. “We just have to acknowledge this is a tough time, there are no easy answers … I wish I had better information other than to say that, at least while this Delta variant is very common in our communities, now’s the time again to unfortunately go back to where we were, before the surge, in terms of how we address the issue of being with our kids and grandkids.”

Marr, too, said we should be once again setting limits. “If you are fully vaccinated, you are much better protected than you were before. But with Delta circulating … the vaccine is not a get out of jail free card; we still should be taking precautions like avoiding crowds … We still need to be doing these other precautions in order to get past this current wave,” she said, noting she, herself, is “wary” of indoor dining.

Beyond the fall

It’s hard to know if coronavirus infections caused by the Delta variant will peak and rapidly fall in the United States, like they did in the United Kingdom, or if they will remain stubbornly high.

“We are not sure how this is going to play out for the next four to six months,” said Osterholm, pointing out that we are in a critical stage of the surge. “If … the Delta variant follows this pattern that it’s taken in other countries, we can expect to see — particularly the Southern sunbelt states that are getting hit so hard right now — actually show a really rapid decline in cases probably in two to three weeks. The real challenge is what’s going to happen with all the other states where we’re seeing increases … If they too light up, then this surge could actually go on well into mid-September or later.”

Regardless of which way infection rates go, Gandhi said we should aim to reduce viral transmission by all means necessary, even in the setting of effective vaccines.

“[J]ust the fact that you have more circulating virus alone will make it more likely that you get a mild breakthrough infection. And the problem with a mild breakthrough infection is you can pass on to another and that other person, if they’re unvaccinated, can get sick,” she said.

We just have to find the common sense to implement the measures we know to be effective.

And that is how we dance with the coronavirus. It’s that simple and we already have the tools at our disposal.