You probably know a lot of sick people right now. Most parts of the U.S. are getting pummeled by respiratory illness, with 7% of all outpatient health care visits recorded during the week ending Dec. 30 related to these sicknesses, according to the U.S. Centers for Disease Control and Prevention (CDC).

Many people are sick with flu, while others have RSV or other routine winter viruses. But COVID-19 is also tearing through the population, thanks largely to the highly contagious JN.1 variant. Just like every year since 2021, this one is starting with a COVID-19 surge—and Americans are getting a good glimpse of what their “new normal” may look like, says Katelyn Jetelina, the epidemiologist who writes the Your Local Epidemiologist newsletter.

“Unfortunately,” she says, “signs are pointing to this [being] the level of disruption and disease we’re going to be faced with in years to come.”

The CDC no longer tracks COVID-19 case counts, which makes it harder than it once was to say exactly how widely the virus is spreading. Monitoring the amount of virus detected in wastewater, while not a perfect proxy for case counts, is probably the best real-time signal currently available—and right now, that signal is a screaming red siren. According to some analyses, wastewater data suggest the current surge is second in size only to the monstrous first wave of Omicron, which peaked in early 2022. By some estimates, more than a million people in the U.S. may be newly infected every single day at the peak of this wave.

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Wastewater isn’t the only sign that things are bad. Almost 35,000 people in the U.S. were hospitalized with COVID-19 during the week ending Dec. 30—far fewer than were admitted at the height of the first Omicron wave, but a 20% increase over the prior week in 2023. Deaths tend to lag a few weeks behind hospitalizations, but already, about 1,000 people in the U.S. are dying each week from COVID-19.

Yet even as the trends veer in the wrong direction, people are still working in offices, going to school, eating in restaurants, and sitting shoulder-to-shoulder in movie theaters, largely unmasked. It can be hard to know how to feel about that reality. Viewed through a 2020 lens, many people would consider it catastrophically concerning that people are living normally even as COVID-19 sickens the equivalent of an entire city’s population every single day. But is it as worrisome in 2024, when the pandemic is over on paper, if not in practice?

Not according to Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration’s former COVID-19 response coordinator. Almost all of the U.S. population has some immunity from previous infections or vaccinations; treatments like the antiviral Paxlovid are available for people at risk of severe disease; and most people know the basics of masking, testing, and other mitigation measures. All of these factors, Jha says, mean COVID-19 is becoming less of a threat over time. Some groups of people, including the elderly and immunocompromised, are still at greater risk than others, and Long COVID—the name for potentially debilitating chronic symptoms that sometimes follow a case of COVID-19—remains a possibility for everyone. But Jha maintains that vaccines and treatments should make everyone feel safer.

“The straight facts are: COVID is not gone, it’s not irrelevant, but it’s not the risk it was four years ago, or even two years ago,” Jha says. “It’s totally reasonable for people to go back to living their lives.”

The big challenge now, says Dr. Robert Wachter, chair of medicine at the University of California, San Francisco, is wrapping our heads around that change. “We’ve got to somehow reprogram our minds to think about this as a threat that is just not as profound as it was for a couple years,” Wachter says. “When your minds have been pickled in terror for a couple of years, it’s very hard to do.”

How to assess COVID-19 risk in 2024

In the earlier days of the pandemic, Wachter closely watched the COVID-19 data and used exact numbers and percentages to decide what he felt comfortable doing. Now, with fewer of those precise numbers and more disease-fighting tools available, he goes by trends.

During COVID-19 lulls, “I’m living my life about as normally as I did in 2019,” Wachter says. Once indicators like COVID-19 hospitalizations and wastewater surveillance data start to suggest the virus is on the upswing, he wears a KN95 mask in crowded places like airports and theaters, where there’s little downside to masking. And in a full-blown surge, like now, Wachter masks almost everywhere and avoids some places he can’t, such as restaurants.

Those decisions feel right to Wachter, based on his personal risk tolerance and vulnerability to severe disease. He’s up-to-date on vaccines, which slashes his chances of being hospitalized or dying if he gets infected—but, at 66, those outcomes are still likelier for him than for his 30-year-old children. “Other people might make different choices,” Wachter says. “And there are going to be people who say, ‘This is a lot of mental energy…screw it.’”

With hard numbers scarcer than they once were and lots of people no longer willing or able to make detailed risk assessments, Jetelina instead recommends letting your objectives shape your behavior. Want to avoid infecting your grandmother before a visit? Maybe skip having dinner in a crowded restaurant a few days before and test before you go to her house. Want to minimize your risk of getting very sick if you do get infected? Stay up-to-date on boosters—as far too few people do, says Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development.

“The biggest failing right now in our response to COVID,” Hotez says, is that only about 20% of U.S. adults got the latest vaccine, which was updated to target newer viral variants. “That should be the number-one priority,” he says, since vaccination is the best way to prevent complications like hospitalization, death, and, to some degree, Long COVID.

The risks that don’t go away

Even with boosters, Jetelina says Long COVID is a hard risk to plan around. The only tried-and-true way to avoid it is to avoid infection entirely; staying up-to-date on vaccines reduces the risk by up to 70%, according to recent research, but people can and do develop it even if they’re healthy, fully vaccinated, and have had previous infections without incident. With variants as contagious as JN.1 running rampant, doing almost anything in public opens up the possibility of getting sick.

But there are plenty of choices between ignoring the virus entirely and completely locking down at home, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID. She recommends wearing good-quality masks in public, socializing outside or using open windows and air filters to improve ventilation inside, asking people to test before gatherings, and avoiding especially crowded places during surges. “I wish more of those were normalized, because they do at least decrease the chance of getting infected and causing long-term harm and disability to yourself or other people,” she says.

But, Davis says, all responsibility shouldn’t fall on individuals. She says it’s a “huge injustice” that the government hasn’t done more to warn the public that people can still get Long COVID, and that reinfections can lead to serious health issues. She also feels the data support policy measures like ventilation requirements for public places and mask mandates on public transportation.

The unclear future of COVID-19

Some mask mandates in health care facilities and nursing homes have been reinstated during this surge. But Jha says widespread mandates are unlikely to come back—and in his view, they shouldn’t. “There was a role for mandates in the early days of the pandemic…when we had no other tools, no way of protecting people,” he says. “Mandates four years in, when we have plenty of tests, plenty of vaccines, plenty of treatments, plenty of masks,” are not as crucial, he says.

Jetelina says she wouldn’t be surprised if 2024 brings a further relaxation of COVID-19 guidance rather than increased mitigation measures. She speculates that the CDC may change its isolation guidelines, for example.

“The threat [of COVID-19] will get baked into the other threats people have in their background that aren’t front of mind,” Wachter predicts, similar to the ever-present risk of getting sick with other illnesses or getting into a car accident. And, “as long as the virus doesn’t shape-shift its way into laughing at our immune status,” he says that’s not such a bad thing. People will continue to reach different conclusions about the level of risk-taking they can stomach and behave accordingly, just as they do in other areas of life.

It’s natural for guidance and behavior to change once a public-health menace begins to transition from emergency to endemic, Jha says. But that doesn’t mean we should turn a blind eye toward COVID-19 or the numerous other pathogens swirling around.

“For a lot of people it’s been about, ‘How do we go back to 2019, to life before the pandemic?'” he says. But, in his view, that’s not the right goal: “We actually want to look forward.”

Jha says he’s hopeful that lessons learned during the COVID-19 pandemic will spark a reimagining of how we deal with respiratory diseases in general. Such an approach wouldn’t necessarily single out COVID-19, as much of the public-health messaging has done since 2020. Instead, Jha says, it could standardize and broaden guidance around all infectious diseases, hammering home the importance of things like vaccines, masks, ventilation, and sick-leave policies that allow people to stay home when they have any disease—not just the one that has dominated our collective consciousness for the past four years.

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