The next phase of the pandemic begins with a degree of uncertainty for some and a sense of welcome reprieve for others.
Washington will lift its indoor mask mandate in most settings this Saturday, making it the second-to-last state to do so.
The move marks a distinct shift in the pandemic at the state level – notably, that the onus is now on each individual to assess their risk for COVID-19 instead of state health officials assessing collective risk .
What does this look like? That depends on your risk tolerance. And it might be wise to keep a mask in your pocket, just in case.
When the statewide mask mandate is lifted on Saturday, the pandemic is not over – even if it feels like it.
In fact, the Spokane County case rate is still higher than it was the last time mask mandates were lifted, last summer.
The two-week case rate is hovering around 200 cases per 100,000 residents in Spokane County.
For this reason, public health experts recommend people make a plan. Get some test kits, for example, and know where you would quarantine if needed.
Families will still get calls from school districts about their child testing positive or experiencing COVID symptoms. The virus won’t disappear just because masks come off. In fact, it’s possible case rates might even increase a bit.
“We’re not done with this yet; just because you don’t have to wear a mask doesn’t mean there’s no COVID transmission and indeed, one could expect that transmission will rise slightly when masks go away,” said Eric Lofgren, epidemiologist and professor at Washington State University.
The important thing to remember going forward, he added, is that you’re making a choice about your risk for exposure to the virus whether you consciously consider it or not.
Wearing a mask. Attending large gatherings. Dining out in restaurants. Going to the game. Getting vaccinated. Getting boosted.
These are all choices that will impact the risk for a person moving through this next phase of the pandemic.
“This is hard because we’re placing this burden on individual people to say, ‘I need to opt out,’ when society has decided to go back to normal,” Lofgren said.
For Lofgren, meeting with a friend who is also vaccinated and boosted and dining outdoors with friends are both activities during which he’s OK not wearing a mask . Group game night, where individuals have high-risk family members? He’ll mask up. Going to the grocery store? He’ll mask up.
Concerts and movie theaters? He will wear a mask in those settings for the foreseeable future, he said.
The risk of contracting COVID-19 has become politicized in the last two years, but also crystallized.
The virus has killed nearly 12,000 Washington residents and more than 963,000 people in the United States alone, according to Johns Hopkins University of Medicine.
Older adults and those with underlying health conditions are at highest risk for developing severe disease and dying.
Long COVID has impacted thousands of survivors nationwide who continue to suffer months and even years later.
The virus can impact not just your lungs, but your brain, nervous system and heart. Additionally, the virus can lead to lifelong disabilities and health complications for those who do survive.
What data matters
Data during the COVID-19 pandemic has been hard to keep track of, let alone contain and understand. The omicron surge made it nearly impossible for health departments to keep up with the sheer volume of cases being reported each day, and as a result, trends over weeks – not days – are always more reliable when trying to interpret what COVID activity looks like in your community.
Case rates and local hospital use are both factors Lofgren suggests people keep an eye on to mitigate their risks.
Both the Washington Department of Health and the Centers for Disease Control and Prevention track case rates for counties.
Currently, most Washington state counties have substantial or high transmission rates by the Department of Health’s measures, with most counties reporting a higher than 50 cases per 100,000 rate for the last week for which data is available.
The CDC uses new hospital admissions and inpatient bed metrics, as well as the number of new COVID-19 cases in the past week, to determine whether a county is low, medium or high. Most counties in Washington state have low or medium virus transmission as of March 10, by those metrics.
Hospitalizations for COVID-19 in Spokane County have dropped significantly the last month.
Health Officer Dr. Francisco Velázquez told reporters this week that hospitalizations have dropped 82% in the last month, and the district will monitor that metric closely going forward.
“I think it’s very important to keep track of the people in the hospital because that’s what affects hospital capacity,” Velázquez said.
Procedures and surgeries that were delayed due to the omicron surge are being rescheduled and likely will keep hospital capacity high throughout this spring. Knowing what hospital capacity looks like is also important if you need treatment after getting sick, Lofgren said.
“If something goes wrong, are there resources available to help me? And that’s a very local question; that’s not state (data), it’s county data, and that’s a thing to think about sort of gauging your risk,” he said.
Therapeutics for COVID-19 are still in short supply locally, and while health officials expect the amount of those drugs and treatments to increase, currently treatment even for high-risk immunocompromised people is hard to come by in the Inland Northwest.
For example, Evusheld is an injection used for people who are immune-compromised or those who have severe allergies that prevent them from being vaccinated. The drug can help prevent severe infection with COVID-19, as long as it is administered before a person tests positive.
In Spokane County, there are just 81 doses of Evusheld available currently.
Will masks be effective?
Lifting the mask mandate essentially ends masking as a source of limiting transmission of the virus as a collective. When everyone wears a mask, it breaks down the potential chains of transmission at both ends: the person with the virus and the person potentially infected are both more protected from spreading and catching the virus.
Now, masks will serve as personal protection alone, for those who choose to wear them.
Lofgren said research from health care settings and elsewhere suggests that KN95s and N95s will both work for this purpose, but cloth masks and neck gaiters are going to be “essentially pointless.”
Masks will still be required in certain high-risk settings like hospitals, health care clinics, long-term care facilities and correctional facilities. Additionally, buses, trains and airplanes will require masks for at least another month, NBC reported on Thursday.
Both public health and elected officials are asking the public to be gracious and respect the rules of the room where they are. It might be a good idea to keep a mask on-hand, as businesses can require masks if they want to going forward. Some venues may continue to require masks, and they are allowed to do so.
Some high-risk people will continue to wear masks at their doctor’s advice, while others might feel more comfortable going without one.
“As we venture into this new maskless world, what I hope people will do is give each other some grace, understanding and compassion, because there will be people out there that feel better masking up and that’s their choice and that’s OK,” Dr. Gretchen LaSalle, a family physician at MultiCare Rockwood Clinics, said.
Vaccines remain important
While masks may fall by the wayside, vaccines remain crucial, LaSalle said.
She added that they offer not just personal protection, lessening the severity of COVID disease for a person who gets vaccinated (and boosted) should they also catch the virus, but also offer protection to those in the community who cannot be vaccinated or have been but are still very high-risk.
People with compromised immune systems or those going through cancer treatment who have gotten vaccinated and boosted more than once are still at serious risk for falling very ill with COVID-19. Additionally, children under 5 years old still can’t be vaccinated against COVID-19.
While serious cases and deaths in children are rare, last week, the Spokane Regional Health District reported its first suspected infant death related to COVID-19.
Statewide, 81% of the population 5 and older have received at least one dose of a COVID vaccine. In Spokane County, 66% of the population 5 and older have received at least one dose of a vaccine.
Vaccines have served two roles in the pandemic and will continue to do so, LaSalle said. Vaccines limit the spread of the disease, as well as decrease the chances of bad outcomes if you do test positive for COVID-19.
The vaccines continue to be incredibly effective on that latter point.
COVID death rates are seven times higher for those 65 and older who are unvaccinated compared to their vaccinated peers, state data show.
Another booster might be in store later this year, perhaps before the respiratory season, LaSalle said, and health officials also hope that a vaccine for kids 0 to 5 is available this year too.
No one wants to predict what’s ahead. If that’s confusing, think back to July 2021, when case rates were the lowest they’d been in more than a year, vaccines were widely available and things seemed better. Until they weren’t.
The delta variant emerged, and the pandemic whiplash led to the most intense and most prolonged wave of COVID deaths in Spokane County and in many other parts of the country.
It’s possible another variant is on the way. Health experts in other countries are monitoring the rise of BA.2, a subvariant of omicron, which is leading to a marked increase in cases in some parts of the world.
So far, BA.2 is not increasing or posing a threat in Washington state, according to the state’s latest variant report.
Local health officials are watching, however. Velázquez told reporters this week that the district will monitor virus activity and work with school districts should they need to adjust their strategies and potentially require masks again .
This is a possibility.
“We have moderate levels of vaccination, which is a sort of awkward position to be in because you have just enough selective pressure to promote variants that can escape or partially escape immunity,” Lofgren said.
With mask mandates lifting, gatherings increasing and the lag time in getting vaccines out globally, there are lots of opportunities for new variants to emerge, Lofgren said.
And while some assume that these variants will be less severe than omicron, that’s not a foregone conclusion.
And when masks are no longer required come Saturday, that doesn’t mean they never will be required again, a point Lofgren worries the public might not accept.
“My main concern is, it’s a dial not a switch thing; all of this seems to be predicated on the belief that these (policies) can come back if needed, and I am somewhat skeptical that that’s true,” Lofgren said. “I think that’s a very large assumption that these will come back and we’ll see good compliance with them when they do come back, and I think that’s a large assumption and not something we can rely on.”