COVID-19 isn’t over. How do we navigate life now?

March 22, 2022 2:45 PM

As the world transitions to the “endemic” phase of this pandemic, experts address what individuals, leaders and researchers should do.

With spring in the air and COVID-19 cases and hospitalizations far below where they were even a few weeks ago, a lot of Americans may have a sense that things are back to normal and the pandemic is in the rearview mirror.

But a panel of University of Michigan experts who spoke in a recent livestreamed event say that’s not quite the case. The coronavirus that has killed millions worldwide – and left countless more with lasting physical, mental and economic scars – is still very much with us.

This new “endemic” phase, where the virus can’t be eliminated from circulation and could still rise up again, requires a different attitude, they say. Cases have risen quickly in parts of Asia and Europe in recent weeks, and may start doing the same in the United States as the BA2 form of the omicron variant becomes more widespread.

“Endemic doesn’t always mean that the virus doesn’t matter or doesn’t affect our lives,” said Emily Martin, Ph.D., an epidemiologist and associate professor at the U-M School of Public Health whose research focuses on understanding and predicting the spread of viruses including the one that causes COVID-19.

“We aren’t going to fully control or eradicate it for a very long time,” she said. “By understanding that we will be living around COVID-19 for a while, we can turn our attention to making sure we have systems in place for monitoring and responding,” including continued monitoring of vaccine effectiveness as well as surveillance for new variants, an uptick in virus levels in wastewater and more.

What does the immediate future hold?

“In this spring break and holiday time, I wouldn’t be surprised if we see some upticks that may not lead to a major surge, but that’s what we need to watch,” Martin said. “We are seeing more and more seasonal patterns,” with the virus, she added, so even if there is an increase in cases now the overall trend should continue downward to summer, at least in Michigan.

Martin, and three other experts on the panel, members of the U-M Institute for Healthcare Policy and Innovation. The event was hosted by IHPI director John Z. Ayanian, M.D., M.P.P. on March 10, 2022.

Here are highlights from their remarks, which are also available in the recording.

On the importance of continuing to monitor and respond to COVID-19 outbreaks:

Across the board, the speakers emphasized the importance of acting on the lessons of the past two years, including research showing the power of strategies like masking, testing and vaccination, as well as current understanding of how the pandemic affects different groups of people.

Kao-Ping Chua, M.D., Ph.D., a Michigan Medicine pediatrician and health care researcher, has studied the kinds of costs that COVID-19 patients are bearing for their care as part of his work at the Susan B. Meister Child Health Evaluation and Research Center. It can add up to thousands of dollars for people who develop a severe case and end up in the hospital.

That means people could avoid seeking the hospital because of worries about what they might have to pay. And that could increase their risk of serious complications or even death, he says. 

The experts also discussed the recent move to drop mask requirements in most places that still had them, and the recent introduction of a new Centers for Disease Control and Prevention system for advising the public on the level of COVID-19 risk in their county.

Lindsay Kobayashi, Ph.D., a social epidemiologist at the U-M School of Public Health and leader of the COVID-19 Coping Study, noted, “COVID-19 is not gone, its impacts are not equally distributed, and there remain many people who are vulnerable to long-term effects and future infections.”

People who are fortunate enough not to have experienced serious personal effects from the pandemic need to keep this in mind, in order to understand why action is still needed, she says.

“One danger of ‘endemic’ COVID-19 being inscribed into our collective consciousness is that we may fail to act to prevent it,” she said. “If we become complacent, outbreaks will crop up again and they will hit the most vulnerable the hardest.”

Like Kobayashi, panelist Lona Mody, M.D., M.Sc., focuses her research on older adults, and specifically on pandemic preparedness and infection prevention in nursing homes.

"It’s important not to walk away from the tools that have already worked."
Emily Martin, Ph.D., M.P.H.

Mody, a geriatrics professor at Michigan Medicine, leads a research program that has yielded important insights into how coronavirus and other microbes spread in group living settings such as nursing homes, and how to prevent that spread during outbreaks.

“COVID-19 uncovered many health disparities that were decades old and systemic in nature,” she said. In this new phase of the pandemic, “we will learn to recognize patterns of the virus and refine the immunization schedule based on the virus and also the host, including factors like the age of the population and the settings they’re in.”

Nursing home deaths, she pointed out, have already been reduced monumentally because of vaccination of residents and staff.

Even as mask requirements end in many settings, Martin notes they are still important for prevention of infection.

“If you have vulnerabilities and are at risk of serious infection, or people in your life are, or even if you want to make a decision to be more cautious, the ending of mask guidance doesn’t change the fact that masks still work to reduce transmission,” she said. “It’s important not to walk away from the tools that have already worked.”

On what from the pandemic still needs attention moving forward:

In addition to calling for policies that would reduce cost-related issues for people with COVID-19 and long COVID (health effects of COVID lasting more than 4 weeks after an initial infection), Chua pointed out that the nation’s other health crisis – the opioid pandemic – has not stopped in the past two years.

In fact, it has gotten worse, with higher opioid overdose death totals than ever. Policy changes to help more people get access to substance use disorder treatment, and emergency overdose rescue medicine, are still needed.

He's also concerned about the impacts of COVID-19 vaccine misinformation.

“It may keep us from ever achieving a high rate of vaccination in older children, and inhibit uptake whenever we do get a vaccine for children under the age of five,” he said. “I’m worried that there could be spillover effects to other childhood vaccines; the anti-vaccination movement has been able to plant the seeds of doubt about other vaccines even among parents who previously had been rock-solid about routine childhood vaccinations.”

Children who lost a parent or caregiver, or whose parent or caregiver is dealing with lasting physical, mental or economic impacts of COVID-19, should also receive additional support, Chua notes. An adverse childhood experience such as this can have lasting impact on the child’s own health as they grow.

Kobayashi, meanwhile, said it’s important to continue to focus on the mental health effects of the pandemic. Her research, including a report from IHPI’s National Poll on Healthy Aging that she helped write, so far shows that the oldest Americans experienced initial declines in mental health but many have proven resilient.

However, just as some groups of people are more susceptible to severe cases of COVID-19 itself, other groups appear to be more vulnerable to pandemic-related mental health effects. These include people who have suffered economically, those with major caregiving responsibilities, and those in poor physical health.

Mody notes that preparing for future pandemics, including shoring up nursing home preparedness, will be critical. She remarked that 15 years ago, she had trouble getting funding for studies on pandemic planning in nursing homes.

Sustained research funding, including from philanthropy that can fund innovative ideas that federal agencies might not be ready to support, will be key, she said.

Learn more about COVID-19 research by these and other members of the Institute for Healthcare Policy and Innovation

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