What does the future look like with COVID-19?
We asked three experts for their opinions on co-existing with the ever-evolving virus.
Por Leslie Goldman
Do you think that COVID-19 will always be with us, like the flu?
Dr. Monica Gandhi, deputy chief of the Division of HIV, Infectious Diseases and Global Medicine at UCSF/San Francisco General Hospital: Yes. The fact that COVID-19 can spread before a person has symptoms, that it does not show clear characteristic symptoms, and that it is transmitted by animals (almost 30 species) makes its elimination practically impossible. Vaccines are great for protecting us against serious disease, but they won’t make the virus go away.
Will COVID-19 always be more dangerous than the flu or the common cold? Gandhi:
I think no. We rarely hospitalize people—including older adults—with COVID-19 or COVID-19-associated pneumonia in the ICU anymore. This is due to generalized immunity (more than 95% of the country’s population has antibodies, thanks to vaccination, natural immunity or both); to good hospital and outpatient treatments, such as remdesivir and Paxlovid, respectively; and the fact that the omicron variant and its subvariants are less likely to infect lung cells than earlier strains.
Will receiving the current booster help me if I have contact with the new variants?
Dr. Eran Metzger, director of psychiatry, Hebrew SeniorLife, Boston: Yes. It may not completely prevent you from getting COVID-19, but it can help prevent serious illness. Like an annual flu shot, these boosters are tailored for new strains, but increase overall immunity against the virus.
Will there finally be an annual vaccine, like the one against the flu?
Gandhi: If COVID-19 becomes more of a winter respiratory virus—and I believe it will—an annual booster will eventually be recommended for people 65 and older to maintain elevated immunity and stay in the lower margin of risk. Vaccination is particularly important for older adults who have other diseases, such as heart disease or emphysema.
Many people are confused about Paxlovid. Do you have to be very sick to take it?
Dr. Emily Landon, a medical specialist with the High-Consequence Pathogen Preparedness Program at the University of Chicago Medical Center: Surely everyone over the age of 50 with COVID-19 should take it, no matter how sick they feel. Paxlovid acts as a cleaning crew, removing part of the virus so that the immune system can do its job more easily. That means there is less risk of getting seriously ill. Additionally, preliminary data suggests that it may help reduce the risk of prolonged COVID-19. The sooner you take Paxlovid after getting sick, the faster and better the effect will be. You should make sure your prescribing doctor is aware of all other medications you take, as it can interact with some drugs, such as statins.
What is your advice for older adults regarding masks?
Landon: With the removal of the mandates, the use of masks becomes a very personal decision. There are still excellent reasons to try to avoid COVID-19, including the fact that we are just beginning to understand its long-term consequences. We must ask ourselves if in a certain situation it is worth not wearing the mask and contracting COVID-19.
In some cases, such as a granddaughter’s wedding, it could be said that yes, enjoying the celebration without a mask is worth it. And if you’ve received the vaccine and booster and have no underlying illnesses, you’re at little risk of serious illness. In other cases, such as when shopping, you could say no. In my opinion, the mask is essential whenever there are many people in small spaces, such as airports, planes, buses or gyms.
Research shows that almost 100% of planes have COVID-19 in the wastewater after every flight, which means that at least one passenger on the plane is diagnosed with COVID-19. My mom is 76 and still wears a mask on planes and to church, but not when she plays golf or meets friends outdoors. In principle, every time you put on a mask you reduce the risk. But it must be a well-fitting N95, KN95 or KF94 mask, as cloth masks don’t really help.
I have a loved one who lives in a long-term care facility where there are frequent outbreaks of COVID-19. Will I ever be able to visit him safely?
Metzger: When the pandemic began, long-term care facilities, such as nursing homes, were placed under strict isolation. Now we’re looking at the lingering health effects that such drastic isolation caused: depression, post-traumatic stress disorder. Some doctors refer to them together as “the second pandemic.” All of this, combined with high vaccination rates, has led many nursing homes to take a more flexible approach to visiting.
We also know that loneliness is a risk factor for many chronic diseases, including depression, dementia, and heart disease. Therefore, visiting your loved one with precautions, such as vaccinations and masks, may not only be possible, but also positive. Find out if there is a COVID-19-free area where you can visit, such as a private family room. If you won’t be passing any staff or residents with COVID-19 on the unit, the risk is minimal.
Responses have been edited for clarity and brevity.
