Three Years After the Start of the Pandemic, Reasons for Hope and Continued Vigilance

It has been three years since COVID-19 was declared a pandemic on March 11, 2020, by the World Health Organization. With New York City as an early epicenter, residents were hit hard. But from that experience, health care providers and researchers across the city found the opportunity to learn more about the virus and how to prepare for future pandemics.

Today, the city’s level of community transmission of COVID-19 is considered low, and the percentage of people who have completed their primary series of COVID-19 vaccinations is relatively high, according to the Centers for Disease Control and Prevention (CDC). Similarly, hospitalization and mortality rates from COVID-19 remained low in recent months, compared to the period between 2020 and 2022.

These factors mean that New Yorkers can probably afford to relax their vigilance compared to previous years, notes Bernard Camins, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and Medical Director for Infection Prevention at the Mount Sinai Health System.

Who should remain vigilant?

Vulnerable groups include those who are immunocompromised, and those aged 50 and older, even if they’ve been vaccinated for COVID-19. People with certain underlying medical conditions, such as cancer; chronic kidney, lung, or liver disease; dementia; diabetes; heart conditions, or obesity are also considered at heightened risk.

For younger or healthy individuals, having COVID-19 these days might involve cold-like or mild symptoms, says Judith Aberg, MD, Chief of Infectious Diseases for the Mount Sinai Health System and Dr. George Baehr Professor of Clinical Medicine at the Icahn Mount Sinai. But vulnerable populations are at risk for developing severe disease, she adds. This includes hospitalization, needing intensive care, requiring a ventilator to breathe, or even death.

For at-risk groups, masking is recommended, as is avoiding large indoor gatherings. People planning to be organ donors should also remain vigilant for signs and symptoms of COVID-19, as an active infection could complicate one’s ability to donate, Dr. Aberg says.

“Also, people seem to have forgotten about hand hygiene; that is still important,” she notes.

What protection measures are available today?

With the federal Test to Treat initiative in place nationwide since 2022, symptomatic individuals who test positive for COVID-19 at testing sites can receive antiviral treatment, such as Paxlovid, on the spot.

“Taking Paxlovid provides that extra protection from developing complications, and the sooner it is taken, the better,” says Dr. Camins. Patients are recommended to receive antiviral treatment within five days of developing symptoms.

According to the CDC, 17 percent of the U.S. population ages 5 and up have received the updated booster. In New York, that number is 18 percent.

Data have shown that the updated boosters either prevented infection or reduced the possibility of developing severe disease in people who received them. Another possible benefit of keeping up to date with vaccination is that it might prevent new variants from being as deadly as previous strains, Dr. Aberg says.

Will we need annual boosters?

Just as the bivalent boosters were updated to protect against current circulating variants and strains of SARS-CoV-2, the virus that causes COVID-19, researchers and officials are monitoring how the pathogen continues to evolve. Most of the scientific and medical community believe that the virus is headed in the direction of becoming endemic, or regularly occurring, Dr. Aberg says. “However, the jury is still out on whether annual updated boosters will be necessary,” she adds.

Neither the Food and Drug Administration nor the CDC has made any determinations on recommending annual COVID-19 shots, unlike what they have done with the flu. The data on COVID-19 collected over the recent winter could provide clarity on whether another shot might be needed this fall, says Dr. Aberg.

There are other seasonal coronaviruses and rhinoviruses that cause respiratory infections that do not require annual boosters. “It’s hard to predict whether the virus will take another turn to cause more morbidity or mortality. We’ll have to wait to see what the data shows us,” Dr. Aberg says.

What other things about COVID-19 should we be aware of?

The public health emergency declaration, which has been in place since 2020, will come to an end on Thursday, May 11, 2023. This might have implications regarding cost sharing or coverage regarding various COVID-19-related services, such as testing, treatment, or vaccinations. This might mean some services will no longer be free or will start requiring copays, depending on the insurance.

While the New York State Department of Health has not released any guidance on cost impacts, providers need to inform their patients and communities to follow up with their insurance companies and be aware of possible coverage changes, Dr. Aberg says.

“People need to be informed about potential costs before seeking COVID-19 care,” Dr. Aberg notes. “But on the other hand, we don’t want people to avoid seeking help because of cost.” If a patient experiences troubling symptoms, such as shortness of breath or fever, they should see a primary care doctor or go to the emergency room, she adds.

This has allowed providers to be better educated about the sorts of things that could cause long COVID symptoms to flare up, Dr. Putrino says. The availability of objective biomarkers also means the ability to start testing therapeutics to treat long COVID.

“A year ago, I would have thrown my hands in the air and said there were no good drug trials for long COVID,” Dr. Putrino says. “Now, I feel a little confident that we can start promising patients that these trials are on the horizon.”

“We’re getting close to getting therapeutics to prescribe. I’m hoping that will be a reality over the next two years or so,” Dr. Putrino says.