The numbers bear this out — and that’s why vaccine mandates, as unpopular as they may be, have been so effective. When United Airlines issued a mandate for all employees, fewer than 1 percent faced dismissal for noncompliance. Novant Health, a hospital system in North Carolina with 35,000 employees, had to dismiss only 175 for noncompliance. In Washington state, less than 3 percent of the 63,000-person state workforce chose to quit or be fired rather than get the vaccine.
“It’s like car insurance,” Wolfe says. “If we didn’t make it mandatory, a lot of people wouldn’t get it because it costs money and we all think we’re great drivers who will never have a car crash.” The vaccine resistant may never get that shot, even though 50 million people have gotten COVID. But vaccine mandates so far have helped “insure” millions against future infection. That’s good progress.
5. What is long COVID — and how do I know if I’m at risk?
We’ve learned much about this novel virus over the past two years, but one aspect that continues to confound doctors is “long COVID,” in which certain patients suffer from symptoms for months after the infection has run its course.
Many other viral diseases — from chicken pox to polio to influenza — have been shown to have “long haul” effects, as do bacterial diseases like Lyme. But long COVID may be far more common than anyone thought.
A large study in PLOS Medicine of more than 273,000 COVID survivors found that 37 percent had one or more symptoms of long COVID three to six months after infection. And the risk of long COVID symptoms rose with age, with 61 percent of the 65-plus group having symptoms like breathing difficulty from lung damage, cognitive issues (brain fog and memory), muscle pain and fatigue. The risk was higher in people who’d had a more severe bout of the illness. Other common long-term symptoms include headache, anxiety/depression and pain in the chest or throat that people may not even attribute to COVID.
The overall cause remains a mystery, but researchers are making inroads. A new study of deceased COVID patients by the National Institutes of Health found the COVID virus can infect specific organs — such as the heart, lungs or brain — and persist there for months. But there is still much to learn.
“We don’t yet have a great understanding of what this is, how it occurs and what the treatment should be,” Badley says. “I think in 2022, we’ll begin to get a handle on those.” What makes it especially challenging is identifying which symptoms are actually long COVID and which aren’t. “It’s very nebulous,” Wolfe says. “I can predict with some accuracy who’s going to get sick enough with COVID to wind up in the hospital. It’s proportional to your age, your weight, to how bad your heart or lungs are at the beginning, how bad your diabetic control is. I have yet to find a good way of predicting who gets long COVID. I have no idea how that pans out.”
If you have had COVID and have ongoing symptoms, Badley suggests talking to your doctor immediately. Everyone presents differently, and the long-term effects of COVID remain a mystery. But there’s another reason to talk to your doctor: Your symptoms might not be COVID-related.
“Many people deferred routine health care maintenance during the COVID era,” Badley says. “Some of these symptoms we’re seeing after recovery could be unrelated health issues.”
Lung and neurological issues are particularly worrisome, as they may require a specialist’s care.Vaccines may play a part here, as well. A U.K. study in The Lancet found that long COVID risk was reduced by half in vaccinated folks who developed breakthrough infections. Also, though anecdotal, a Yale research team found that receiving the vaccine reduced long COVID symptoms in 40 percent of people surveyed — possibly because the inoculation took out some remaining viral factors.
Bottom line: Ask yourself, “Am I worse off health-wise than I was before COVID?” If yes, call the doctor.
6. Is omicron really a game changer?
The delta variant was responsible for the massive outbreak in the summer of 2021, and omicron has caused a much greater spike. But while these variants seem to be more communicable than the original virus, those who are fully vaccinated and had a booster are still far less likely to experience a severe infection.
“The more viral replication you have in the community or in an individual, the more likely you are to see mutations occur. So absolutely, I believe we will see new variants moving forward,” Badley says.
But even if a vaccine-resistant variant does emerge, “the vaccine manufacturers can develop new vaccines to these new strains very, very quickly because they know exactly how to do it,” Yale’s Vermund says. An omicron-specific vaccine has not been necessary, but if the situation changes in the months or years to come, experts suggest a new mRNA vaccine could be created within a few months.
7. I’m vaccinated. Is there anything else I can do?
First off, get your flu vaccine (it’s not too late) and a COVID booster if it’s been five months since your second Pfizer shot (six months if you got the Moderna series; two months if you got the Johnson & Johnson vaccine). The two vaccines can be given simultaneously (you might want to get one in each arm) and function so peacefully together that drugmakers are working on a single flu-COVID combo vaccine that could be available in autumn 2022. The goal is to stay healthy and out of the hospital — and prevention is your best weapon, Badley says the first “flurona” case of someone having the flu and COVID at the same time has been confirmed in Israel.“
"Last year, we were pretty good at distancing and masking and handwashing,” he adds. “Now in many places, that’s relaxed and the opportunity for influenza spread will be back to where it was pre-pandemic.” So while you’re probably tired of wearing a mask, experts say you should wear one in indoor public spaces.
And continue to follow the advice of your health care provider. Just as vaccines against other diseases need periodic boosting, COVID boosters may become a regular part of your health plan.
8. What will 2022 bring?
One way to analyze what might happen later this year is to look at what the people who have the most skin in this game are planning. In this case, that’s health insurance companies. Insurers offering health plans via the Affordable Care Act marketplaces must file plan offerings for 2022 to justify their premiums. Most ACA marketplace insurers are predicting COVID-19 will have no effect on their 2022 costs.
That’s a bold and optimistic statement about the future of this pandemic. But the virus is still out there. COVID is still most dangerous for people 50 and older, and real safety has remained elusive.
“I think we’re going to get there [in 2022] in certain parts of the country,” Vermund says. “I think you’re going to have a very favorable circumstance because you have very high vaccine rates. In places where we’re only getting 40 or 50 percent of adults vaccinated, that’s a long way from herd immunity. And if people similarly resist vaccination for their children, you’re going to have a big chunk of the population in whom the virus is going to continue to circulate.”
Wolfe, a native Australian, has faith in Americans. “I’d be wrong to say I’m not optimistic. We know so much more than we knew a year ago. We have far better treatments. We understand distancing and masking. People can do it. We’re absolutely better than we were a year ago.”
A Mask Hater’s Guide to Masking
Two years later, masks remain a critical weapon for keeping COVID in check. “We know how this spreads,” says Johns Hopkins’ Panagis Galiatsatos, M.D. “You have to breathe it in after someone actively breathes it out. The vaccines work even better if you inherit a small viral load. And if you should breathe in the virus, you’ll get a smaller viral load if both you and the other person are masked.”
Mask rules for early 2022 are:
If you’ve had a booster in the past two months, have no chronic health issues, and are under age 65, you could consider going without a mask:
- When attending an outdoor event
- When gathering indoors with others who have been fully vaccinated or had negative COVID tests in the past two days
- But mask up when indoors with the general public. The transmissibility of the omicron variant means overall risk is elevated. AND … if you feel unsafe in any situation, make the smart move and don a mask.
If you’re over 50 and have not been fully vaccinated, consider yourself at high risk —even if you’ve had COVID in the past. You still need to wear a mask:
- Anywhere indoors in public, or outdoors when in crowds
- Particularly in hospitals, nursing homes or other facilities housing vulnerable populations
- When entering areas where mask mandates are in place.
Just think of masks this way: “I look at wearing masks no differently than wearing a helmet to enjoy a motorcycle ride,” Galiatsatos says. “You are just being safe."