(CNN) — As families prepare to gather for Labor Day and children head back to schools, coronavirus cases are once again on the rise.
COVID-19 hospital admissions are up more than 18% in the most recent week, according to the U.S. Centers for Disease Control and Prevention. Some experts are encouraging a return to masking, especially for older adults and individuals most vulnerable to severe disease.
With concerns that COVID-19 could spread as people gather, this has led to many questions about disease prevention: What virus prevention measures should those planning Labor Day events consider? As kids return to the classroom, should they mask? And how should families prepare for the possible confluence of the coronavirus, flu and respiratory syncytial virus (better known as RSV) that may occur this fall?
To guide us through these questions, CNN spoke with Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.
CNN: What precautions should people take to protect themselves against the coronavirus?
Dr. Leana Wen: It depends on people’s circumstances.
We are at a very different point in the pandemic compared with the first couple of years of COVID-19. At this point, it’s clear that the coronavirus is endemic — it’s become one of many viruses that we have to contend with. Thankfully, we have many more tools to reduce the severity of coronavirus infection, including vaccines and treatments, and options to reduce virus transmission, including masks and improved ventilation.
The primary factor people should consider in thinking through the degree of precautions to take is how vulnerable they are to severe illness if they were to contract COVID-19. For younger and generally healthy people, especially if they have had the coronavirus before and have been vaccinated, the chance of severe illness is very low. As a result, they might decide that they will use good hygiene practices like handwashing and sneezing into their elbows, but otherwise not take the more restrictive measures that they adopted earlier on in the pandemic like masking, social distancing and avoiding indoor interactions.
CNN: Are older people still particularly vulnerable?
Wen: Yes. Most people still becoming severely ill from the coronavirus are those 65 and over and who have serious underlying medical conditions such as heart disease, lung disease and immunocompromise. These individuals should take additional precautions. To begin with, they should be sure they are up to date with coronavirus boosters. According to the CDC, less than half of those 65 and over received the bivalent booster shot that was first released in fall of 2022. Older individuals and those with underlying medical illnesses should certainly get the new booster shot when it comes out, which is expected to happen next month.
People should also know whether they are eligible for the antiviral medication, Paxlovid, and to have a plan for how to access it. Studies have shown that Paxlovid can reduce the risk of hospitalization or death by as much as 80% when taken within five days of symptom onset.
Individuals should speak with their physicians to discuss their risk of severe illness from the coronavirus, taking into consideration the effect of boosters and antiviral treatment. Those who are still vulnerable should take added precautions to avoid contracting COVID-19 in the first place. This includes wearing a well-fitting, high-quality N95 or equivalent mask in crowded indoor places, and opting for outdoor rather than indoor gatherings.
CNN: Who else should take extra care?
Wen: I think there are two more categories of people who may wish to take precautions. One is people who are living with someone who is high-risk. They should consider masking and reducing indoor gatherings to reduce their risk of transmitting the coronavirus to their vulnerable loved ones. They should also test regularly to reduce their risk of asymptomatic transmission.
In addition, because every COVID-19 infection comes with the risk of developing post-COVID symptoms — also called long COVID — those who prioritize avoiding long COVID might also take precautions to reduce their likelihood of contracting the virus.
CNN: What measures should those planning Labor Day events consider?
Wen: It’s important to put the recent COVID-19 numbers into perspective. While it is true that hospitalizations are on the rise, they are about one third of hospitalizations last year at the same time. People who didn’t put Labor Day events on hold last year probably don’t need to do so this year.
Organizers should consider their own medical circumstances and those of their attendees. If there are some attendees who have expressed their concern about contracting COVID-19, organizers could consider hosting the Labor Day festivities outdoors. Outdoors remains far safer than indoors, and good ventilation with open windows and doors is a great strategy for reducing transmission. I’d also recommend having hand sanitizer readily available and encouraging people to stay home if they are symptomatic.
Individuals who are high-risk can further reduce their own risk by attending only events where they can stay outdoors, or, if they must be indoors, wearing a high-quality mask when in crowded areas.
CNN: As kids return to the classroom, should they mask? Should mask requirements return in schools?
Wen: I do not think mask requirements should return in schools. COVID is going to be with us in perpetuity, and unless we are prepared to ask kids to mask all the time in the classroom, the level of virus is not at the point where we need to consider mask mandates for kids, who are generally at very low risk for severe illness.
That said, there may be circumstances where families may consider masking their own children in schools. Schools may have policies that request kids to mask if they are symptomatic, for instance. Also, a child who is about to visit, say, a grandparent in a nursing home, may also choose to mask for a few days before the visit to reduce their risk of contracting COVID-19. Families with children who are immunocompromised or who have severe underlying medical conditions should also discuss with their physicians whether continued masking is an appropriate measure, especially as virus levels increase in the fall and winter months.
CNN: How should families prepare for the possible confluence of the coronavirus, flu and respiratory syncytial virus (RSV) that may occur later this fall?
Wen: We could very well have a confluence of increasing virus activity as we did last year, with coronavirus, influenza and RSV cases rising at about the same time. Families should plan to get everyone the flu vaccine — essentially everyone 6 months and older should receive it. The new COVID booster is expected to come out next month, and vulnerable individuals should plan to receive it. There are now two new RSV vaccines that people 60 and older are eligible for, and options for pregnant patients and babies. People should discuss all of these options with their health care providers.
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