‘We don’t want to restrict life’: How to navigate COVID risk at an uncertain time

After being vaccinated and having mild cases of COVID, the Infurna family decided it was time to take a family vacation.Erin Clark/Globe Staff

Just about every day, the news is punctuated by more cases of COVID-19. Vice President Kamala Harris. Secretary of State Antony J. Blinken and others who attended the jam-packed White House correspondents’ dinner last weekend.

Case numbers and hospitalizations are rising, too — in Massachusetts and across the country. On Thursday, the state reported its highest number of new cases in a single day, 4,376, since early February. And COVID hospitalizations have more than doubled in the past month. Late Thursday, the CDC said that seven Massachusetts counties, including Suffolk, now have “high” community levels of COVID-19.

But this time, many are simply shrugging and moving on. Mask mandates have lifted in schools and on mass transit; Dr. Anthony Fauci, the country’s top infectious disease official, has said it’s up to each American to decide how much risk they want to take.

So what’s the best road map for people trying to live life as normally as possible in this seemingly endless pandemic purgatory?

The choices are so personal and variable that even the experts the Globe consulted had different suggestions; some endorsed the choice to go maskless most of the time while others advocated masking in crowded public places.

But when it comes to counties the CDC ranks as having high community transmission — currently most of Massachusetts — everyone was on the same page in favoring indoor masking.

Dr. Megan L. Ranney, an emergency physician and academic dean of the Brown University School of Public Health, said she rarely wears a mask indoors these days, because the rise in cases hasn’t overwhelmed hospitals.

But Ranney lives and works in Rhode Island, where community levels of COVID-19 are ranked “medium” by the US Centers for Disease Control and Prevention. For counties with high transmission levels the CDC recommends indoor masking.

Ranney cautioned that going maskless, while a reasonable choice in some regions, means a high likelihood of catching the virus. “If you have not had COVID in the last few months, expect to get it,” Ranney said. “That may not matter. If you are vaccinated and boosted and not high risk, you’re going to be, for the most part, OK.”

Meanwhile, her colleague, Jennifer Nuzzo, director of Brown University’s Pandemic Center, lamented that research hasn’t been done to show which environments and activities are most risky.

“I can’t tell you where people are contracting COVID these days,” Nuzzo said. “We should know this. We should be doing these studies.”

Nuzzo believes it’s often reasonable for those who are healthy to go about their lives normally — but the risk calculus must change with the data.

After the CDC raised the community levels for much of Massachusetts, she said, “people may want to take more precautions to reduce their risk of infection and to reduce possible strains on health care. I’d particularly recommend this for people who are at higher risk for severe illness were they to become infected.”

At all times, Nuzzo said, those with weakened immune systems, or who have contact with such a person, should take more precautions than someone without those risks.

And there is the real chance that someone who gets infected but hasn’t been wearing a mask or taking other precautions may unknowingly pass the virus to another who doesn’t fare as well.

“It’s a time to be cautious but not fearful,” said Dr. Syra Madad, an infectious disease specialist at Harvard’s Belfer Center for Science and International Affairs and director of the special pathogens program at New York City’s hospital system.

Madad, who has a young unvaccinated child and an elderly mother-in-law she cares for, continues to mask in airports and on other public transportation, as well as at indoor gatherings.

“People should try to avoid getting infected even if the disease is manageable,” she said. “We still don’t know the repercussions of long COVID.”

Emerging research suggests being vaccinated seems to substantially cut the risk of developing the chronic, debilitating symptoms associated with the longer-term illness. But estimates vary about how many will go on to develop long COVID, from 10 percent to as many as 30 percent.

At the same time, national and state data show COVID cases and hospitalizations rising again, though far below the pace and numbers of the Omicron peak in January. COVID hospitalizations in Massachusetts have more than doubled, from 218 on April 3, to 516 on May 3. New confirmed cases have increased to a seven-day average of 2,416, from 1,174.

Philip Infurna Jr., with children Henry, 9, Gracie, 10, and Tucker, 12, and wife, Jen, wants to start living normally again.Erin Clark/Globe Staff

And scientists say a new sister of the BA.2 Omicron variant, known as BA.2.12.1, is 25 percent more transmissible than its fast-moving predecessor, with both prevalent now in New England. A new study that has not been peer-reviewed suggests this latest Omicron variant, and two new emerging ones, BA.4 and BA.5, show an increased ability to evade disease-fighting antibodies in vaccinated people and those previously infected with an earlier form of Omicron.

Comparing COVID-19 to influenza, Ranney said that COVID kills more people because it is highly transmissible and thus more prevalent, and it can cause long-term symptoms, as well. “But for those who are vaccinated and boosted and otherwise low-risk,” she said, “the current variant is much closer to the flu than it was even a few months ago.”

Amid the dizzying array of information, there are online tools that can help people navigate their risks.

The “MyCOVID-19 Visit Risk Calculator” [https://covidvisitrisk.com/riskscore-english.html] asks users about 20 questions, from a person’s vaccination status to the type of transportation they intend to use, to estimate their risk of infection.

“There are so many elements that go into [a decision], from how many people you are visiting with, to how are you going to get there, and you realize it’s not a simple yes-no answer, which everyone would like,” said Dr. Samir Sinha, who developed the tool and is director of geriatrics at Sinai Health and the University Health Network in Toronto. He said he continues to mask in public places.

Brown University’s “MyCOVIDRisk” https://mycovidrisk.app/ asks users several questions about their location and planned activity and then rates their risk from low to high. Grocery shopping in Cambridge for 45 minutes, for example, is deemed low risk if the shopper is vaccinated and wearing a high-quality mask.

The COVID-19 Event Risk Tool https://covid19risk.biosci.gatech.edu/ developed at Georgia Institute of Technology enables a person to find out, based on COVID-19 prevalence in their county, what is the risk that at least one person with COVID-19 will be present at gatherings of various sizes.

The site can make people “realize maybe breathing the air of other people at this particular moment is not really worth it,” said Joshua S. Weitz, founding director of the Quantitative Biosciences Graduate Program at Georgia Tech, and co-developer of the tool. “I would at least begin to think through what are the consequences of me getting infected.”

Those sentiments were echoed in responses from readers to an informal Globe online survey asking whether and what type of precautions people were still taking. Most of the roughly 40 people who responded said they still wear masks in many indoor places, and some said they are still limiting certain activities, such as indoor dining or large gatherings.

But some, such as Philip Infurna, Jr., a 44-year-old Winchester father with three children, have moved on. The entire family is vaccinated, and Infurna and his wife are boosted, too

After all five weathered mild cases of COVID in December, they decided they were as protected as they’d ever be. The family went on a theme park vacation to Florida last month and have ditched masks. Infurna and his wife work in health-related fields.

“We don’t think [COVID] is fake. We don’t think it’s not serious,” Infurna said. “But having been vaccinated, and having had it, at a point there’s only so much we can do. We don’t want to restrict life and not have moments you can never get back.”

This story has been updated to reflect new data from the CDC as of May 6.