Call it COVID 4.0. We are soon heading into our fourth fall — aka the season for flu and other respiratory viruses — with COVID-19 still lurking among us. But this time, for the first time, there is no federal or state public health emergency to dictate which services must be widely available or rules to be followed. Those largely ended in May. That means there is no official mandate for masking in health care settings or public transportation, and no more free rapid tests by mail or widespread testing sites.
With waste water surveillance showing signs of COVID creeping up, yet again, we asked several infectious disease experts their advice for riding the COVID-19 waves ahead.
Are there any COVID testing sites still operating in Massachusetts?
All of the free “Stop the Spread” testing sites in Massachusetts have closed, and the federal government is no longer providing free at-home tests. But the Boston Public Health Commission just announced that a number of sites across the city, including the Bruce C. Bolling Building in Roxbury and City Hall, will provide free at-home test kits. In general, however, access to testing is now similar to that for other infectious diseases when ordered by a doctor and is usually covered by insurance, according to the state’s health department. From the state’s website you can link to the Centers for Disease Control and Prevention testing locator site, which shows CVS, Walgreens, Quest, and other locations that conduct tests within 5 miles of where you live. If you have a flexible spending account or a health savings account, you can use that money to purchase at-home testing kits.
How accurate are the expiration dates on my pile of at-home COVID tests?
Don’t toss out your tests without checking the government’s site for updated expiration dates. Many of the FDA-authorized at-home COVID tests are actually effective for up to a year past the date stamped on the carton.
Do you still need a mask?
Infectious disease experts say the answer depends on several critical points: your own general health, the health of those you live with, how crowded your surroundings are, and the amount of infections in your region. If you’re in good health, and don’t live with someone who has a weakened immune system, then masking in most places that aren’t super crowded probably is not needed, especially if local waste water data is showing relatively low levels of infections, as it is now. Dr. Syra Madad, special pathogens epidemiologist at Harvard University’s Belfer Center, said she always has a mask in her pocket and still wears one if she’s in a crowded subway system.
“Don’t think of it as a tool of the past,” she says. “Think of it as a tool for now, much like an umbrella.”
Dr. Leonard Mermel, medical director of epidemiology and infection control at Rhode Island’s Lifespan, put it this way: “If there’s a significant uptick in your community and you are riding a train for a half hour or hour, then why not mask?”
Should I get the current bivalent booster or hold out for the new one coming sometime this fall?
Once again, infectious disease experts say it depends. Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, advises people to hold out, if they can, for the new booster shot expected later in September or early October. The new shot was developed on a past variant that is similar to EG.5, the Omicron relative that is most prevalent now in the United States, and is likely to offer better protection than the current shot, he said. The current vaccine, known as a bivalent booster, was crafted from the original coronavirus strain and an earlier Omicron variant that is not nearly as similar to the one now gaining ground.
“It’s a constant race against this virus and typically we are a day late and a dollar short,” Osterholm said.
But Dr. Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health, said if waste water data is showing infections going up in your area, and especially if you are considered high risk for complications from a COVID infection, she would advise someone who is at least six months past their last booster to get one now.
“That’s a tricky dance because we don’t know when the new shots are going to come available,” Nuzzo said. “I tend to be more, a bird-in-the-hand approach. The best time to get a vaccine is before you get infected.”
Should you quarantine if someone in your household tests positive for COVID?
The CDC’s Isolation and Exposure Calculator can walk you through the steps you should take if you, or someone in your home, is exposed or infected. Generally speaking, the CDC does not advise people who might have been exposed to an infected person to quarantine. Instead, the agency says you should wear a high-quality mask inside your home when around others or when indoors in public places. Five full days after being exposed to someone who is infected, you should take a COVID test — even if you haven’t developed symptoms, the CDC says. You can still develop COVID up to 10 days after you have been exposed, so you should continue masking through the 10th day.
Is long COVID still a threat?
In a word, yes, say infectious disease experts. But there is still a lot of uncertainty about the mystifying syndrome, which is a constellation of symptoms that persist for months, and sometimes years, after a COVID infection.
“There’s a clear indication that COVID vaccination ... will reduce the likelihood of getting long COVID,” Osterholm said.
The percentage of all adults reporting long COVID has declined in the past year, according to a report last week from the CDC. It dropped from 7.5 percent in June of last year, to 6 percent this past June. Among adults with previous COVID-19 infections, approximately 1 in 10 were experiencing long COVID, and, of those, one in four said the condition significantly impacted their activities.