Pastor Robert Pope has been talking about COVID-19 since the virus first took hold. He talks about it at the gas station, at restaurants, and – most frequently – at his church.
Pope has made Encanto Southern Baptist Church in San Diego a hub for pandemic education, testing and vaccination. He’s been following the statistics, he said. The church shut down, then reopened with masks, temperature checks, and social distancing as the congregation got vaccinated.
Though the church never experienced many coronavirus cases, several members are living with COVID’s long-term effects. For some, the chest pain lingers. For others, it’s hard to catch their breath.
As the number of cases has declined following the omicron surge, Pope sees his community feeling safer. They’re loosening up a bit too much, he said: “They’re getting way ahead of the stats.”
California recently stopped requiring masks indoors, including in schools and child care centers, as the state moves to an “endemic” approach to managing the virus. That approach is rooted in the idea that, while the virus is still present, caseloads are at a level that medical institutions can handle. It’s a shift from the crisis state of the pandemic, when hospitals were overwhelmed and testing was limited.
The Centers for Disease Control and Prevention updated its masking guidelines in February, allowing most Americans to go maskless indoors. In turn, many states have made adjustments like California’s. Hawaii, Oregon and Washington are among the last states to require most residents to wear masks in indoor public settings. In most other states, mask mandates have expired or been lifted. States like Florida, South Carolina and Oklahoma never implemented similar mandates.
Some places, such as Chicago, have continued to mandate masks in schools. The White House and Congress have also dropped their mask mandates for those vaccinated.
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Though the number of cases driven by the winter omicron surge is dwindling, the crisis for Black Americans remains. New research shows that Black Californians make up an even larger share of the fatalities than early in the pandemic. And recent polling indicates that many Black Americans are concerned about COVID-19’s impact.
“We still have about 2,000 people dying every day,” said Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center. “That’s not normal. That’s someone’s mother, father, child.”
In California, as vaccines rolled out in the spring of 2021, the total number of deaths declined, but for Black Californians, the decline was much slower. Vaccine disparities don’t explain the gap, said Alicia Riley, an assistant professor at the University of California Santa Cruz and one of the study’s lead researchers. Black and Latino residents were getting vaccinated at similar rates, and while the equity gap narrowed for Latino Californians, it worsened for Black residents.
This trend, which was tracked using data from just before the delta surge, might mirror where we are now, said Riley: Everyone felt like the pandemic might be over. Masks were thrown out. People were planning vacations.
“It’s a warning,” she said. “This is exactly the moment to not let our guard down. We know from this study who’s going to be left behind.”
Health fears linger
In a January survey by Yahoo News, half of white respondents indicated that we need to learn to live with the virus and return to normal, compared to only 30% of Black respondents. Black respondents were also more likely to describe COVID-19 as more of a health concern as opposed to an inconvenience.
More than 40% of white respondents said the worst of the pandemic was already over. Less than a quarter of Black respondents indicated the same.
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Pastor Pope said he’s hearing more varied opinions within his community about this phase of the pandemic and how to proceed.
“We don’t agree on everything,” he said. “Some are more cautious. Some are less cautious. Some are for masks. Some are for vaccinations.”
He understands that people are ready to get back to life as it was before the virus swept through the community and he said he sees them removing masks.
Medical experts say centering the needs of the most vulnerable gives everyone more protection from severe complications from the coronavirus. But “it feels like we are not centering those populations,” said Dr. Oni Blackstock, founder and executive director of Health Justice, a consultancy that focuses on reducing health inequities. She noted that children under 5 still are not eligible to get vaccinated and those with underlying conditions remain vulnerable.
While the omicron wave may have resulted in less severe infection among adults, some children’s hospitals saw the highest hospitalization rates yet, said Dr. Rebekah Fenton, a Chicago-based pediatrician. And across the nation, Black children faced a hospitalization rate twice that of white children. Death rates were three times as high.
“The challenge is that vaccination levels for young people, even those who are eligible above 5, is still quite low compared to adults,” said Fenton. “Children are not as protected as we’d hope for them to be at this point.”
Endemic? ‘Not right now’
Despite the inequities in COVID-19 deaths, California Gov. Gavin Newsom recently said the pandemic’s crisis phase was now over.
“This pandemic won’t have a defined end. There’s no finish line,” Newsom said during his announcement that the state would move toward an endemic approach to managing the coronavirus. “There is no end date.”
California became the first state to outline an endemic plan, called the SMARTER plan, which stands for shots, masks, awareness, readiness, testing, education and Rx. The plan is a milestone toward returning to a sense of normality after two years of protection measures. It outlines intentions to keep a steady supply of masks, increase testing and vaccination, and to respond to future surges with more medical staff.
The term “endemic” suggests the virus is spreading in a more predictable pattern, which experts say we have not reached yet. An outbreak is endemic when it’s “consistently present but limited to a particular region,” like Malaria, according to Columbia University.
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Looking at recent COVID-19 graphs tracking infection and death rates, “what you see is a repeated pattern,” said Dr. Kim Rhoads, an associate professor at the University of California San Francisco. The numbers skyrocket, come back down, stay down and shoot back up. “What it looks like is a bunch of spikes.”
With mask and quarantine guidelines constantly shifting despite high case and death rates, “it’s confusing for the community,” she said. “That’s damaging.”
Rhoads has been in the community organizing campaigns around COVID-19 education, vaccination, and testing for two years, including hosting weekly meetings where residents can ask questions and get answers. The recent wave of removing protections is inconsistent with the dialogues happening within the community, she said.
At some point, we’ll reach the endemic phase, said Rhoads, “but not right now.”
Doctors are now advising their patients to protect their families based on their specific risk. Getting vaccinated, boosted, and wearing masks in high transmission indoor settings is always the recommendation, said Dr. Stella Safo, a New York City-based primary care physician.
“What I’m telling my Black patients is to prepare yourself and be as safe as you can,” said Safo. As the virus continues to change, she remains concerned about the unknowns.
“We don’t know what we don’t know about COVID,” said Safo. “COVID keeps changing.”