Do they mask? Are they eating out? How covid experts like Dr. Ashish Jha are living now

Former White House covid-19 response coordinator Ashish Jha has told his elderly parents to get a coronavirus booster, flu shot and RSV vaccine by Halloween. MUST CREDIT: Washington Post photo by Demetrius Freeman

In the past year, many Americans have stopped thinking about covid-19, ditched their masks, skipped the latest coronavirus boosters and returned to living more normal lives. While cases of covid-related severe illness and hospitalization remain low, infection counts are spiking again, new variants are emerging, and flu and respiratory syncytial virus (RSV) loom as winter approaches.

There’s a lot of news about the coronavirus and other respiratory viruses these days, some of it confusing. A new coronavirus variant – BA.2.86 – is attracting the attention of infectious-disease specialists. But on the good news front, a key federal panel is meeting Sept. 12 to discuss the latest coronavirus booster, which should target the XBB variants of the virus; officials expect the booster to become available by the end of the month. A new flu shot and new vaccines to protect against RSV are already out.

Vaccination and awareness of virus transmission nationally and locally are important elements of the U.S. disease prevention “tool kit,” said Demetre Daskalakis, the acting director of the National Center for Immunization and Respiratory Diseases. “Pay attention to the [Centers for Disease Control and Prevention] website … pay close tabs to what’s happening in the local health department [and] keep an eye on what they’re saying,” he advised. Also “if you do get the infection, whether it’s covid or flu, there are some treatments that you might qualify for.”

The Washington Post has interviewed numerous medical experts several times over the past three years to learn what precautions they were taking as the coronavirus circulated. With so much news swirling about, we’ve done this once again, and here’s what they have to say. Responses have been edited for space and clarity.

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Q: What worries you as we head into the fall and winter months?

-William Schaffner, professor of preventive medicine in health policy and professor of medicine in the division of infectious diseases at Vanderbilt University Medical Center:

I am most concerned that a large proportion of the public will not take advantage of the new monovalent [coronavirus] booster that will become available in mid-September. That could lead to a substantial number of preventable hospitalizations and deaths.

-Elizabeth Connick, chief of the infectious diseases division and professor of medicine and immunobiology at the University of Arizona:

After the last three years, I have used up my “worrying” capacity. It has been depleted. We know that respiratory viral infections will be increasing, and the major question is, “How bad will it be this year?”

-Joanna Dolgoff, a pediatrician with Wellstar Health System in Marrietta, Ga., and spokesperson for American Academy of Pediatrics:

I am worried about the return of the “tripledemic,” meaning covid, flu and RSV. Each virus can cause significant disease. The effects only multiply when infection with more than one occurs. Most people are now so relaxed about the viruses that they are no longer taking the simple precautions necessary to keep these diseases at bay.

-Ashish Jha, dean of the Brown University School of Public Health and former White House covid 19-response coordinator:

I’ve been worried that the anti-vaccine sentiment directed toward covid will rub off against the flu. I look at this winter and think we’re going to have three effective vaccines that can prevent a large chunk of deaths of older and vulnerable people. I worry that we’re going to substantially underuse them, and it means tens of thousands of people will die unnecessarily.

-Anthony S. Fauci, university professor, Georgetown University School of Medicine and McCourt School of Public Policy, and former director of the National Institute of Allergy and Infectious Diseases:

I am not worried, I am just preparing for the possibility that we might have [a] surge of cases as we enter the fall and winter. We are already seeing an uptick in cases. Hopefully, the degree of background immunity in the population will prevent a significant increase in hospitalizations and deaths.

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Q: Are you going to rush out to get the newest coronavirus booster as soon as it lands, or is it wiser to wait till the weather turns colder? Will you get a flu vaccine at the same time? What about the RSV vaccine?

-Dean Blumberg, chief of pediatric infectious diseases at the UC Davis Children’s Hospital:

I would like the updated booster as soon as it is available. I’m planning on [getting the] influenza vaccine in October but will be monitoring influenza activity and will get vaccinated sooner if it turns out to be an early flu season.

-Jha: We have a crazy situation with different viruses – RSV, covid and flu – peaking at different times. I told my elderly parents to get all three shots and just get it all done before Halloween. I have tended to recommend to my family to get the flu shot in October to give you better protection when the flu peaks in late January and February.

-Robert T. Schooley, professor of medicine in the division of infectious diseases and global public health and co-director of the Center for Innovative Phage Applications and Therapeutics at the University of California at San Diego:

Yes, I’m going to get the newest covid booster when it becomes available. I received my flu and RSV vaccines yesterday [Aug. 30].

-Demetre Daskalakis, acting director of the National Center for Immunization and Respiratory Diseases within the CDC:

I’m ready to line up as soon as [the booster is] available. [Daskalakis said he plans to get the coronavirus booster and flu shot at the same time.]

-Katie Lockwood, a pediatrician with the Children’s Hospital of Philadelphia and associate professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania:

Getting your covid booster and flu shot early in the fall is a good idea because although we often see viruses surge in late fall and winter, we never know exactly when that will happen, so being protected early is recommended and immunity will last through the season.

-Schaffner: I definitely plan to receive all three vaccines – influenza, covid and RSV during October.

-Monica Gandhi, professor of medicine at the University of California at San Francisco (UCSF) School of Medicine:

I am still in my 50s so I do not qualify for the RSV vaccine, which has been approved for those 60 and older and pregnant women. However, I plan to get the influenza shot, which seems well matched to the circulating strains this season. I will encourage my parents, 88 and 82, to get the new XBB1.5 directed vaccine. However, since they contracted covid in July, I will ask them to wait 4 to 6 months.

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Q: Are you starting to do anything differently to protect against the coronavirus and other viruses? Are you going to avoid anything in particular?

-Donna Tyungu, associate professor and chief of pediatric infectious diseases at the Oklahoma Children’s Hospital, OUHealth in Oklahoma City:

I am closely watching viral numbers within our hospital system (which have more than doubled what they were in July). I pay attention to the CDC website for national case and hospitalization statistics, and I also monitor wastewater cases.

As cases have gone up, my family has started to avoid large crowds a bit more than we were last month but are generally living life normally so far. I carry hand sanitizer with me, and I do plan on wearing a mask whenever I travel or find myself in crowded areas.

-Schooley: I’ll be monitoring viral activity over the course of the winter. In the case of covid-19, I’ll rely mainly on wastewater data since case counts will not be as accurate going forward as they have been in the past.

With cases that are more often mild and confused as “colds,” fewer people are being tested and, those that are, are more often using antigen tests but not reporting positive tests to local health departments. The CDC Fluview platform is an excellent source for influenza information. When either or both viruses show spikes in activity, I’ll avoid poorly ventilated indoor locations and be more likely to mask when with others indoors.

-Connick: As cases rise, I will likely become more circumspect in my behavior. In general, I avoid large group events where I don’t know anyone, particularly if a lot of children or young people are present.

-Peter Hotez, dean of Baylor College of Medicine’s National School of Tropical Medicine, professor in the departments of pediatrics, molecular virology and microbiology, and co-director of the Texas Children’s Hospital Center for Vaccine Development:

I will get my XBB covid booster as soon as it is available, which will probably be in the last half of September. In the meantime, I have already gotten my RSV vaccine. I wanted to avoid getting the RSV vaccine at the same time as influenza vaccine. … Also, keep in mind [getting] your pneumococcal vaccine (Prevnar) as well, also Shingrix (for shingles) and TDAP, so there is a new wave of adult immunizations to consider.

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Q: Will you eat (or continue to eat) inside restaurants as the weather gets colder and if covid continues to spike? Will you go to the movies, concerts, other big indoor events? Will you mask up when you do so? Have you been masking all along? What about church and singing there? Is that a big risk? How do you mitigate it? Indoor sports events?

-Schaffner: My wife and I, along with friends, will continue to go to an occasional restaurant. Doing so, we’re mindful of seating separate from others and the server must have been vaccinated against covid. We [Schaffner is 86, his wife is 83] have avoided large indoor events and we continue to use our masks. Sit far back [in houses of worship] and wear a mask. We have avoided such [indoor sports] events.

-Tyungu: Most likely we will continue dining out. We will avoid crowded venues. If hospitalizations become a major issue again, we will likely cook at home for a while. … I actually have some travel and events planned over the next few months. Based on the transmission in the area I will likely wear a well-fitted mask to avoid illness.

-Connick: I will eat in restaurants but try and select ones that are “airy.” I will not go to movies or concerts. It is not worth the risk. I will probably avoid large crowds.

-Dolgoff: At this time, I will continue to eat in restaurants as long as they are well ventilated and not overly crowded. If somebody near me shows signs of illness, I will be prepared to leave immediately. If covid cases continue to spike and if illness becomes more severe, I will stop eating inside restaurants until cases subside. I believe we need to see the effects of the new variants before we can make hard-and-fast rules

-Blumberg: I am continuing with usual activities, including traveling. I’m a big believer in masking, so I’m comfortable at indoor or outdoor crowded events while I’m masked. I usually use a regular surgical mask for crowded outdoor events, but upgrade to N95 or KN95 if close to people indoors or on a plane.

-Natascha Tuznik, associate clinical professor in the department of internal medicine at UC Davis Health:

If covid continues to spike, then I will likely avoid unnecessary indoor environments. I have been masking up in health-care settings regularly since covid cases have gone up, both for my own protection and the patients. With our current covid trends and flu and RSV entering the picture, I foresee myself continuing this practice in the health-care setting, and, depending upon viral trends, when I am out in busier indoor settings, such as grocery stores.

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Q: What pandemic protocols were you still following as of this summer? Did you mask in certain situations, for instance? Were you eating indoors at restaurants?

-Blumberg: I stopped masking this summer, it felt weird sometimes to be maskless. But with covid rates increasing, I’m thinking of going back to masking while indoors at stores and other venues. I’ve maintained masking on planes – it’s so crowded and people close by are sniffing and coughing, I’m not comfortable without a mask on flights.

-Fauci: Since the level of SARS-CoV-2 virus was low in the community this summer, I did not mask, and I have eaten indoors on occasion. However, I preferred eating outdoors when possible. This could change if cases markedly increase for the remainder of the summer.

-Lockwood: Over the summer, I felt comfortable resuming normal pre-pandemic activities, including indoor activities without masks, due to lower rates of covid and my being vaccinated and boosted. However, I think the pandemic has forever changed how I feel about hand hygiene – I’m sanitizing quite often when out – and has made me more aware of the risk of going out with mild cold/allergy symptoms.

I’m testing myself often to make sure others are safe around me. I sneezed in the car today and my children both screamed at me “do you have covid?!” So I think we are all more aware of the potential risks around us, even when we overall feel safe.

-Tuznik: Ever since the pandemic I try to eat outdoors as much as possible and avoid going to movies on opening night. In general, I stopped masking, except in the hospital, but have been more cognizant of it this past month.

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Q: What are you telling friends and family about protecting themselves?

-Schaffner: Those who are at increased risk of severe disease should use masks in crowded indoor events. One of our extended family members is receiving cancer chemotherapy, so, if you wish to visit, you must test negative.

-Hotez: The single most impactful thing you can do is to keep up with your covid boosters and get your XBB covid booster as soon as you can; also other vaccines that you are eligible for.

-Lockwood: There is so much that we can’t control about the upcoming viral season that I tell my friends and family to do what they can about the factors we can control: wash your hands, stay home when sick, and get vaccinated for flu, and covid boosted if needed. If you have some sniffles or a mild cough, do not assume it is nothing and make sure you test yourself for covid or stay home.

-Connick: Get vaccinated.

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Q: For those with school-age children or grandchildren/also for pediatricians: Are you advising any special precautions for them (or for your patients)?

-Tyungu: Within two weeks of my niece starting classes, she came home with a respiratory infection. My son will start preschool next week; I anticipate the same fate for him. These infections are expected when attending school, but there are some things we can do to mitigate risk. These include providing age-appropriate vaccinations, teaching children how to wash their hands and avoid touching their faces, explaining the importance of not sharing drinks or eating utensils with friends.

Other simple tools families can use are sleep and food. Assuring adequate sleep and providing nutritious meals will promote healthy immune systems.

-Jha: We should keep people home when they’re sick and help them get better. We don’t need to be spreading these viruses unnecessarily. Making sure everyone is up-to-date on vaccines will slow things down, and that includes kids. Good hand hygiene can help a lot for flu and other respiratory viruses.

-Lockwood: So many of my young patients tell me that they chew on their pencils or bite their fingernails when I see them for sick visits shortly after school starts, and my advice is always that they need to wash their hands more often and keep nonfood items out of their mouths.

Lots of germs are shared at school, so it is important to keep your children home when they are sick. Last year’s early RSV surge showed many parents what pediatricians know about RSV: It can be very dangerous for young infants.

I hope that parents offer their infants protection with nirsevimab [a monoclonal antibody for infants that works much like a vaccine], so that our youngest and most vulnerable patients can have a healthier fall and winter this year.

Grandparents should make sure they are up-to-date with their vaccinations, including Tdap, flu, covid and Pneumovax, as many of them are caregivers for young children who can become seriously ill from these vaccine-preventable diseases.

-Connick: Obtain appropriate age-related vaccines. It is impossible if you live with children to avoid getting covid.

-Dolgoff: Very young children are often unable to wear masks. It is more important to keep them out of risky situations, such as large, indoor group gatherings.

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