The Checkup With Dr. Wen: What a 'new normal' can look like

The vaccinated have done their part. They should be able to return to their pre-pandemic lives. ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌  ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

Sign up for this newsletter Read online Guidance on navigating the pandemic and other public health challenges       By Leana S. Wen Opinions columnist  Email Last week, I attended a large in-person conference. It was the first time in two years that I was maskless around hundreds of people. The experience gave me perspective into what a new normal can look like. Organizers followed my "two out of three" rule — that is, when coronavirus rates are high, large gatherings should have two out of three precautions: vaccines, testing or masking. In this case, vaccines were required along with mandatory on-site rapid testing. Masking, therefore, became optional. A few attendees continued to mask during sessions. The vast majority did not. I myself took a calculated risk and chose not to mask while attending presentations. I ate lunch with the other attendees and participated in an indoor dinner banquet. But every time I was outside the conference "bubble," I donned my KN95 mask, including in hotel hallways and elevators. I stayed away from bars and other settings where I'd be in contact with people of unknown vaccination and testing status. Of course, I remained extremely vigilant during travel and masked the entire time at the airport and on my flights. I took these extra precautions because I wanted to decrease the chance of contracting the coronavirus and then transmitting it to my children, who are still too young to be vaccinated. If I were medically vulnerable myself, I would have gone further by wearing a mask during all sessions and avoiding indoor meals. Following "three out of three" precautions is what I'd recommend to individuals who prioritize avoiding covid-19 but still wish to attend large indoor gatherings. ADVERTISEMENT   I was comfortable enough with the reduced risk from two out of three precautions. Yes, vaccinated people can still carry the virus, and rapid tests can still miss some positive cases, but the combined protection of vaccination and testing was enough for me to forgo masking. When I returned home, I did not quarantine from my kids. Other people may be more relaxed if everyone in their household is vaccinated and boosted. For them, "one out of three" might be sufficient, and they could forgo testing before gathering indoors with their vaccinated friends. Some might go further and decide that as long as they are vaccinated and boosted themselves, they can resume dining inside restaurants. They may have no qualms about going unmasked in public spaces even if others around them are unvaccinated. I'm not there myself, but I fully support those who are. The vaccinated have done their part. They should be allowed — and encouraged — to venture back to their pre-pandemic lives, with the choice to take precautions that fit their individual circumstances.   My latest column Parents of little kids might be disappointed, but the FDA was right to delay vaccine authorization Opinion ●  By Leana S. Wen ●  Read more »   ADVERTISEMENT     Ask Dr. Wen Submit your question and I may answer it in a future edition of this newsletter.  Not subscribed yet? Questions to Dr. Wen from Washington Post subscribers are prioritized. Subscribe   "I'm immunocompromised due to medications for my rheumatoid arthritis and have had four doses of Moderna. I still plan to mask indoors in stores and avoid restaurants. How risky is it for me to be with my grandchildren who are in day care? They are not vaccinated yet. Their parents are all vaccinated and boosted." — Elizabeth from Virginia Is it practical for your grandchildren to be tested before seeing you? If so, that substantially reduces their risk to you.  If not, consider your grandchildren's exposures. Are they of the age that they can reliably wear masks during day care? Do their parents limit their risk in other ways by, for example, not having indoor, maskless playdates and avoiding indoor restaurants? Without testing, visiting with them outdoors is still the safest option, but you might also decide that because the grandkids are taking additional precautions, you could see them indoors, too. One additional consideration is the availability of antiviral treatments. If you have easy access to molnupiravir or paxlovid (the two pills authorized thus far to treat covid-19) or to monoclonal antibodies, that could also change your risk calculus. These treatments substantially reduce your risk of severe disease if you were to contract covid-19. "Is it safe to meet with a friend who is unvaccinated? I plan to stay outside. Also, when do you think it will be safe to visit indoors with unvaccinated friends?" — Adrienne from New York The risk of covid-19 transmission outdoors is very low, and I think it would be pretty safe to meet your unvaccinated friend outside for a walk or a picnic. If you want to meet indoors, you could ask that your friend to be tested just before getting together. Vaccination, testing and masking are all layers of protection. Without one, another can take its place. "I am a board member of a community chorus of about 50 people. We require singers to be vaccinated and boosted, and we're currently rehearsing while wearing KF94 masks. What local conditions would signal that we could make masks voluntary? I estimate the average age of the group is above 60 years." — Raymond from Florida The Centers for Disease Control and Prevention recommends masks in areas of substantial or high transmission, defined as more than 50 new cases per 100,000 persons in the last seven days. Much of the United States falls into this category. Singing is a relatively higher risk activity, especially if done indoors, in close proximity to one another, without masks. Above 50 cases, I think you should consider the "two out of three" rule. All your singers are already vaccinated and boosted. If you want to go maskless, the safest option is to have everyone test before singing. Another option, as you suggest, is to make masks optional. Masking with a high-quality mask like KF94s protect the wearer well regardless of what others are wearing (though there is even better protection if everyone is masking). Consider having a discussion with members of your choir. How strongly do they feel about continuing to mask? Will some refuse to participate if others around them no longer mask, or is everyone fine with the potential risk? If the entire choir thinks one-way masking is a reasonable compromise, you might consider optional masking even if community transmission has not fallen below the CDC threshold, though the safer option is to wait just a bit longer for rates to fall further. The Post has also compiled Q&As from my previous newsletters. You can read them here.   What I'm reading A fascinating JAMA Pediatrics study looked at covid-19 hospitalization rates for children and compared them to influenza in winter of 2020 and early 2021 (before coronavirus vaccines were available for kids). Included in the covid-19 numbers are children with the rare but serious condition known as multisystem inflammatory syndrome in children (MIS-C). Interestingly, children were hospitalized for around the same number of days for covid-19 and MIS-C combined as for influenza. The hospitalization rate was actually lower for covid-19 and MIS-C as compared to the flu (10.8 per 100,000 children vs 17.0 per 100,000 children).  Another JAMA paper raises the alarm for pregnant women. The study, which was funded by the National Institutes of Health and tracked 2,400 expectant mothers with covid-19, found that pregnant patients with at least moderate coronavirus symptoms were at elevated risk of delivering preterm, requiring a Cesarean section, experiencing postpartum hemorrhage and suffering a miscarriage. These findings further highlight the necessity of vaccination for pregnant individuals and women looking to become pregnant. The Pew Charitable Trusts published an issue brief for state policymakers on improving addiction treatment. This comes as drug overdose deaths reach new heights, with more than 100,000 deaths in the 12-month period ending in June 2021. The brief includes tangible steps that do not need federal action, including integration of mental health and addiction care, and allowing mobile dispensing of methadone and other medication-assisted treatment.   More from The Post Boris Johnson lays out 'living with covid' plan, while Queen Elizabeth II remains in isolation By William Booth and Karla Adam ●  Read more »   In a reopening world, travel is enticing and terrifying all at once By Emily Fagan ●  Read more »   Hong Kong's 'zero covid' days are over. But where's the exit plan? Opinion ●  By Keith B. Richburg ●  Read more »   Overwhelmed by chaos and uncertainty, families with kids under 5 are on a vaccine roller coaster By Lindsey Bever and Frances Stead Sellers ●  Read more »   How Paul Farmer helped save the lives of millions of people Opinion ●  By John Green ●  Read more »   How many people died believing vaccine misinformation? Opinion ●  By the Editorial Board ●  Read more »     We think you'll like this newsletter Check out Must Reads for a curated selection of our best journalism in your inbox every Saturday, plus a peek behind the scenes into how one story came together. Sign up »

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