Back in March of 2020, not many of us thought we'd still be thinking about COVID-19 in 2023. But here we are. And while the virus has evolved since the pandemic began, so has the landscape of tests, treatments and vaccines.
"It's been a long three years, but we're certainly in a different position now," Dr. Scott Roberts, infectious disease expert and assistant professor at the Yale School of Medicine, tells TODAY.com. And with how much has changed, he says, he "feels more optimistic now" than at pretty much any other time during the pandemic.
So, considering how much has changed and that the virus is still with us, how worried should we be about COVID-19 right now? And what is the appropriate amount of precautions to take in 2023?
How much of a threat is COVID now?
"I feel like everything has changed since the beginning," Dr. Megan Ranney, emergency medicine physician, deputy dean of the Brown University School of Public Health and incoming dean of the Yale School of Public Health, tells TODAY.com.
Three years ago, we knew so much less about how the virus spreads, how to test for it and how to treat the infection, she says.
"The virus is clearly not as deadly as it was in the earlier days of the pandemic," Dr. Taison Bell, assistant professor of medicine in the divisions of infectious diseases and international health and pulmonary and critical care medicine at the University of Virginia, tells TODAY.com.
And that's largely due to the immunity people have acquired through vaccination and infections, he says. We've also come a long way in learning how to care for people with severe COVID-19.
This past winter, COVID-19 became yet another virus to worry about during the usual cold and flu season rather than the singular public health concern, Roberts explains.
"But it's still a big enough issue that lots of people are going to the hospital every day," Bell says. "There are a lot of people getting long COVID, and a new variant could change all this in close to an instant."
As much as things have evolved, it's important to recognize that COVID-19 can still cause illness, severe complications, long-term health consequences (such as blood clots and long COVID) and death.
"We know some people can have long COVID for vast amounts of time, which can lead to pretty devastating complications," Roberts says. "We also know that even mild disease could lead to long COVID."
All of that reinforces the need to keep up with appropriate COVID-19 precautions and to resist "accepting the inevitability of catching COVID," Roberts says.
How much should I worry about COVID?
Many of the same rules and risk factors from earlier in the pandemic still apply, Ranney says. The experts shared these factors to consider when thinking about your own COVID risk:
You’re more likely to catch COVID-19 in crowded, indoor spaces surrounded by strangers than you are in a small, outdoor gathering with people you know are vaccinated. You're also more likely to be infected when COVID-19 rates in your local area are higher than when they're lower.
The precautions you take against COVID
Getting vaccinated and boosted, wearing a high-quality mask and asking people to test for COVID-19 before a gathering can help protect you from catching the virus and from developing severe symptoms if you do get sick.
Your individual health risks
Older adults and people with certain underlying conditions are still at a higher risk for developing severe COVID-19 complications and may want to consider taking more precautions — and doing so more frequently — than others.
“There is a subset of the population (for whom) the pandemic may never end, and that includes some of the immunocompromised or those at risk for severe disease,” Roberts says.
How much time you spend with high-risk people
If you live with, care for or frequently interact with people who fall into those categories, you may also want to be more cautious.
But, Roberts adds, “it’s not a binary bucket where you’re either high risk or you’re not. There are degrees of risk.”
For fully vaccinated and boosted people without underlying risk factors, “the day-to-day risk from catching COVID is much, much lower,” Ranney says. And these people may have shifted the way they make decisions about COVID, thanks to improvements in vaccines, testing and treatment, as well as the evolution of the virus itself, she adds.
However, there are still reasons to avoid it: “Of course, we could still catch it and spread it to someone close to us who is vulnerable,” Ranney stresses.
Concern about long COVID
Long COVID — or the "long-term effects" of a COVID infection that some people experience, as the Centers for Disease Control and Prevention define it — includes a variety of symptoms that range from annoying to debilitating or deadly. These symptoms, such as brain fog, fatigue, breathing problems, chest pain, headaches, dizziness, joint and muscle pain, can last weeks, months or years.
The individual risk of getting long COVID is between 5% and 10%, NBC News recently reported.
But this possibility “alone is a reason why I would like to avoid getting COVID again,” Bell says.
There's also the pragmatic element to keep in mind: "If there's an event coming up that I wouldn't want to miss, then I do tend to mask more commonly," Bell explains. Doing so reduces the chances that he'll get sick and have to cancel plans, and it also curbs the risk that he might spread the virus to people while traveling, he says.
"It's about situational awareness, knowing and balancing the risks and benefits and thinking about what would happen if you were to get COVID," Bell explains.
Wherever you are on that spectrum, these precautions can still help lower your risk:
"One of the best things that we have to mitigate the risks (of severe COVID-19 complications) are vaccines and boosters," Ranney explains. "Even with the variants, even with the fact that many of us have been infected, the vaccines and boosters have continued to significantly reduce the risk of hospitalization and death, even among those highest risk groups."
If you haven't gotten vaccinated or boosted, it's not too late.
In higher-risk situations, Roberts still recommends masking when you can. For instance, he suggests wearing a mask on public transportation, "but if I'm in a car with my friends, I probably won't," he says.
"My guidance to people continues to be: If you are higher-risk and you really don't want to get infected, that mask becomes your best friend in those indoor, poorly ventilated conditions," Ranney says.
The availability of at-home rapid COVID-19 testing has made it easy to take that extra step in keeping yourself and those around you safe. For instance, Bell says his family still tests "aggressively" at home if someone comes down with cold- or flu-like symptoms.
Some COVID-19 treatments (particularly monoclonal antibodies) have been rendered useless by the emergence of new variants.
"The antibodies are toast. They've been so for a while," Bell says. "They're a single antibody that depends on one specific interaction at one specific site. It just takes one (viral) mutation or a couple of mutations to completely lose efficacy," he explains.
The preventive treatment Evusheld, which had previously been useful for very high-risk people, has also been taken out of the rotation for the same reason, Ranney says. "It's been frustrating for those folks who are higher risk because what's available to them keeps shrinking as the virus evolves."
But antiviral medications like Paxlovid have proven to be significantly helpful — if patients can access the medications early in their infection.
That's why it's a good idea to have a conversation with your doctor about what treatment options would be right for you before you actually get COVID-19, experts told TODAY.com previously. That way, if you do get sick, they can implement the plan and get you that medication ASAP.
The future of COVID and other pandemics
The rapid development of vaccines and at-home tests "showed what's possible when we put our minds and our finances to it," Ranney says. "That really deserves celebration, but it also deserves extension beyond COVID to other diseases."
And the quick response to last summer's mpox outbreak became another great example of that — as well as the power of effective messaging from within an affected community, she adds.
But the way our response to COVID-19 became politicized and since stalled has some experts worried about our ability to tackle the next inevitable threat.
If another pathogen emerged, what would we do? “I think it’s going to be immensely difficult to go back to mask mandates and (the other measures we took) at the beginning of COVID,” Roberts says. “I think society has changed a lot since then.”
All the experts TODAY.com spoke to say they hope we see a renewed investment in preserving our ability to effectively respond to threats like COVID before we hit its four-year milestone. That's particularly salient as the end of the COVID-19 federal public health emergency looms in May. It's poised to reduce coverage for testing, vaccination and data collection that health care systems and the public grew to rely on.
"Having that infrastructure in place is very important because there are going to be other threats," Bell says. "They may be viruses or they may be other infectious agents, but we know they're going to happen."