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Are masks for the birds? We field reader queries about this new stage of the pandemic

A gull picks up a discarded protective face mask from the shoreline in the marina on August 11, 2020 in Dover, England.
Leon Neal
Getty Images
A gull picks up a discarded protective face mask from the shoreline in the marina on August 11, 2020 in Dover, England.

How many COVID tests should I keep on hand? Can I toss my masks? Should I still be afraid of long COVID?

These are a few of the questions you sent us when we asked what's on your mind in this new stage of the pandemic. Last month, the World Health Organization and the Centers for Disease Control and Prevention declared that the state of emergency is over even if the virus is still circulating.

The questions you sent revolve around prevention and treatment. We posed a few of them to COVID specialists we have turned to throughout these past 3 years.

One thing to note: While in previous FAQs on the pandemic, there was often consensus about the best ways to keep safe, we're now in a period when different experts sometimes have different opinions. And with mandates largely lifted, the responsibility rests more than ever onthe individual to figure out how much risk they can tolerate and what measures make the most sense for them.

How many rapid tests should I have at home ... just in case?

In many places, tests are easy to come by. But if you're exposed to someone you later learn is contagious or you start to show COVID-like symptoms, you don't want to scramble to find a nose swab. Some of the health experts we interviewed suggest having one test per person in a household – or possibly a couple if folks in your home are at high-risk for severe disease, says Charlotte Baker, director of epidemiology and health equity lead for Truveta, a data company that tracks electronic health records. She herself is immune-compromised.

The answer to "how many" is mainly about finding a strategy that puts your mind at ease, says Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security: "I think it depends how frequently a person anticipates testing. Some people never test, others test frequently." If there are shortages in your neighborhood, keep in mind the tests are also sold online – and that the Food and Drug Administration has extended the expiration dates of some COVID tests and has a list of affected brands.

I've heard all kinds of things about Paxlovid [the pill prescribed to people who contract COVID-19 and are deemed at higher risk of severe disease]. You should get a secret prescription if you're traveling. No, that's against the rules. Visitors to another country can't get it. What's the best advice for travelers?

The Pfizer drug has been approved for use not only in the U.S. but in many other countries. It's currently easy to get a prescription filled in the U.S., but there are reports of international travelers being unable to obtain Paxlovid if they catch COVID in another country. It might sound prudent for a high-risk American traveler to get a prescription filled in the U.S. ahead of time, but there's one problem: That's against the rules of the original FDA authorization for the drug, which says you need to show symptoms before a doctor will write an Rx.

Some doctors will make an exception. Dr. Amesh Adaljaof Hopkins says, "I've said for some time that it makes sense for high-risk people who are traveling to have [Paxlovid with them] just in case. The emergency use authorization precludes this type of usage. However, as a physician I would have no problem prescribing this to a patient in this manner, and I suspect other physicians are of the same mind."

An important reminder: Paxlovid can interact with other medications you take, so it's key to check with your doctor before beginning a regimen. If your health-care team nixes a preventive prescription, ask if they consider your travel to another country without the drug risky to your health — then decide if a trip abroad with COVID-19 still circulating is a good idea, suggests Dr. Gregory Poland, an infectious disease specialist at the Mayo Clinic.

Note: Although Paxlovid got full approval from the Food and Drug Administration on May 25, Michael Ganio, senior director of pharmacy practice and quality at the Asssociation of Health System Pharmacists, says the rules of the emergency authorization still apply since U.S. supply of the drug was purchased by the government before the approval and the government continues to oversee distribution of the drug.

You interviewed a doctor who says she doesn't mask in meetings or when traveling unless she feeling symptoms, even mild. But ... you can be asymptomatic and contagious, right? So, shouldn't you still just mask up?

Yes, it's true, you could be contagious and not know it. But right now, transmission rates are low in the U.S. and other countries, points out Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine. So that means the likelihood of catching COVID is low, she says – as is the likelihood of being asymptomatic and contagious.

But our interviewees all stress that if you're feeling sick, masking up is a way to be a good citizen — to protect others in case you are contagious with COVID or another virus.

"Please be nice and stay at home," advises Baker. "Hopefully [that's] a lesson we've taken away from this, says Weatherhead.

What about wearing a mask to protect yourself? Still advisable in certain settings?

Okay, let's back up a bit. At surge times during the pandemic, we were urged to layer on a lot of protective measures: vaccines, boosters, masks, avoiding crowds, handwashing ... and remember scrubbing down your mail and groceries back in the early days when we mistakenly thought catching the virus from touching contaminated stuff was a major risk?

When transmission in a community is at a low level, health experts say you can begin peeling off some of those layers.

Masks still have protective benefits, our interviewees stressed. When deciding whether or not to mask up, Dr. Preeti Malani says, "I personally think about air circulation and how close I am to people and for how long." She's an infectious disease specialist at Michigan Medicine. According to the CDC, your risk of infection increases the longer you're exposed to someone with COVID.

To sum up, Malani says about masking: "This is a personal decision of how much risk is acceptable. If rates of infection go up, the benefit of masking also increases. "Right now, for me personally, says Malani, "it feels acceptable to not mask, understanding that others feel differently."

Charlotte Baker of Truveta adds a couple of mask cautionary notes. If you're at risk of severe disease, you might opt for a mask in a crowded setting. Or for anyone in an airport or other transportation hub, she thinks a mask might be advisable – you don't know where all those passengers have been, she says. Aboard a plane, the improved air circulation systems put in place during the pandemic do offer a measure of protection. But if the passenger next to you is sneezy or coughing, you might consider masking up. That's why Baker suggests always having a mask along with you – perhaps dangling from your wrist in case you make an impromptu decision to don it.

Our sources urge you to do what feels right for your circumstances and not worry about being out of sync with everyone else. There's no reason to be embarrassed about being the only masked person in a room.

Also, keep in mind that COVID could surge again. Sometimes it surges in hot weather when lots of people stay inside in air-conditioned comfort. Ditto for winter, when the cold keeps folks inside. So there may be periods ahead when masking and other precautions are again recommended.

How do we monitor levels of COVID in our community – or a destination for a trip — now that many public and private data sources are no longer keeping track.

In the U.S., since the public health emergency ended on May 11, requirements for states to report COVID data such as case counts to federal agencies have ended. Some like Maryland and Texas do offer updates on their public health site and may characterize transmission rates as low, medium or high. Others, like Illinois, do not. To check on a particular state, try searching for "public health" and "COVID" and the name of the state. For a national picture, the Centers for Disease Control and Prevention offers weekly updates on hospitalizations and deaths. The World Health Organization offers updates around the globe. Here's their Kenya page, for example.

Are outdoor gatherings still safer than indoors?

Absolutely, says Dr. Malani. For a respiratory virus like SARS-CoV-2, "outside is extremely safe." That's because COVID-19 is mainly spread from person to person among those in close contact. The virus spreads through respiratory droplets from your lungs, mouth and nose, which are released into the air when you talk, cough, breathe or sneeze. In indoor spaces with poor ventilation the virus can stay in the air for minutes to hours. But outside, fresh air is always moving and the droplets move along with them, so you're less likely to breathe in enough droplets to contract the virus."

How does someone at higher risk (or even just a regular person) think about shopping in a crowded store, going to an indoor concert, going to the gym?

"The amount of close exposure that you have in any of these spaces tends to not be very high," says Malani. If you're worried, she recommends shopping and working out during less busy times. "Of these activities, the indoor concert is probably the highest risk because of the prolonged exposure [to other people]. So that's where masking might provide the most benefit." The same concern applies to other crowded indoor events. And Charlotte Baker reminds us that one positive outcome of the pandemic is the introduction of video-streaming options for those who might be nervous about an indoor event or gathering. (Although with cases waning, live streams could wane as well.)

Has the likelihood of getting long COVID decreased since the beginning of the pandemic? If so, why?

We know that the phenomenon of long COVID exists – but we don't yet know a lot about who's most at risk. One reassuring note is that if transmission is low in your community, your chances of catching COVID altogether — and thus potentially developing long COVID — are lower than during surge times. Being vaccinated and boosted as well as adding layers of protection like a mask will reduce your risk of contracting the virus.

Is there good guidance now for people in contact with kids – when should they be isolated, kept home from school, when should at risk family members stay away?

The guidance for kids is more or less the same as the advice for adults.

"Standard practice for respiratory viruses other than COVID-19 is staying home until 24 hours after fever has resolved without a fever reducer and symptoms are improving," says Dr. Michael Chang, a pediatric infectious diseases physician at UTHealth Houston and Children's Memorial Hermann. "Anyone who tests positive for COVID-19 should follow the CDC's guidance which includes five days of isolation and wearing a mask if around others, followed by another five days of masking after ending isolation."

Dr. Weatherhead also urges that you make sure your kids are "up to date on vaccines and boosters they're eligible for."

I worry for myself and others I know who have not yet had COVID, who have been vaccinated and boosted but like me are very high risk with almost all the risk problems. Am I expected to remain mostly isolated or just wear a mask everywhere or just return to living normally and hope for the best? I am very concerned.

Dr. Malani says she recommends that people who feel anxious speak with their health-care provider to help guide what each person does to manage risk. In general, finding activities that are lower risk (smaller gatherings, well-ventilated spaces, being outdoors, for example) are ways to move while balancing safety and the need to engage socially.

Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health. Find her on Twitter: @fkritz

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Fran Kritz
Marc Silver
Marc Silver, who edits NPR's global health blog, has been a reporter and editor for the Baltimore Jewish Times, U.S. News & World Report and National Geographic. He is the author of Breast Cancer Husband: How to Help Your Wife (and Yourself) During Diagnosis, Treatment and Beyond and co-author, with his daughter, Maya Silver, of My Parent Has Cancer and It Really Sucks: Real-Life Advice From Real-Life Teens. The NPR story he co-wrote with Rebecca Davis and Viola Kosome -- 'No Sex For Fish' — won a Sigma Delta Chi award for online reporting from the Society of Professional Journalists.