As COVID-19 mitigation strategies are changing across the country, in the St. Louis region, and here on the Washington University campus, we know there are a lot of questions. Here, WashU doctor Steve Lawrence, MD, explains the science behind new guidance.
Updated March 11, 2022
What can I do to keep from getting seriously ill with COVID-19?
The best way to protect yourself from serious COVID-19 is to be up-to-date with recommended COVID-19 vaccination. For most people at this time, it means getting your booster, if you haven’t already. The original vaccination series does still provide very good protection for serious illness (i.e., hospitalization, need for critical care, or death), but there has been some waning of this protection over time, particularly for older individuals. Booster doses restore greater than 90% reduction in the risk of serious illness for most people. This is particularly important for those who are at higher risk because they are over 65 or have certain underlying medical conditions.
I’m at higher risk for serious COVID-19. Should I be doing anything as an extra precaution?
Individuals who are at higher risk for serious illness should always be on the lookout for new symptoms and test early if they develop. There are now monoclonal antibody treatments and antiviral medications available that markedly reduce the risk of a new COVID-19 diagnosis progressing to serious illness if started early. For people who have compromised immune systems, there is also a recommended preventive monoclonal antibody treatment that provides additional protection beyond that given by the vaccine. In all cases, people who are at higher risk of serious illness should seek guidance from their health care providers.
We know the pandemic isn’t over yet. So why is masking guidance changing now?
We’re navigating a particularly tumultuous, yet cautiously optimistic phase of the COVID-19 pandemic. First, let’s all recognize that there’s good news to celebrate on the COVID front. Our community has seen dramatic drops in the numbers of COVID-19 cases since the Omicron variant caused record levels of transmission over the holidays. We’re now at levels lower than at the start of the Omicron surge and still trending downward. Our risk of unknowingly encountering COVID-19 is receding; at this moment fewer than one out of 1,500 people in St. Louis County are known to have active infection. We also have continued to get reassuring data throughout the Omicron surge that severe illness is very rare for most people who are up to date with their COVID-19 vaccinations. There is also evidence that vaccination significantly reduces the risk of developing long-COVID. And, we now have an adequate supply of effective therapies to prevent serious illness for higher risk individuals who become infected. These conditions are making it possible to start relaxng some of the mitigation strategies locally and across the country.
But we still need to be careful, right?
Yes, absolutely. Despite the emerging optimism, there are still important reasons to remain cautious. While the transmission rates are coming down, there is still a moderate level of spread and a measurable risk that we can come into contact with COVID-19 in our daily interactions. And importantly, there are many people who remain vulnerable to the possibility of more serious COVID-19, including those with severely compromised immune systems, those over age 65, and children under age 5 who are not yet eligible to be vaccinated. There are also many more people who, even if they are not at elevated risk for severe illness, may live with or care for someone who is, or may have other reasons for a high level of concern about getting COVID. For this reason, we all need to look out for others and be mindful of taking steps to protect the most vulnerable when we are around people with elevated risk.
Why were masks so important during the pandemic, particularly at the beginning? And what’s changed?
Before vaccines were available, universal masking requirements were necessary to prevent serious illness and deaths. Once vaccines became widely available but transmission rates remained high, universal masking served as an important public health tool on our campus to reduce the risk of large-scale disruptions to daily operations in our core missions of research and education, and reduced the risk that our health-care system would be overwhelmed. At this time, when transmission rates are much lower, and we know that vaccines provide very high levels of protection against severe illness for most people, the requirement for masking is not currently needed to prevent a public health crisis. For many people, however, masks are still an important tool for personal safety.
How are we making decisions about whether to require masks on campus?
We take into account guidance from public health authorities and our own data. The CDC updated its guidance on February 25 to say that universal masking requirements are not necessary to prevent a public health crisis in places where hospital systems are not overwhelmed and weekly case rates are less than 200/100,000 people. Individual jurisdictions or institutions may still decide requirements are right for them depending on local conditions. St. Louis County meets the new relaxation criteria and lifted its mask requirement order on February 28. We are relaxing mask requirements on our campus in response to our own declining case rates that mirror the surrounding community, which, when combined with our very high vaccination levels, makes mandating universal masking less necessary to prevent large outbreaks.
Should I still wear a mask, even if it’s not required?
There are several reasons why you might want to continue wearing a mask when around others. First, if you feel that the lower levels of transmission we are currently experiencing remain too high for you to feel comfortable unmasked, then it is perfectly fine to continue wearing a mask to further lower your risk of being exposed. One-way masking does still offer substantial protection to the wearer by reducing the risk of infection by up to half or more, depending on the quality of the mask. Second, even if you personally feel comfortable unmasking indoors around others, you may want to continue wearing your mask out of courtesy to those who do not yet feel comfortable. Third, if you have some symptoms of illness but have tested negative and have been cleared to return to work or classes (see below) then you should wear a mask until your symptoms have resolved. We all need to recognize the different perspectives of individuals on this campus as we move forward. As we progressively relax COVID mitigation on campus and individuals make personal decisions about masking, we must also focus on how we care for each other, even if our own risk perceptions and tolerances are different from others in our community.
What other steps can we take to protect our community?
Most importantly, stay home if you’re sick. This will become even more important as mask requirements are relaxed. If you have even mild symptoms of COVID-19, you should seek guidance and testing, but do not come to campus or leave your on-campus residence. The COVID Call Center (314-362-5056) or, for students, Habif Health and Wellness Center (314-935-6666) can advise you. If you test negative and are cleared to return to work or classes, wear a mask until your symptoms resolve.
What if others are wearing masks and I’m not? Won’t that be awkward?
WashU is a community that cares for each other and the community we learn and work in. When we move to fully mask-optional on March 14, it’ll be your choice whether to wear a mask on campus, but we all need to be courteous and respectful to each other. Don’t question someone or make assumptions about them because of their choice to wear or not wear a mask. Some may choose to wear a mask, say no to a social engagement, or otherwise exercise more caution than others. If a classmate or colleague asks you to wear a mask, please consider doing so to be supportive, even if the rules don’t require it. Keep in mind they may be at a higher risk, caring for others at a higher risk, or feeling less comfortable in a mask-optional environment. It may take a little time to adjust to the new policy, but by extending patience and grace to one another, we’ll find our way.
I’m nervous about working or learning in a mask-optional environment. How do we know it’s safe?
With the number of COVID cases dropping in St. Louis and on our campus, the risk of transmission within our community is dropping dramatically as well. If you’re uncomfortable without a mask, you may decide to continue to wear one, which will further lower your risk of exposure.
Are we done with masks for good, or is this just a temporary change?
The universal mask requirement has proven to be an extremely effective tool to help us get through the pandemic thus far. We will continuously monitor the data and weigh the pros and cons of reaching for this tool again. We are quite certain that COVID-19 will be with us for a long time and it will cause future surges due to either new variants or seasonal variation. However, it’s too early to say if these future surges will be dangerous enough to require resuming universal masking. It is good to know, however, that it is available to pull out from the toolbox if we need it.
How will I know if I’ve been exposed to COVID-19? Is contact tracing still taking place?
Contact tracing is still happening for exposures in some settings and situations. Technology also is making it easier for everyone to share and gain valuable information about whether they may have been exposed. In collaboration with Google, the university has launched a smartphone tool that allows students, faculty, staff and trainees to participate in a COVID-19 exposure notification system. All members of the university community are encouraged to use the MO/Notify system, which alerts users when they have had close contact with another user who has tested positive for COVID-19. Learn more about MO/Notify. Occupational Health and Habif are also continuing with their regular contact tracing processes.
Steve Lawrence, MD, MSc, FIDSA, is Professor of Medicine in the Division of Infectious Diseases and Assistant Dean for Curriculum in the Office of Medical Student Education at the Washington University School of Medicine.
Have a question for Dr. Lawrence? Send an email to covidquestions@wustl.edu.