What health experts expect from the next COVID phase in Massachusetts

Editor's Note: This is adapted from a special coronavirus edition of WBUR's morning newsletter, WBUR Today, in which our health reporter, Gabrielle Emanuel, spoke with a number of experts about what they expect in the post-omicron phase of the pandemic.

You can get regular weekday morning updates about the evolving pandemic and all other essential Boston-area news by signing up for WBUR Today. 

If you missed it, the special edition led with Roberto Scalese's clarifying look at the current state of things in Massachusetts in the aftermath of the omicron wave.

Massachusetts is moving into the next phase of the pandemic.

The amount of COVID detected in Boston-area wastewater has dipped way down. At the height of the omicron surge, there were measurements as high as 14,000. Now, the measurements are in the double digits and reminiscent of levels seen last July.

Citing such promising indicators, the state is pushing for pandemic restrictions to be relaxed. Gov. Charlie Baker is lifting school mask mandates and easing mask guidance for fully vaccinated adults, saying they no longer need to mask up in most indoor public places. His administration is urging colleges and universities to follow suit in reducing COVID restrictions.

WBUR reached out to several local experts to understand what they think the future of the pandemic looks like, and what metrics they are continuing to monitor.

When Is It Safe To Exhale?

“Things are really looking good in terms of overall case counts,” said Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital.

Among experts there is a sense of optimism about the spring — but, after that, there is a lot less certainty. They are confident another variant will emerge, but it is unclear how severe or transmissible a future variant might be. However, experts say a few things are becoming clear.

Ofer Levy, director of the Precision Vaccines Program at Boston Children's Hospital, painted a probable scenario: “We're going to see it come and go, and be worse in the winter and better in the summer,” he said. “We might end up in a pattern where there are vaccines that come out in September, October time that are matching the strains that are circulating.”

Levy said he’s also holding out hope for a universal coronavirus vaccine.

“This is quickly transitioning into an epidemic of the vulnerable,” Lemieux said. “The largely healthy, the immunized can likely return to pre-pandemic life with little risk to life or limb, so to speak. And the complete opposite is true for the immunocompromised, despite vaccination, despite taking all precautions.”

What To Watch So We Know When To Go From ‘Crisis Mode’ To The ‘New Normal’

There are a few different metrics that experts are monitoring to know when it’s safe to return to something closer to pre-pandemic life, and when it’s time to ramp up precautions again.

1. Hospitalizations and wastewater data. Many epidemiologists pointed to hospitalizations as an important factor. “Hospital capacity is really the key metric for when we’ll need to move back to control measures,” said Andrew Lover, an epidemiologist at the University of Massachusetts, Amherst.

However, hospitalizations are a lagging indicator. So, Lover said, wastewater surveillance is an important tool and should be used routinely in communities across the state. The Massachusetts Water Resources Authority has been monitoring COVID in the Boston-area sewage and makes the data publicly available.

2.  Vaccination rates. When it comes to jabs, Massachusetts has done a very good job compared to other states. However, there are some distinct pockets where experts are concerned. For example, pregnant women. About one in every three pregnant women in the U.S. is unvaccinated. That is true despite a growing body of evidence that shows COVID vaccines are safe and the risks of COVID are worse in pregnancy. Andrea Edlow, an obstetrician at MGH, said, “We have a lot more work to do.”

3. Good — and more available — treatments. Right now, we have a couple of medications to turn to when someone is at risk of getting severely ill from COVID, but they are in short supply. For instance, paxlovid is a promising oral medication that can be taken at home, but it is not yet available to children, it has a number of drug interactions and many treatment centers have resorted to a lottery system to distribute the limited available doses.

Lemieux said he’s watching for when our options and our supply improve. “One key thing that is missing — that I hope won't be missing for too long — is widespread availability of easily distributable oral medications,” he said. If that were available, it could go a long way toward making COVID a much less significant concern.

4. A lot more research is needed on long COVID. There is still a lot we don’t know about all those lingering symptoms that can, sometimes, be debilitating for individuals and challenging for the economy. There’s been a call for more study of long COVID, including in kids. The hope is to better understand things like how often people develop long COVID, whether vaccinations reduce your risk and how to address the symptoms.

“The literature on long-COVID is very difficult to interpret because it's often done without control groups and, unfortunately, it is not as well studied as we would like it to be,” said Hanage.

In Massachusetts, Is It Safe And Appropriate To Return To Something Closer To Normal?

The commonwealth has among the highest vaccination rates in the country and — after omicron — a lot of natural immunity too. That’s led many to wonder whether it’s okay to resume pre-pandemic life.

“I wish that were true,” said Robert Horsburgh, a physician and professor of epidemiology, biostatistics and global health at Boston University. He said, before things can relax, there needs to be a real focus on getting school-aged kids vaccinated.

“At present, only 51% of children 5-11 in Massachusetts are vaccinated,” he said. “Studies have shown that they are the ones that keep flu circulating in our communities, and I am certain that will be the case with [COVID] as well.”

He pointed to a study on flu vaccinations in Japan, published in the New England Journal of Medicine. For more than a decade, Japanese schoolchildren were required to be vaccinated against the flu. But that law was relaxed and eventually repealed. What happened next is telling: Vaccinations among schoolchildren dropped to a low level, while flu deaths among older adults increased.

The study concluded, “the vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year.” Horsbugh said the findings have been confirmed by subsequent studies.

While it is unclear whether there will be a COVID vaccination requirement for schools, and experts are divided over the easing of mask restrictions, there is one thing epidemiologists seem to agree on: the lull between surges should be used to prepare for future variants. That means working to boost vaccination and booster rates, as well as improving wastewater monitoring and the availability of COVID treatments.