A new approach to covid protection
Up till now, the main approach to dealing with covid has been to implement public health measures that “flatten the curve”. The idea has been to reduce the total number of cases that end up in hospitals, since hospitals are overwhelmed with patients (including patients coming in for things other than covid) and cannot handle them all. This approach called for vaccinating as many people as possible and getting as many as possible to wear masks inside — virtually any masks, since all masks provide protection to the group and hence reduce cases.
Now that cases are coming down, it is time for a new approach. In proposing this approach, I am making a couple of factual assumptions. First, I am assuming that covid cases are coming down pretty fast, and will continue to come down to fairly low levels (levels seen before the delta variant). So the timing of the transition to the new policy might be different in different parts of the country, depending on when we get to that low level of new cases. Second, I am assuming no new variant of concern. If a new variant crops up and cases rise again, then it would be time to re-evaluate the policy depending on the characteristics of that variant.
The new approach would be based on self-protection. Those who want protection from covid should be given the education and tools to do so. Those who are less concerned should be free to take risks on their own. True, the more there are in the latter category, the greater the risk to the vulnerable, but there are pretty effective ways that the vulnerable can protect themselves.
First, vaccines. Vaccines are generally available, so the main thing to do here is continue to educate people about the benefits of getting vaccinated. It is especially important to educate about getting a booster. Those eligible for a booster already have gotten a vaccine, so they are not hard vaccine resisters. They need to know that a booster really is needed to provide robust protection against omicron and potential future variants.
Second, rolling out prophylactic therapies like Evusheld to the immunocompromised. These therapies--like the vaccine--are not 100% protective, but they should provide pretty good protection against severe illness and death.
Third, rolling out therapies effective against omicron (or whatever new variant comes along), so that those who are infected can be saved from severe illness, death, and, in most cases, hospitalization (currently Paxlovid and sotrovimab.
Fourth, masks. When everyone wears a mask, it is not so critical what kind of mask it is. Wearing even a cloth mask protects others, because it greatly reduces the amount of viral particles the wearer would spread. Now that masks will largely come off, it becomes much more important for those who do not want to contract covid to wear a well-fitting N-95 or equivalent mask to protect themselves. These masks should be made available and people need to be educated about fit and reuse. You can reuse an N95 multiple times as long as it does not get wet and the fit remains good. Who might want to wear an N95? Obviously, those whose are immunocompromised or who have not been able to get a vaccine on the advice of their doctor. Also, those living in the same household as one of the above. Those who are vaxed and boosted but who have underlying health conditions or are elderly (maybe over 80) probably should wear an N95 because the protection they have is not perfect, and another layer of protection makes sense. Finally, front line workers (meat packers, grocery and other retail store workers, restaurant servers, teachers — anyone coming into contact with large numbers of unmasked people who does not want to get sick and have to stay out of work, even if they are fully boosted, healthy, and hence at low risk for severe disease. These people need to up their mask game to an N95 with good fit. The implication is that as long as the U.S. is in a position where hospitals are not being overwhelmed with patients, it is ok to drop government mandates to wear masks. At the same time, even though not required to do so, many people will voluntarily want to wear masks for their protection.
Fifth, testing. If you want to go maskless but are concerned about getting covid, one approach is to test everyone who will be in the same room with a rapid test. They are not 100% perfect to detect infectious people, but they are pretty good. This approach works for a dinner party, a wedding, or other social events where everyone will be unmasked.
This means the rest of the population do not need to wear a mask, or at least not all the time in indoor spaces. If you are healthy, do not live with a vulnerable person, do not work a job where you cannot afford to be out sick for a week or so, and are vaxed and boosted, then it should be ok not to wear a mask, but you might still want to wear a mask occasionally where not inconvenient, for example on public transport or when going into a retail store. Save your maskless time for spending quality time with other such as in a restaurant or even at work (such as in an office). And when you do wear a mask it should be a well-fitting N95 or equivalent.
Special considerations should apply for facilities like residences for the elderly, nursing homes, hospitals and the like. Here, all staff should be wearing masks and should be fully vaxxed and boosted, and probably tested periodically. Not all patients can be well masked all the time, and protecting vulnerable patients by ensuring that staff are as covid-free as possible makes sense. Facilities like cruise ships should require all passengers and crew to be fully vaxxed and boosted, and test periodically especially those who have disembarked and returned to the vessel. Those passengers in a vulnerable group should wear masks at least much of the time when in an indoor space for self-protection.