What is the endgame here?

I want to take this question in good faith but we’re so catastrophically far from acceptable levels of illness and death that no, I don’t have some magical idea of when I might wind down mitigations. “It will likely catch up with you” is minimizer talk. Not trying to be snarly but my quality of life is great in that I’m never sick anymore, and it doesn’t sound like you want to respectfully communicate with your friend. It sounds like you want to badger them into accepting what you accept, which is high risk of severe illness.

I do anticipate taking precautions like masking on planes the rest of my life, which could be many decades still. Why wouldn’t I? I’ve been humbled by Covid and learned a lot about how I can protect and respect others with simple choices like these. And I like protecting myself and my loved ones too.

I don't think wearing a mask is a "severe quality of life reduction". It is one of the easiest & most effective things you can do to prevent disease transmission.

I think if there were some significant improvements in how we're handling Covid, it would make things a lot safer for everyone like:

• Improved air quality & ventilation in buildings
• Improved vaccines that actually prevent transmission
• Treatments that would stop Covid from causing damage to the immune system
• Treatments that would prevent the 2nd phase of the illness when it becomes vascular (because that's what's causing the heart attacks, strokes, blood clots, etc.)
• Better treatments and/or a cure for Long Covid (I know it's a BIG dream, because I'm basically asking for a cure for autoimmune conditions)
• AND the treatments need to be made available to everyone
• Having masks become common & accepted (like they are in Japan)

If you really want to understand how to have a rational discussion with someone who has anxieties about contracting Covid, I think it's important to understand why they have anxieties about it. What are they scared of? Are you aware of the dangers of Covid? What concerns do you have about their behaviors? Do you understand that every time you get Covid it damages your immune system & raises your risk for stroke, heart attack, ED and a number of diseases?

Do you know anyone with Long Covid or another autoimmune condition? Are you aware of how much it can affect someone's life? For a quick summary, please take 5 minutes to watch Life with Long COVID

There is a reason why MANY people are concerned about getting Covid and would prefer to avoid it as much as possible, for as long as possible.

The answer to the “why care if it’s inevitable” is a question back: “how many times are you willing to get Covid?” We know by now that it’s basically possible to get Covid infinite times if the proliferation of variants continues. We also know that each infection creates additional and increasing levels of organ damage across organ systems. Additionally, each infection increases the likelihood of long COVID. Going maskless is asking for getting Covid numerous times and creating permanent damage to your body.

However, one can get long COVID from even just one infection at a chance of 10-20%. That’s a huge chance to take on one’s health. It’s likely much higher if you look at only younger people since elderly people are more likely to die of Covid.

If you are not aware of the aforementioned statistics, you are likely turning a blind eye to the data from the scientific community. Try to peruse literature from scientists and not politicians. There’s still 3k people dying each week from Covid in the US, and we are far from over.

Would you call someone wearing a helmet on a motorcycle having “anxiety?”

People typically equate anxiety with irrational fear. Your belief that your friend's anxiety is unnecessary is driven by what exactly? The behavior of the majority? Scientific evidence? What exactly causes you to feel their behavior is wrong and yours is right?

A child playing near an open flame or live electrical wire is not worried about the danger they are in. Is it irrational for the parent to be concerned? Is it suddenly less concerning if a larger group of children are playing near or and the majority of parents aren't concerned or aren't aware of the danger? Does ignorance or indifference to a danger make it less of a danger? I think that's what it boils down to.

The acute phase of covid is a lesser concern to most these days, but that's unfortunately not where covid stops giving. All cause mortality is significantly higher across all age groups post infection. Hell, death from heart attacks in the 19 - 42 age range is up 30% alone done 2020, that ignores strokes, cardiac arrests, and an assortment of other issues. The list goes on and on from new onset autoimmune diseases on the rise, neurological issues on the rise, type 1 diabetes, arrhythmias, it's an exhausting list affecting millions of people and growing. There is even evidence that the immune system is being damaged leading to increased severity of previously less severe diseases.

My heart doctor told me he's never seen so many young people with heart issues in all his life.

So are precautions warranted still? I think the evidence says yes. Is that inconvenient, sure. Should that matter? No.

What we should have done was never take our foot of the gas. Fund improved ventilation, wear masks in social settings that medically vulnerable people can't avoid, and fund the hell out of treatments and improved vaccines.

There's no reason to go from, do nothing and ignore the death and disablement around you, to everyone lock yourselves up for the rest of your life. This is still an interim period and it need not last forever. It's being prolonged by human selfishness, greed, and shortsightedness.

We can still live fulfilling, safe lives with simple precautions and some of the best activities for us are inherently covid safe, like outdoor exercise.

Here's just a few anecdotes and a linked article that touches on just a single type of issue we're seeing now post covid. None of this is normal. https://www.reddit.com/r/Coronavirus/comments/10yxtei/since_covid_more_young_people_are_dying_of_heart/

Edit: similar story with more anecdotes here https://www.reddit.com/r/Coronavirus/comments/10yw6az/explainer_how_does_covid19_affect_the_heart/

If you think wearing a mask is a "severe reduction in quality of life" then you should really try long covid even for one day

Framing your friend as having "ongoing anxieties" tells me you are not fully hearing your friend when they speak and have decided that their concerns are not based in material reality. I am sure you mean well but that feels like crap to be on the other end of.

Most of us in this sub are not "anxious". We're well informed on the risks of contracting an airborne vascular virus repeatedly. I'm an epidemiologist, I know there's some clinical medicine folks in this sub, as well as other scientists, people who themselves have been disabled by covid or have other chronic illnesses that leave them at very high risk, and others who spend time digging through scientific literature to learn. Plenty of covid cautious people aren't even that concerned for themselves personally, but believe the current population levels of sickness and death are unsustainable and/or morally abhorrent (I consider myself in this camp, though I'd be pretty bummed if I could no longer do activities I enjoy). Most also aren't miserable-I like my life. I find it incredibly distressing how many people I love and once respected are eager to declare how unbothered they are by people being harmed, and I dislike having to worry about whether my covid denier aunts are going to kill my grandma, but the actual day to day is great.

In terms of dropping precautions, well, society has done absolutely none of the macro things that that would make it safer-no air quality upgrades, no sick leave, no isolation, no mask mandates, data is getting harder to access, not easier, and the increasingly erratic viral evolution means that there are no longer real like, super low transmission points like early summer 2021. And we keep learning more about the consequences: life expectancy (especially in the US) is still dropping. Cardiac events in younger adults are up 30%. We're seeing more unusual infections, indicating immune dysregulation. We know that other viruses are associated with neurodegenerative diseases and cancers, though those links for covid will take time to examine. Excess deaths are still very high. Damage from reinfection is cumulative. Somewhere around 1 in 5 people develop long covid-that is extremely high and there is no cure and minimal treatment for symptoms. The idea that we need to "eliminate mitigations" when we haven't even tried to eliminate the freaking pathogen is wild.

You ask us what level of transmission is the "end"-well, how many dead bodies are acceptable? How many newly disabled people? Preventable heart attacks? People dying of unrelated issues because they cannot get proper medical care in an overburdened system? Orphaned kids? I'm really not trying to snark here, but there is a big disconnect between something being the third leading cause of death (and contributing to #1, heart disease) and acting like it's done and over and time to move on.

Due to climate change (and possibly helped along by the widespread immune dysfunction related to covid, TBD on whether that goes away or not), there will almost without a doubt be other pandemics in our lifetimes, particularly but not limited to influenza. The details of landscape may change, but certain precautions like masking in public spaces are here to stay. I hardly think masking is a "significant reduction in quality of life" though.

Going to respond in good faith. I won't stop taking basic precautions against COVID (masking in public, avoiding majorly packed events indoors or outdoors like concerts, clubs, bars, eating indoors) until the risk of contracting COVID is either completely gone or there's some miraculous medical development that makes it so that the risk of long term illness is gone. I've already been doing this for at least two years. It's only a hassle when others make it more of a problem than it needs to be (making fun of what I'm wearing or trying to gaslight me into thinking I'm being extra or really the problem for taking a basic health precaution).

What I don't get is your outlook on masks being a major "quality of life reducer" when their ultimately a useful piece of fabric that basically just sit on your face while keeping a person and others safe. They don't wrap around your legs or arms to prevent you from going places or doing most things (unless you're trying to get a facial from an esthetician I guess). I don't get how wearing an elaborately made piece of fabric is more severe than running the risk of contracting and spreading a highly virulent illness that's disabling and killing mass amounts of people, especially if you're based in the US where accessing basic healthcare is very difficult for people to do.

The idea that masks need to go away is very odd to me as they've long since been a regular part of public health in East Asian countries (when people are sick, when people are taking public transport, when people are in crowded public places, when air quality is particularly bad, when someone's trying to achieve a level of privacy). I can't wait to get to a time where I no longer have to wear it every single place I go to without the major threat of being made extremely ill or my life span shortening isn't looming over my head, but I'm not going to be going out of my way to light my boxes of N95 masks up in a bonfire. I'm going to be incorporating them into my life in a less intense way (on public transport including planes, when I'm feeling under the weather, when flu season starts picking up as it down in the fall/winter months, when pollen has my allergies acting up).

If you carry such a negative outlook on just wearing a mask, the lowest level and easiest pandemic precaution to take, your discussion is going to go nowhere.

OP, thank you for writing this post! It’s elicited so many thoughtful and eloquent replies, and now when I get tired of answering this question irl I have a helpful place to point people to. Hat tip to you!

I share the sentiments of many here. It’s absurd to talk about lifting mitigations when all we’ve done is made the situation worse and more risky to navigate. I have no desire to FAFO with a virus with long-term effects that look increasingly bad according to new peer-reviewed studies coming out almost daily now (I like my internal organs, not having chronic fatigue is A+, and I depend on my brain). Wearing a mask / trying to improve air quality really aren’t that big of a deal in the grand scheme of things: kind of a pain and it’s one more thing to worry about in my day-to-day, but I’ve adapted. I’d rather worry before taking risks than live mask-free but never knowing when my luck with the Russian roulette of repeated Covid infections was going to run out.

We’re not choosing between “never get infected” vs “get it once and be done with it” as you suggest. We’re choosing between “try to avoid it and get infected as few times as possible” vs “get infected repeatedly until you’re dead or disabled.” Personally, I plan to keep up mitigation measures until society catches up in terms of either sterilizing vaccines or air quality infrastructure. I (optimistically?) believe it will have to happen eventually, because we will reach a tipping point where so many people are sick or dead that it will impact corporate earnings and lobbying pressure will shift. Based on current transmission rates, enough people will be personally impacted by Covid that they will start to wake up and will have to care for purely self-interested reasons; at some point they will outnumber the people sticking their heads in the sand. I wish people could have learned vicariously and empathetically from those who were already suffering, but here we are. I don’t have to outrun Covid forever, I just have to outrun it until public sentiment shifts and the world gets safer by necessity.

Since this isn’t an uncommon question from Covid minimizers, I would love to know: what’s your re-entry strategy? Vaccines were the off ramp for a lot of people (myself included! until the data about transmission rates and breakthrough infections in vaccinated people became apparent). At what point would you re-adopt mitigation measures like masking, avoiding large gatherings, skipping indoor dining/gyms, running HEPA filters, etc.?

When you learn the vaccines don’t block infections? (they don’t)

When you learn you can get reinfected repeatedly? (you can)

When you find out repeat infections can be severe, even if your first infection was mild? (they can be)

When the risk of long Covid turns out to be high for your age group? (it is)

When the long term effects of Covid turn out to be really bad? (a growing pile of scientific evidence certainly makes it seem that way)

At what point would you admit that you’re wrong and adjust your life in inconvenient ways again? Having had some version of this conversation many times now, I’m guessing the honest answer is that there isn’t anything that would tip that balance (until, of course, you find yourself immunocompromised after repeated Covid infections, which nobody ever wants to think will happen to them). People are tired of being inconvenienced, and they’re throwing tantrums that life didn’t turn out to look like how we all thought it would. That sucks and I’m right there with you in the grief and anger and shattered expectations. The pandemic took things from all of us in unique ways. But denying reality and hurting yourself and everyone else around you out of a sense of entitlement about how your life was supposed to be is a selfish and ultimately futile way to respond.

I don't have "ongoing anxiety" regarding contracting COVID, but I did learn a lot from the pandemic, namely how to avoid respiratory viruses.

What is your exit strategy for discontinuing mitigations

I don't have an "exit strategy". I don't enjoy being sick, from any virus, COVID or otherwise.

This alone seems to be a severe quality of life reduction

Why? Filtering facepiece respirators are inexpensive, easy to use devices that are highly effective. They also work very well against allergens and urban particulate pollution. Where is the "quality of life reduction" ? My quality of life has improved since I learned how to use these products correctly.

has to be weighed against the risk of contracting the virus

Risk of contracting a virus is one thing, but one should also factor their consequences of exposure to any hazard. Some people have higher consequences of exposure to a certain hazard than others. For example, some folks are perfectly fine walking through a field of ragweed during pollination. Others may risk an allergen induced asthma attack, which could have severe consequences. Some folks have high consequence of exposure to pathogens, such as if they are immunocompromised. Consequence takes other forms as well; for example an athlete experiences a higher consequence from anything that compromises breathing, especially if they are competitive and their performance numbers matter. Others may be taking care of vulnerable people, or they may have personal or professional responsibilities they can't easily put on hold for recovery/quarantine.

Everyone here hopefully has a plan about what transmission risk level it is that you find tolerable to reduce or eliminate mitigations

"eliminate mitigations" is not a goal of mine. My decisions regarding level of mitigation is directly proportional to exposure risk and consequence. This is not a binary decision, and the goal is not less. One should always err on the side of caution with safety related issues... Not the other way around.

you plan to take these precautions in every interaction you make outside of your household from here on out?

I take precautions whenever I am faced with something that can harm me. Not really into playing FAFO with hazards.

I hope this post gets some discussion going. One of our children just finished treatment for leukemia so we had an "at least until done" mindset, but the end date now is so nebulous... I wish that we could rely on society to implement improved air quality, better testing, sick days, masking during outbreaks, etc, but I just don't see those things realistically happening and my family has suffered psychologically/socially through the last 3 years. I'm the only one left that wants to proceed cautiously...

It’s your friend’s health, their body, their decision. Why is it your duty to convince them otherwise?

I suggest asking them more questions with an open mind. You don’t understand why they’re sticking with precautions, that’s why you’re asking random Reddit users for advice. Have you tried asking them more questions and really listening to the answers? What are their concerns? Have you done any research on long Covid? Do you have a good handle on how Covid affects the body? Do you know their medical history? You’re coming at this with your own agenda, and that makes communication and mutual understanding difficult.

If you’re afraid that this person is isolated or depressed, then what are you doing to be supportive? Sometimes you have to meet people where they’re at, even if you don’t agree with it. Maybe this person will be more open to socializing if you agree to take precautions before and during the visit, like meeting outside, testing beforehand, and masking.

Personally, I will continue masking on public transit, airplanes, and doctor’s offices indefinitely. Subway air in my city is literally toxic, and masking also protects against other respiratory illnesses. I don’t want to give an elderly person the flu because we happen to be sitting next to each other in the waiting room. With other precautions, I’m waiting to see what happens over the next few months. My main concern is long Covid and affect of infection on my body. I also have some medical concerns and I hate being sick. I would love better ventilation and improved vaccines and treatments.

Ironically, the people who have decided that its futile and "we're all going to get it so might as well give up" are the ones forcing medically high-risk (or risk averse) folks deeper into maintaining mitigations (and I am gonna go out on a limb and assume your friend is in one of those groups).

Fwiw, in a good faith response, I am medically high risk -- BUT -- there was a magical two-three months after people had their second vax, the weather was warm, masking was required indoors pretty much everywhere except restaurants, and transmission in my region dropped very low. I traveled (masked) to see friends in a warm location -- we ate outdoors but shared hotel rooms and cars unmasked. I even ate inside on three occasions in my city and did not get covid. Transmission was down because masks, open windows, warmer weather, abundant free testing -- were keeping overall circulating virus low. If we could achieve this again, I'd have much more of a public life than I have had since.

As of 2022, you could not pay me to take that same trip because overall transmission is higher since everyone decided to give up masking. I trust in my N95, but worry that even one way masking is no longer enough for a days worth of traveling in a crowded airplane/airport with *everyone else* unmasked coughing on me.

The more everyone else decides its over, the worse it gets for folks still dodging it. I hope you will consider that your friend is not anxious, but is instead having to take a defensive position to protect their health in the face of being abandoned by public health, govt, and their friends.

That's a lot of strawman argumentation right there:

• Assuming the state of the last year is what we'll have for the rest of forseeable future? Ignoring the changes in legislation in some countries?
• Considering masks to be a quality of life reduction?
• Completely ignoring the existence of the medically vulnerable?
• Assuming that it's all about preventing a first infection (no consideration of repeat infections)?
• Calling risk-evaluation anxiety (why is OP anxious about others performing some risk evaluatioin)?

I check the CDC covid transmission level map. Right now my county is red (highest level) so continuing precautions seems reasonable and not obsessive compulsive. I have 4 genetic covid risk factors.

CDC covid risk map: https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Risk

I do imagine being able to not mask outside my home indoors at some point. I am hoping a combination of HEPA-level air filtering, use of covid detectors (like ViraWarn), and the reassurance that if one ends up hospitalized, there is now the lambda vaccine treatment - these will combine to make it safe for even high risk populations to unmask and be socially at ease and lots of overdue hugs.

I don’t see those who take covid precautions as “anxious”. I see them as making smart choices.

The opinion that mitigations are extreme and/or severely restrict quality of life could be applied to other situations where you would surely take the opposite view. Clothing is restrictive and uncomfortable (especially bras!). Condoms are not comfortable for some people, but remain a really effective mitigation against both STDs and pregnancy. Plenty of people choose not to use them and deal with the consequences. A simple shift in perspective like this could help you approach your friend in a truly rational way. If anything, this sounds like a YOU problem—masks aren’t that big a deal, so why do you have such an emotional reaction to them? To the point where other people masking provokes uncomfortable feelings in you? I would sit with that.

So if you want to have an open conversation with your friend, I would first examine your own assumptions: because of your worldview you have assumed that masking and not eating at restaurants feels extreme to everyone. That’s obviously not true, or everyone would do exactly what you’re doing. If you’re approaching your friend with the goal of converting them, you’ll probably just lose a friend.

Secondly, to answer your question: in my case, I’m waiting for (at a minimum) second generation vaccines, vaccines that work for those without B cells (or some kind of new treatment for my condition so I can get off the medicine that kills all my B cells—vaccine didn’t work on me, I have zero antibodies and only half an immune system). Better nasal stuff (I do use sprays, but they aren’t 100% effective). Would love to see us using the tech that we know works: far UV, better ventilation, etc but am not hopeful. I’m not thinking long term, I’m dealing with this horrible crisis that is affecting all of us. I’m not using magical thinking to focus on a mythical endpoint, I’m looking at the (at this point) overwhelming evidence that covid is bad news, and every day I’m deciding if I want to protect myself and loved ones, or not.

Here’s a thought I’ve had often, as I watch people flip a switch and rely on magical thinking: sometimes there are two options and they both suck. That’s the case with covid! The options are :

1. don’t catch it (but deal with mitigations)
2. catch it (and deal with the consequences of infection)

What most people like you have done is decide that there’s a magical third option: catch it and have zero consequences. This kind of thinking flies in the face of the scientific evidence, but I do envy it sometimes

Long covid

There have been multiple studies now that have proven that covid infections can do neurological damage. Just do a Google search on covid neurological effects. This particular study focused on those who have had multiple covid infections.

https://www.reuters.com/business/healthcare-pharmaceuticals/repeat-covid-is-riskier-than-first-infection-study-finds-2022-11-10/

From the article: "People in the study with repeat infections were more than three times more likely to develop lung problems, three times more likely to suffer heart conditions and 60% more likely to experience neurological disorders than patients who had been infected only once. The higher risks were most pronounced in the first month after reinfection but were still evident six months later, researchers found."

So yeah, after multiple covid infections, it's not surprising that ADHD-like symptoms appear (brain fog) or be exasperated for existing ADHD condition. There's another study I read where it was shown that the part of the brain that is most affected by covid is the frontal lobe. Which is also the part of the brain that contains our executive functions.

All it takes for me is 6+ air changes per hour. Mechanical ventilation or HEPA filtration, I don't care either way. It's a small ask.

As far as transmission levels — under 100k copies per liter in wastewater.

It's challenging, but at the end of the day, the main thing I've "given up" is going to restaurants, and a certain amount of seeing extended family less plus some level of mitigations and anxiety when we do see them (in some ways, I wanted stronger boundaries with extended family anyway...). I have young children who are largely my priority and what my life revolves around, so I wasn't bar-hopping and such as my lifestyle going into this. I work in an office on a hybrid schedule (prefer WFH for both non-COVID and COVID reasons), am involved in my kids' school activities and sports. We just do all these "normal" things while masking indoors (we typically only mask outdoors if it's crowded). We went on vacation last year and ate outdoors at restaurants. My kids do briefly unmask to eat lunch, which is a big gap - my wife and I both eat lunch at work outdoors, in our cars, or "worst" case find a closed office.

​

As for my endgame, I don't know. "Giving up" has entered my head as an intrusive thought a bit more in the last two weeks or so. My most significant concern has never been the acute illness (although again from a risk/reward standpoint - there's no restaurant meal or even extended family event that's worth 1-2 weeks of "missing" my regular life and obligations with even mild illness) - it's been Long COVID, which I identified as a risk to my kids and self pretty early on. My kids do all have asthma as a risk factor plus one or two other items.

​

My goalposts have moved a few times in response to changing conditions. I had been waiting until at a bare minimum all children could be vaccinated, and at least until cases dropped to a low enough level (10 per 100k or similar). I have no idea what my endgame is, but this wasn't it and isn't particularly close to it. Alternate possibilities might include better understanding around Long COVID, or better treatments or vaccines.

I think you have some serious misconceptions of what is to be a “NoVid.” And if you keep framing it to your friend as just anxiety and a lack of rationality, you are likely to lose that friend. This question is full of bias and loaded language and it would take hours with you to explain why. And I am not sure you are ready to listen.

And, you have to realize, it’s not just mitigation’s anymore for us, it’s now a way of life and in so many ways this life is better.

For the purposes of a honest discussion, could you walk us through your COVID journey, exit strategy, and the evidence that supported your choices.

I am the only person in my family that regularly masks at this point in time. My family will mask when flying, sick or high incidence of COVID is zipping around, or when all the clerks at the store are suddenly wearing masks. My family did not have an exit strategy. I'd say in almost in every case it was an emotional response or exhaustion. They don't think I am anxious.

The other day I thought do I have an exit strategy or when will I stop wearing a mask in certain decisions. The only reason that I came up with was social approval in a somewhat bonkers work environment. I can't unread what I know about the long-term effects of multiple infections, or that wearing a mask is a rational and ethical choice. So, I imagine it is a few years out when we know more about the evolution and our vaccines improve before I change the status quo - masking in most public situations with a kn95, using an air purifier and opening my window in my work office, reducing indoor eating to about 1% of the time, and avoiding meeting up people at high peak times. Given the Super Bowl is in Phoenix, I plan on avoiding any indoor dining for a few weeks. So, the game plan is to carry on as is with the once in a blue moon lapse.

My only ongoing risk is that I will eat inside with my family that includes several kids +aka virus factories. I've yet to test positive. I also got married last year and I didn't mask in Church, but I asked all non wedding party to mask and brought kn95s for people. The reception and rehearsal dinner were outdoors. I've gone to Hawaii, the Pacific Northwest, and East Coast with my trusty mask, concerts, and movies.

My only regrets have been not masking at the ship museum in San Diego. I picked up a nasty flu. I've found that masking has cut down on many of the bugs around my workplace and improved my quality of life. When I am in my office, I typically open the window, turn on my air purifier, and take off the mask.