Covid cases are waning. What does that mean for high-risk Vermonters?

Heather Benjamin came to Burlington to skirt the worst of the pandemic in New York’s nightmarish April 2020.

Between her autoimmune condition and the immune-suppressing drugs she takes for it, she knew she’d be at high risk for severe complications for the disease. So when she started seeing the seniors in her New York building come down with Covid — seeing “how sick everyone was getting” — she made the “hard decision” to leave her home of about a decade to come to Vermont, where her family had vacationed before.

They came because “Covid was projected to stay within the health system’s capacity, and because we were pleased to see how quickly the governor acted and really put good policies into place to keep people safe,” she said. 

But more than two years into the pandemic, and a year after Gov. Phil Scott dropped all Covid restrictions, Benjamin feels very differently about the state’s response. 

“It’s been a huge disappointment to see the complete 180 of the health department and the governor on Covid, and the complete denial that there seems to be, even of the huge surge that we’re just now hopefully coming out of,” she said.

Benjamin is not alone in feeling conflicted about the news that Vermont appears to be coming out of a surge led by the BA.2 variant of Covid. Experts and other high-risk Vermonters interviewed by VTDigger expressed cautious optimism about the future, but worried that the state’s guidance, which places the burden of prevention on individuals rather than the general public, may leave high-risk people behind.

Some are even skeptical of whether Vermont’s Covid levels are actually “low,” as reported by the state Department of Health and the U.S. Centers for Disease Control and Prevention. 

Anne Sosin, a health equity researcher at Dartmouth College, pointed out that the CDC’s “community levels” are a relatively new metric, launched in February to replace the agency’s old community transmission map. According to that map, several Vermont counties still have “medium” or “high” transmission as of Tuesday.

“All signs are pointing to receding Covid levels at this point in time. However, I would not characterize Vermont as in a state of low transmission,” Sosin said. The state was reporting about 140 cases per day as of last Wednesday, with about 30 to 40 people hospitalized for the virus at a given time.

Other experts expressed more confidence in the CDC’s determination. Tim Lahey, an infectious disease physician at the University of Vermont, said the exact categories were an “educated guess,” but one that’s “worked out pretty well” in the past few months.

The new levels, he pointed out, are also based on both cases and hospitalizations, giving a fuller picture of the virus at a time when more Vermonters are using at-home tests and not reporting cases to the health department.

Benjamin said she finds it difficult to fully trust the data, given the recent changes the health department has made in its reporting. The state stopped updating its daily Covid dashboard in May, replacing it with a “backward-looking” and “confusing” weekly report, she said.

“It was hard not to feel completely abandoned, especially as a high-risk person,” she said. “It’s just impossible to actually make informed decisions about how to engage with seeing people, with going places — even essential places, like grocery stores and pharmacies — without knowing what’s actually happening in our community.”

What, exactly, should high-risk people do?

The CDC’s Covid levels come with guidance for each category, both for high-risk people and the general public. During high Covid levels, according to the CDC website, everyone should wear a mask in public, and in medium-level areas, people at high risk should consider masking. 

Now that most of Vermont is in a “low” category, the agency’s recommendations state only that everyone should stay up to date on vaccinations and get tested when symptomatic. 

But experts’ advice for high-risk people varies far more than that guidance would suggest. 

Sosin said high-risk individuals should assume that “transmission will remain relatively high,” and to make decisions accordingly.

That includes wearing high-quality masks, like N95s, in indoor environments. They should also test before and after gatherings, if possible, and take activities outside, she said.

“We can think about, ‘How do we reduce the risk while continuing the activities that we value?’” Sosin said.

Jon Levy, a professor of environmental health at Boston University, said masks can be both comfortable and protective.

“If you are someone who is vulnerable, or (if) getting Covid would create havoc and disruption in your household, wearing a mask in a crowded indoor setting is a smart thing to do. It doesn’t cost too much to wear the mask,” he said, and the harms of infection “could be great.”

The Vermont health department does not recommend that anyone wear masks, but its website states that individuals “can decide” to wear masks if their health status calls for it. 

Benjamin said she plans to continue taking precautions to protect herself, avoiding indoor settings as much as possible and wearing masks wherever she can.

But she’s also frustrated Vermont has abandoned its philosophy of community-based behavior, such as masking, to limit Covid transmission and protect vulnerable people. “That messaging was really resonant, especially in Vermont, at the beginning. And now it’s entirely out the window, and it’s entirely an individual’s decision,” she said.

Benjamin has been shut out of conferences and school events because of the lack of Covid precautions, while fewer organizers offer remote options for people to attend. Fewer businesses are now offering takeout or curbside pickup, limiting her ability to enjoy local restaurants.

At the height of the BA.2 surge, Benjamin took her 6-year-old to a doctor’s appointment, only to find the practice had completely dropped masking guidelines without warning. 

“It just makes it really hard to feel safe in any environment,” she said.

Feeling forgotten

Tamara Rice, a Springfield woman with heart disease and a husband with lung disease, said she was similarly anxious during a recent visit to the Department of Motor Vehicles.

Rice had made an early morning appointment, hoping to avoid crowds as much as possible, only to find plenty of people walking in at the same time. 

“I was stuck there for 20 minutes trying not to have a panic attack,” she said.

A health scare in 2019 made her realize just how “fragile” the medical system is in Vermont. So she plans to avoid public places and indoor gatherings for the foreseeable future.

Rice said she feels forgotten. Early in the pandemic, “there was so much online discourse about how, ‘Oh, only the elderly and the sick are at risk,’ like we’re acceptable losses. But I was proud of how Vermont handled that,” she said.

“And then it reached the point where it was just like, ‘We’re done with all of that,’” Rice said. “This attitude that it’s somehow over is what I can’t understand.”

Benjamin said the upcoming closure of state testing sites later this month will also make it harder for her to get “in front of any infection” if she does get sick. Experts and officials recommend that high-risk Vermonters seek antiviral treatment as soon as they test positive for Covid.

Sosin said Vermont’s policy response hasn’t prioritized high-risk Vermonters, and its guidance has lacked the clarity that vulnerable people need to make decisions.

“It’s not surprising that people aren’t comfortable,” she said. “Personal responsibility needs to be coupled with community and institutional responsibility.”

Another new reality

Since the beginning of the pandemic, Vermonters have had to pivot to respond to the new reality of each stage of the virus: The waxing and waning of new surges, hope — and disappointment — with vaccines, and variants that change the basic nature of what it means to get sick.

Looking ahead, experts struggled to predict what the new reality of this summer, and the subsequent fall and winter, would be.

“It’s very hard to know,” Levy said. “The notion from a couple of years ago that we’ll hit herd immunity and everything will dwindle away is clearly not the world that we’re in.”

He said it’s reasonable to expect another wave from the latest subvariants, BA.4 and BA.5. But beyond that, “people need to continue just to be vigilant, be smart about things and be flexible.”

“People need to recognize that there’s times when things are safer, and we can remove some of the layers of protection, and there’s times when things are going to be less safe and we have to increase layers of protection,” whether you’re at high risk or not, Levy said.

Sosin likened previous waves of the virus to tsunamis that slammed into the state, then ebbed again, allowing people to return to some sort of normalcy. But the newer variants are more like “sea level rise” with “higher sustained levels of transmission,” she said. 

In the summer of 2021, vaccines “obliterated” Covid cases and the risk of most activities was truly low, she said. But “we’re in a really different summer.”

“The pandemic is at a very different point, even though we all have more protection,” Sosin said. “The virus has changed. And the tools that we have to control it have changed as well.”