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Peter Millard is a family physician and epidemiologist living and working in Belfast. Michael Howard is an emeritus professor of philosophy at the University of Maine. He is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the Bangor Daily News every other week.

As the federal COVID pandemic emergency ends, we in Maine can congratulate ourselves for a job well done. Maine had one of the highest COVID vaccination rates in the U.S. and  one of the lowest age-adjusted death rates. Maine hospitalization rates for COVID have now fallen to the lowest level since last year.

The pandemic phase of COVID has now ended, but we are not out of the woods. COVID has now become an endemic disease, which means that it will continue to haunt us, especially in the winter months when respiratory viral diseases like influenza peak. COVID will remain alongside influenza as a potentially fatal disease that we must protect ourselves against in the future. In the U.S., we continue to see 200 to 300 deaths per day from COVID and will probably do so for the foreseeable future. Annually, that’s still about double the death rate of the worst flu season since 2010.

Epidemics are a force of nature, like other natural disasters, and we will very likely see new epidemics and pandemics in the future. Viruses that transmit via the respiratory route are always concerning, since we all share the same air. How can we apply the lessons of the COVID epidemic to ongoing issues with COVID, influenza and future viral epidemics?

First, the rapid development of vaccines is essential. We were able to develop safe and effective vaccines for COVID very quickly, because the mRNA technology had already been in the works for many years. Like the influenza virus, the COVID virus mutated rapidly and vaccines were not good at preventing infection via the mutated strains, but were very effective in preventing serious illness and death. Unfortunately, very elderly and seriously immune-compromised people were not able to mount an immunological response to the vaccines, and, as a result were vulnerable and continue to be vulnerable to COVID.

Likewise, effective medications were developed rapidly, and they continue to be effective at preventing serious illness and death in high-risk people. Unfortunately, people who were not vaccinated and decline medications will continue to die from COVID.

Improved ventilation, masking, and social distancing were quite effective at the beginning of the COVID pandemic. Since we continue to have a substantial proportion of the population who are not vaccinated or at very high risk, they remain important preventive interventions in the appropriate settings.

Although the risk of transmission in outdoor settings has never been directly tested, it is very unlikely that transmission does occur outdoors, so precautions can be “cast to the wind” outdoors.

Indoors, we still need to worry about breakthrough infections among the vaccinated, as well as infection among the unvaccinated. Although reinfections may confer some additional immunity, they may also increase the risk of “long COVID” — a catch-all for an array of symptoms, sometimes disabling. Symptoms may emerge soon or months after the initial illness, including heart, lung and neurological conditions.

To further reduce the risk of reinfection, individuals can mask in public places, encourage others to mask and, as Dr. Rambod A. Rouhbakhsh recommends in an interview for the American Medication Association, “If you’re getting together in a big gathering, say a wedding, graduation or big holiday event with lots of family members, it’s also a good idea to get tested and ask people to get tested. …. Now that tests are ubiquitous, you can pre-screen yourself before you get together if you don’t want to get together with masks on.” Continued government subsidies for masks and test kits would send the message that COVID is still a public health menace and should be taken seriously.

Because long COVID is a chronic disease, even small numbers of ongoing cases may potentially result in long-term disability for millions of Americans. The National Institutes of Health is sponsoring research in Maine to better understand the implications of long COVID in order to develop strategies to better treat it. In the meantime, prevention is our best medicine.