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In South Africa, coronavirus cases were growing with a ferocity that was hard to wrap your mind around. The country counted only 300 new cases a day in mid-November. By mid December, that number topped 20,000.

But after that, the numbers started to fall off a cliff.

Between mid-December and the end of December, cases plummeted from more than 20,000 a day to 10,000. And that happened in only about two weeks.

The decline proved as mind-blowingly fast as the increase had been, prompting the South African government to do away with contact tracing, remove quarantines for asymptomatic people, and eliminate curfews.

In Massachusetts, meanwhile, we’re probably not far behind. In early November, we logged about 1,500 cases a day. On Jan. 6, that daily tally had risen close to 30,000.

In the midst of all of this, hospitals are hurting, schools are scrambling, tourism-related businesses are panicking, and many colleges are back to virtual learning.

But there are signs that — despite all the chaos — the tide is turning.

In the New York City metro area, as the statistician Nate Silver has pointed out, Google searches for “COVID symptoms” have declined in recent days. And even reported case numbers seem to be peaking.

So it’s worth taking a moment — as we edge closer to two years of COVID-related restrictions — to contemplate what’s next.

In the spring of 2020, I would have discussions with colleagues about what we would do “when this ends.”

Two years on, more of us are asking: What if it doesn’t?

About a year ago, the journal Nature asked virologists, infectious disease experts, and immunologists whether they thought the virus would be with us for many years to come (perhaps forever). About 90 percent thought that was likely or very likely.

Yet we still have no long-term plan.

We have largely sleepwalked our way through the pandemic, unprepared to provide our hospitals with PPE, unprepared to test our citizens, unprepared (at least initially) to distribute vaccines. Each variant has sent us scrambling.

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But what if you knew that waves of COVID would wash over your life and the world around you indefinitely? How would you live differently? How should governments regulate differently? And how do you weigh the risks of COVID against the risks of more restrictions?

These are not easy questions. Consider this: If a first-grader came to school wearing a mask in the fall of 2020, should they still be wearing it as a third-grader in the fall of 2022? What level of risk, if any, are we willing to accept to have kids go to school unmasked again?

And once you start to consider not just masks but quarantine periods, mandatory boosters, regulations around restaurants and travel and hotels and museums… the questions mushroom. But we must start contemplating the answers now.

On Thursday, a group of President Biden’s former health advisers wrote in the Journal of the American Medical Association that “a ‘new normal with COVID’ in January 2022 is not living without COVID-19.”

They called on the president to create a new strategy that includes better surveillance of all respiratory viruses, of which coronavirus is now just one. They also pushed for better distribution of tests, high-quality masks, vaccines, and therapies, and clearer use of metrics for understanding when precautionary measures (by individuals or hospitals) should be taken.

Jeffrey Shaman, a professor at Columbia’s Mailman School of Public Health, has noted that comparisons between COVID-19 and the flu — one of the most frequently invoked respiratory viruses — are flawed.

Shaman believes COVID is markedly more “aggressive” than the flu and, as he’s noted on Twitter: “[M]ultiple outbreaks each year, such as we’ve seen during 2021, may be the norm for the foreseeable future. We may find ourselves in a different kind of endemic equilibrium in which boosting is needed every 4-6 months.”

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This, Shaman says, “is a daunting prospect. And psychologically challenging.” (It also seems impossible to jab everyone in the world — or even the country — every few months.)

So, with that as the backdrop, let’s come back to our test-case question: masks in schools. The argument for masks is clear: Disease is often spread through breathing on people, and masks lessen the amount of breathing-on-people that kids do.

The argument against kids wearing masks indefinitely is cloudier: Will it alter socialization to have kids don masks for years? Will it alter relationships with teachers? Will there be any long-term effect of inhaling the disintegrating paper fibers of surgical masks, or the synthetic material that makes up N95s?

And then there’s the question of risk tolerance. Since the beginning of 2020, car accidents have killed about triple the number of children as COVID, but it’s also true that children who contract the coronavirus can spread it to grandparents and others who are at higher risk in the wider community. This might lead to increased hospitalizations and deaths.

Public health experts themselves are divided on issues like masking, some advocating for it in all indoor spaces. Others, like Joseph Allen of Harvard, have argued over the past few months that “It’s time to set firm dates for ending masking in schools.” He noted that, to him, the issue is not “whether masks work. They do. But as with all control measures, there is a time and place for them.”

We will have to confront similarly complex questions when it comes to workplaces — and our answers will be particularly salient for people in hot, active environments (like chefs and waiters), who must wear masks for many hours a day, even when those they serve do not.

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And that’s not even a state-by-state question, it’s town-by-town. Over the past few months, for example, waiters in Foxborough have often not worn masks, while those just 30 minutes away in Boston — which has an indoor mask mandate — have been compelled to.

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We tend to think of coronavirus rules as eliciting a binary response: Some folks are pro-restrictions; some are not. Increasingly, though, we may see breakout factions that are not so easily pigeon-holed.

You’ll have people who are vaxxed and boosted and yet feel fatigued with restrictions, while others who have been more circumspect about getting themselves or their children vaccinated may strongly support the continued use of masks.

The Democratic research firm Equis has found, for example, that the keep-everything-open approach to the pandemic has been notably popular with Latinos, “including liberal Latinos.”

Though public health experts will continue to weigh in, it will ultimately be politicians and other leaders whose rules will most profoundly shape our lives, much as they have for the last two years. And those rules will, ultimately, reflect the will of constituents.

Which is why it’s time to start thinking about what we want the next chapter of our lives to look like, so we can tell decision-makers what’s important to us.

Follow Kara Miller on Twitter @karaemiller.


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