Twenty-five people on the mid-South Side, in the four lakefront ZIP codes from 35th to 79th streets, died from COVID-19 in the past year, per Chicago Department of Public Health data. That is down from 179 between April 2021 (when vaccines were widely available) and the middle of last March. More than 500 people on the mid-South Side have died of COVID-19 since the pandemic began.

The mass rollout of Paxlovid, an antiviral drug that stops the coronavirus from replicating in the body, has prevented many COVID-19 deaths, even as the disease continues to spread. Vaccinations look to be an annual suggestion, and society has in many ways moved on from the worst epidemiological calamity in a century.

"We're the best that we've been in compared with any of the other anniversaries, with respect to the number of cases we have," said Dr. Emily Landon, the University of Chicago's lead epidemiologist. "We're in the best place that we've ever been in in terms of cases, hospitalizations and mortality. But I think that we may be over-celebrating a bit, because we still have a lot of people who have COVID — many of them may not realize they have COVID — and we still have a lot of people dying of COVID and seriously ill with COVID."

Up to 400 Americans die from COVID-19 every week, including an average of one or two a day in Chicago. They are predominantly immunocompromised, unvaccinated and elderly people. Even otherwise healthy elderly people are dying — especially if they have not been boosted in the past few months, as boosters are more effective in the months immediately after they are given — and the high-risk age is over 50. Though the great majority of Chicago deaths are among elderly people, people in their 30s continue to occasionally die. (Landon did note that most unvaccinated people have had the disease at this point, which means they have some immune advantage.)

Overweight people, who make up the vast majority of the United States population alongside obese people, and those with other medical complications are disproportionately dying. Landon noted that even medical conditions like high blood pressure that are under control are disproportionately coordinated to bad COVID-19 outcomes.

And no matter if someone dies "with" or "of" COVID-19 — with COVID-19 alongside another illness or condition or of COVID-19 alone — if they were not infected with the coronavirus, they likely would not have died, Landon said. Over the coming years, she anticipates studies of how long COVID and what health outcomes are attributable to COVID-19 and which are not.

At the CDPH, Commissioner Dr. Allison Arwady intends to continue on in her role as the mayoral administrations transition, though keeping her on is a decision the next mayor will "obviously" make, she said.

"In the last 12 months, we've learned what it means to 'settle' a bit with COVID," she said. "We've learned that in a year where we've not seen an emergence of a big scary new variant, we are able to adjust responses. Not 'stop paying attention to COVID,' but not need it to be top-of-mind in a way that I think is really appropriate at this point."

A quarter of eligible Chicagoans have gotten the bivalent boosters that came out last Labor Day — more than the national average, but "nothing to be proud about," Arwady said. Less than 45% of Chicago seniors have gotten the booster, which is below the national average. Arwady is most worried about un-boosted older people.

She is also worried about people who are not connected to health care, saying that CDPH is working to get people insured, especially as the end of the national public health emergency looms and many people will have to get reattached to Medicaid. A new city phone number, 2-1-1, now exists to connect people in Cook County to health and human resources, like food, medical care and housing.

CDPH's COVID-19 hotline, 312-746-4835, still operates seven days a week. The Protect Chicago at Home program, through which CDPH administers vaccines and boosters directly in people's houses, still operates on weekends and Mondays.

"That's been a really popular program on the South Side," Arwady said, "so I really want people to know that, even now, even as the emergency ends, you can call 312-746-4835 or you can book online, and we will come to your house free of charge and get anyone over the age of 6 months up to date with their COVID and flu vaccines."

The department has continued epidemiological surveillance work (e.g., testing wastewater for viral levels) and tracking the continual evolution of the coronavirus variants. (Federal pandemic emergency dollars has largely funded that work; Arwady is concerned that the work will end once the pandemic emergency ends.)

"It is always possible" that another Greek-lettered variant will arise, Arwady said. She thinks worldwide variant data is the closest humanity has to a crystal ball to predict COVID-19's future, and she said the fact that well more than a year has passed since the omicron variant emerged "is fantastic news."

"As compared to the first couple of years, it's a whole different game if you're talking about subvariants within omicron. You make a vaccine that is good for omicron, when everything stays omicron, you're in a much better position," she said.

On the other hand, Landon said there are currently no good statistical metrics for long COVID, compared to reliable measurements of COVID-19 hospitalizations and deaths. Long COVID studies are done with people who have identified themselves as long COVID sufferers or of individuals who have study-specific symptoms on their medical charts. Both of these, she said, undercount the number of people who actually have long COVID.

Having had COVID-19 is correlated with later having a heart attack, a stroke, kidney disease or lung problems, and Landon said there are around 20% more patients needing to be hospitalized now than before the pandemic. But Landon said there are no metrics for establishing a solid link between having had COVID-19 and later developing other medical conditions. She anticipates that it will be decades before researchers fully grasp the impact of the disease and the pandemic on overall health in the U.S.

There is some evidence that getting vaccinated somewhat reduces the chance of developing long COVID. Landon also said it is possible that getting COVID-19 at a young age, when the course of the disease tends to be much less severe, correlates with less mortality when individuals get COVID-19 again at an older age. "We know that if you have some prior immunity, it reduces the likelihood that you're going to die of COVID," she said. "I would much rather be getting COVID at age 70 after having had COVID or been vaccinated against COVID as opposed to getting it for the first time with no vaccine protection at age 75."

In terms of immunocompromised people's experiences, Landon, who has rheumatoid arthritis, personally got COVID-19 in December and promptly took a prescription of Paxlovid, meant for people 12 and older with mild or moderate COVID-19 who are at high risk for developing severe COVID-19.

"I did what I could to avoid catching it, but I caught it," Landon said. "I took Paxlovid the very first day I had symptoms. I tested a lot until it was positive, and then I started my Paxlovid right away."

She said the evidence is clear that the less viral replication that occurs, the better, which is what Paxlovid does. At-risk people with COVID-19 who take Paxlovid are doing so to good effect; Landon said she, as a physician, would prescribe it to anyone with COVID-19 who could take it.

"I don't have any evidence that you shouldn't tough it out, but I would give any of my patients Paxlovid who wanted it," she said. "The earlier you take it the better. You want to take it within a few days of the illness getting started. Don't delay. If you've got COVID, you should go and ask your doctor for some Paxlovid, especially if you have any risk factors. But even if you don't, I think you should ask for Paxlovid."

Arwady, for her part, stressed that Paxlovid should be taken as early after an infection as possible.

Landon said discussions will happen this summer among federal regulators about opening up another dose of last year's bivalent boosters to immunocompromised and other high-risk people. She said it is expected that medical authorities will recommend annual COVID-19 vaccines for low-risk people.

For those who want to avoid getting COVID-19 beyond getting vaccinated, Landon advised taking a harm-reduction approach of decreasing risky situations when possible, in part by knowing about local case counts. In times when transmissions trending way up, or when several of your personal contacts are complaining about being sick or have COVID-19, Landon said to be thoughtful about when and where you go without well-fitting masks.

"I'm not saying 'become a hermit, never do anything,' but think twice," she said, suggesting going early to the restaurant when it's less crowded, eating outside or hosting people at home. Service or other public-facing workers can wear well-fitting KN95, KF94 or N95 masks for the best protection.

"Even if you don't wear your mask everywhere all the time, wearing it part of the time makes a difference. And anybody who still doubts whether or not masks work, I don't know what to tell you," Landon said. "Some masks are better than other masks. Masks aren't perfect. Of course you can't wear one all the time. I'm not asking you to be perfect: I'm trying to get you to decrease your risk, not eliminate your risk."

The novel coronavirus is still not seasonal the way the flu virus is. "I think novelty trumps seasonality every time," Arwady said. "In the first few years of this, the virus was just looking for pockets of people to infect. And as you are building more protection as a species, you hopefully will settle a little bit more into seasonality.

"We actually have had some regional seasonality at this point here in Chicago, right? All of the respiratory viruses spread more easily in cold weather: the air is dryer, people are inside more, you're closer together. For all of these structural reasons, we would expect COVID to drop more into that pattern," she said.

Landon said a lesson learned from the pandemic is that indoor spaces need to be better ventilated; she thinks a public discussion should be going on about whether building codes should have better ventilation standards.

"It would improve not just COVID — influenza, all respiratory viruses, and it's better to be breathing not-stale air," she said.

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