This new strategy means using different metrics as the basis for COVID-19 restrictions. In a vaccinated population, the relationship between case counts and hospitalizations has been uncoupled. Because so many vaccinated individuals may test positive for COVID-19 with few or no symptoms, the number of infections in a community no longer predicts the number of hospitalizations or deaths. This uncoupling means that we should no longer focus on the number of COVID-19 infections as predictive of the need for lockdowns, physical distancing, or mask use. Instead, we could follow the path of Singapore which changed their metrics from cases to hospitalizations in September for both protecting the country’s population and to avoid unnecessary harm to the economy, which in turn, has a direct impact on health. A similar path was recently embraced in Marin County, California. If public health officials tie policies to hospitalizations, not cases, the media’s obsession with case counting will likely abate and help refocus attention on serious illness alone, as spelled out here. With this sharper focus, our time can be better spent on vaccinating the unvaccinated and boosting as soon as possible the most vulnerable, such as residents of nursing homes, persons over age 65, and those with chronic health issues. However, this new strategy highlights the need for the CDC to increase its tracking and reporting of severe breakthrough infections by the health status of individuals so that the most vulnerable can be rapidly identified and prioritized for life saving treatment, such as Paxlovid and other powerful antiviral therapies.

Protecting those at risk of severe breakthroughs also means the end of blanket mask mandates. Our adult population has had access to highly effective vaccines for almost a year, and more recently, all children ages 5 and older became eligible for vaccination. Use of N95, KN95, KF94, or even double masking, should be encouraged among select high-risk populations, but perpetual masking of entire populations is not sustainable or necessary. Our children, the demographic group at lowest risk of serious COVID-19 illness, continue to endure more hours of uninterrupted masking than higher risk adults. This strategy would mean making child masking optional at 12 weeks after the last school-age child became eligible for vaccination.