As students walk back into classrooms in the fourth school year amid the coronavirus pandemic, parents may find themselves wondering: When can we stop worrying about COVID-19?

“As we go into our third fall living with COVID, this has been an extraordinary experience for society, for public health departments, for folks that have been most impacted,” said Dr. John Douglas, head of Tri-County Health Department. “It’s been a hugely tragic circumstance. We’ve lost over a million people in the U.S. I think we’ll be learning from this as we go.”

While experts say the pandemic looks much different than it did last year, predictions about what the return of school means in this era of fast-changing variants can be a mixed bag.

“My guess is bringing kids back to school will probably increase (COVID) transmission among kids, but it will probably have a limited impact on the community. Part of the reason I say that is we have so much built-up immunity,” Douglas said, referring to people who have been vaccinated and the unvaccinated who have been infected.

But each COVID variant can behave differently, leaving open the possibility that the virus’s impact across age groups could change, Douglas said.

Meanwhile, the state public health department has continued its loosened approach to addressing COVID risk in schools. And looking ahead, state officials aren’t currently considering adding COVID vaccination to the list of required vaccines for K-12 students for the 2023-24 school year, a statement from the department said.

As many Coloradans continue to return to life as normal, Elizabeth Carlton, an associate professor at the Colorado School of Public Health, emphasized the need to take the virus seriously.

“I think what is challenging is communicating the severity of COVID risk, and it’s not uniform across the population,” Carlton said. She added: “It’s different for different people.”

Colorado still sees ups and downs

Despite the many months of living without broad public health mandates in metro Denver counties, Colorado is seeing much fewer COVID hospitalizations than at the same time last year.

Back in the spring, Colorado hit a milestone: The state saw the lowest number of Coloradans hospitalized with COVID since the start of the pandemic — 77 statewide — on April 12, according to a report from the Colorado School of Public Health.

The low point in hospitalizations arrived even amid the highly contagious Omicron subvariants, and that’s partly because they seem to be less severe than the Delta variant was, Carlton said. Another factor was the rollout of Paxlovid, an antiviral drug that Carlton called “a game changer” for people who are at risk for COVID hospitalization — even though the drug isn’t yet as widely available as she would like.

But like clockwork, hospitalizations came roaring back, reaching 324 in mid-July, according to the state’s COVID website. (Not all patients who are counted are hospitalized “due to” the virus. For some, COVID is a less important or “incidental” finding, such as for patients who are admitted for other reasons but test positive for COVID later. The most recent breakdown showed about 63% hospitalized “for COVID” and about 31% hospitalized “with COVID” in early August.)

And while Colorado’s hospitalizations have come back down after a long plateau — the number was 236 in mid-August — it’s anyone’s guess as to when the next wave will arrive, particularly as school gets underway.

“Sports start again, parents start going back in the office — there’s all this mixing that changes as schools reopen. And that remixing of populations can facilitate” COVID spread, Carlton said. She added: “But we think that immunity is high enough that we shouldn’t see a dramatic spike in cases and hospitalizations.”

At the individual level, though, it’s important to realize that a lot of COVID is still circulating, so it’s a good time for people to make sure they and their families are vaccinated, Carlton said.

Just as the school season arrived, COVID protocols continued to loosen at the federal level, with the Centers for Disease Control and Prevention no longer suggesting people stay home after a virus exposure to see whether they catch COVID. The federal agency is now “recommending that instead of quarantining if you were exposed to COVID-19, you wear a high-quality mask for 10 days and get tested on day 5,” an Aug. 11 news release announced.

In Carlton’s view, “what sometimes gets lost in the messaging” is that the CDC still recommends masking after an exposure — and to stay home for five days if a test comes back positive.

“What we do know is masks are a highly effective tool for slowing the spread of (COVID) from one person to another, particularly if you wear a high-quality mask and both people are wearing a high-quality mask,” Carlton said. A KN95 or N95 mask would count as high quality, she said.

Is it endemic yet?

With some luck, COVID could be moving toward an endemic phase — where the disease is a more regular occurrence.

Douglas, the head of Tri-County Health, broke down the terminology like this: an epidemic is an occurrence of a health problem that exceeds what is expected. A pandemic is when that happens on a global basis.

“Endemic is when things are happening — it could be a high level, could be a low level — but it’s what you expect,” Douglas said.

He added: “I think we are getting to a point where we expect to be living through waves caused by new variants. We expect to (respond) to it with new vaccines.”

New variants could be more contagious and may be either less severe or more severe than earlier versions of the virus, Douglas said.

“I think we’ll know more about endemic stage in the rearview mirror,” Douglas said. He envisions a time when public health officials can look back and notice that the situation hasn’t been changing much — when variants arise but don’t behave much differently from each other.

“I don’t think next spring is an unlikely time frame for us to look back and say, ‘This is probably how COVID’s going to behave,’ ” Douglas gave as an estimate.

And while researchers likely won’t develop a new vaccine for every variant, there could be a new COVID vaccine every year, similar to the flu, Douglas said.

Right now, COVID is much less dangerous than it was, but it’s still affecting society in ways ranging from interrupting kids’ education to driving up the death toll, Carlton noted.

“In a typical year pre-COVID, influenza killed 12,000 to 52,000 people per year in the U.S. … so far in 2022, we’ve had about 187,000 COVID deaths in the U.S.,” said Carlton, who works in the Department of Environmental and Occupational Health at the Colorado School of Public Health.

Strict COVID rules long gone

For this school year, the state public health department signaled it will continue the more hands-off approach to COVID it began a year ago and has since loosened further.

In July 2021, Colorado removed mask requirements for schools and repealed the mandate for school protocols regarding outbreaks and other instances of COVID-19 cases.

That meant that schools no longer needed to adhere to the broad quarantine and isolation requirements in the state’s earlier public health orders. (The state still put forth non-essential guidance for schools.) And state and local public health officials still had “statutory authority to institute quarantine and isolation as needed to stop the spread of disease,” the state public health department said at the time.

In January, the state’s quarantine guidance updated to align with a change in CDC guidance, outlining that students and staff generally don’t need to quarantine if they were up to date on COVID vaccination. For those not up to date, the guidance shortened the recommended quarantine to five days, with five additional days of masking — down from the earlier suggestion of 10 days of quarantine. 

As of August, quarantine in K-12 settings after “routine classroom exposures” is no longer recommended unless it’s part of a strategy put in place at the discretion of the school, district, or local public health agency when COVID cases are increasing, outbreaks are detected or community COVID levels are escalating, according to the state health department.

(Colorado’s August guidance echoes the state’s recommendations back in February, which suggested moving toward focusing less on quarantining of staff and students after exposures to COVID in school, according to a news release.)

“The last few updates to school guidance sought to reduce the burden of quarantine on school-agers and to prioritize in-person learning as tools to prevent severe disease became widely available in Colorado and is aligned with CDC’s recent guidance,” said a statement from the Colorado State Joint Information Center, which takes questions for the health department.

School districts and local public health agencies can make their own decisions as to whether to impose outbreak, quarantine or mask requirements that go beyond what the state mandates.

But in an era where broad mask mandates for the general public are a thing of the past in Colorado — state health officials say they are not aware of any mask mandates implemented at the municipal or county level — local health and school officials are unlikely to take restrictive measures.

Asked whether Tri-County Health Department — the agency that oversees public health for Adams and Arapahoe counties and provides some services in Douglas County — has any school COVID protocols above the state’s protocols, Douglas, said: “We don’t at this point.”

If new variants or bigger outbreaks arise, Tri-County Health could become more active in fighting COVID, Douglas said. But if that happens, the agency would likely take an “educational” stance, he added.

It’s “very unlikely to be anything like mask mandates,” Douglas said.