The pandemic we have been experiencing over the last few years has begun to evolve in ways that we have all noticed. Communities are now considering how best to navigate life with endemic COVID-19.

More tools than ever before are available to help us better understand and assess the burden of COVID not only in our communities, but also on our communities. We are also armed with preventative efforts to protect ourselves, our families, and our communities.

In DC, this means a transition away from tracking COVID community transmission to instead tracking COVID community levels. Dr. Anjali Talwalkar, Chief Science Officer at DC Health, told WTOP the reason for that transition was to recognize the tools we now have, compared to previous phases of the pandemic, which put the community in a better position to combat it:

1.) Vaccines that prevent severe disease

2.) Therapeutics or medications that help prevent progression to severe disease

3.) A sufficient supply of tests

4.) A sufficient supply of masks.

“While we always want to limit transmission and limit infection, our primary goal now with the tools that we have are to prevent severe disease, prevent hospitalizations, and to prevent death and lives lost from COVID-19,” said Dr. Talwalkar. “And at the same time, also to preserve the capacity of our healthcare system. To make sure that system doesn’t undergo any strain so it can treat not only COVID-19, but also all the other conditions that people have to get care for, many of which have gone unchecked over the last two years, because there has been less preventive care, less routine care.”

The change from tracking community transmission to community levels allows DC Health and other community health organizations to become laser-focused on preventing severe disease and protecting the healthcare system. But while this transition puts us in a different phase of the pandemic, it does not mean COVID-19 no longer poses a threat. The virus is here to stay, and Dr. Talwalkar says it is another risk among many we learn to deal with in our day-to-day lives.

As it relates to community levels, there are three different categories: low, medium and high. Currently, DC’s community level is considered low, and there are three different indicators that help to determine that:

1.) New cases of COVID-19 per 100,000 (weekly rate)

2.) New hospital admissions for COVID-19 per 100,000

3.) The percent of staffed, in-patient hospital beds that are occupied by COVID-19 patients

“These three indicators give us a good sense of the burden of the disease on the community, of the capacity of our healthcare system, as well as how much severe disease we are actually seeing,” said Dr. Talwalkar. “Looking at those three indicators, we look at whichever one has the highest measure. There are thresholds set by the CDC for each of these measures, and then we look at these three values or numbers in combination and determine the level from that.”

Over the course of the pandemic, we’ve witnessed trends, the high-highs and the lows. But the question becomes, how do we identify where we are headed before we get there? And the answer, as it turns out, is hidden among community levels as they creep up and down the scale.

“Built into these levels is a bit of a runway—going from low to medium to high—that progression when we look at the values, we can see, ‘Oh it tends to take a few weeks before you have hospitalizations after you see an uptick in cases.’ So that going from low to even medium, you have some runway where you can prepare for, ‘Oh, our cases are a little bit high; it’s possible our hospitalizations will go up,’ and hospitals can prepare accordingly,” said Dr. Talwalkar.

But each new variant is also different. For example, with the current variant, there isn’t as much of a connection between cases going up and hospitalizations automatically going up, like we saw with previous variants. Staying on top of trends with most recent variants will give insight into the advance notice we can expect with these measures themselves.

As for what kind of precautions to take, that is based on community levels, which then dictate guidance for masking indoors in public settings. The recommendation from DC Health when community levels are low is that you don’t have to wear a mask indoors in public settings.

At a medium community level, the recommendation is that the general public still doesn’t have to wear a mask in public settings, but those who are at higher risk for severe disease, should wear a mask indoors including older residents, especially those over 65, as well as those with underlying or chronic conditions and immunocompromised individuals.

When a community level reaches high, the recommendation is that the general public, along with those at higher risk of severe disease, should all mask up. Keeping track of these community levels and knowing whether you should mask or not is the most important way to keep the youngest, oldest and most vulnerable members of the community safe and protected.

“The way that we protect our youngest residents in particular, who aren’t eligible for vaccination, is first and foremost to get vaccinated ourselves. That’s the recommendation on every level—be up-to-date with your vaccinations, and then masking as appropriate to the level,” said Dr. Talwalkar. “Of course at any time, with any level, people are always free in the District of Columbia and everywhere to choose to wear a mask for their own personal preference, their own personal tolerance of risk.”

For more information on community levels and information on COVID-19 in DC, visit coronavirus.dc.gov.

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