August 26, 2024 – On a warm July evening, Raleigh Rivera, 29, went to see a band play in a backyard in East Los Angeles. The audience – about 40 people – wore KN95 or N95 masks maskswere tested for COVID beforehand and agreed to apologize to the rest of the crowd if they had to remove their masks for any reason. Before playing, the band showed their negative test results to the attendees and asked for permission to play without masks. They were illuminated by far-UV lighting, which was shown to safely kill airborne viruses.
It might sound like a scene from three or four summers ago, when most health officials, policymakers and community members were encouraging people to take precautions against COVID-19. But it happened this summer. For Rivera and the rest of the crowd, who identify as COVID-19 aware, life is not “back to normal,” as it is for so many others.
Rivera and others on the COVID watch have reason to be alarmed: In early August, the percentage of people testing positive for COVID hit its highest level since January 2022, according to CDC Data. The public health agency wastewater testing tracking tool shows “high” or “very high” virus levels in most U.S. states.
Many studies Studies have shown that wearing a mask can provide additional protection against COVID-19. But Rivera, like others in the COVID-19 awareness community, is usually the only person wearing a mask in a given setting.
“Continuing to think and live this way feels like you are permanently living in an alternate reality,” she said. POTS (postural orthostatic tachycardia syndrome), a chronic blood disorder that can cause your heart rate to increase if you stand up. In addition to masking up everywhere she goes, Rivera and her husband have air purifiers throughout their home and use a saline nasal rinse and one antimicrobial mouthwash before going out.
Despite her vigilance, Rivera contracted COVID in the fall of 2023. She immediately took Paxlovid, but was struck by overwhelming fatigue that incapacitated her for a few weeks, she said. After she recovered, her POTS symptoms — which can include fatigue, dizziness and nausea — worsened. She is only just starting to regain her appetite, almost a year later.
“Everywhere I go, it’s still a matter of calculating risk. But at this show, I felt like my body could finally relax,” she said. “I felt very present and part of something in a way that I haven’t been able to experience in a long time.”
Local governments in cities like New York and Los Angeles have considered imposing mask ban – primarily in response to protesters wearing masks at rallies to conceal their identities – regardless of the summer surge in COVID cases.
“It takes a lot of self-confidence,” Rivera said. “It takes away some of my social value. I know there are places I’m not invited to anymore because (wearing a mask) either makes people feel weird or makes them depressed because I’m going to have this reminder of the pandemic on my face.”
For Rivera and others, the responsibility for protecting the community seems to fall largely on those with compromised immune systems. One of their biggest concerns is the lack of masks in medical settings. While some health systems have brought back Since the numbers started to climb again, many have not done the same.
Aaron Friedberg, MD, a professor and internal medicine physician specializing in long COVID at The Ohio State University Wexner Medical Center in Columbus, wears a mask in all clinical settings, even though the hospital no longer requires it.
“There are still people getting very sick from COVID, although it’s much less common now,” he said. “To me, wearing a mask is a relatively simple step I can take to improve their health. It’s an important way to show respect for your patients, to protect them.”
Dr. Bernard Camins, an infectious disease specialist at Mount Sinai Hospital in New York City, also understands the concern. The hospital is still seeing many COVID patients, he said, but vaccinated and inoculated hospital staff don’t tend to see transmission of the virus because they continue to wear the proper personal protective equipment.
Olivia Belknap, an associate marriage and family therapist in the Los Angeles area, is aware of COVID-19 and sees many clients with similar concerns. She says being aware of COVID-19 involves a lot.
These days, many might consider COVID precautions to be extreme, but Belknap herself (who was also diagnosed with POTS after a COVID infection) and some of her clients still aren’t comfortable with the idea of getting on a plane or eating outside on a restaurant patio. She sees clients who aren’t ready to set foot inside almost anywhere other than their own home.
“The majority of my clients have reached out to me because they know that no matter how careful they are, I’m not going to pathologize them or discourage them from doing those things,” Belknap said. “It’s more about finding meaning and connection in your life while doing things in a way that works for you and makes you feel comfortable.”
Belknap said it’s not her place to tell people they’re being too cautious or too lax in their precautions. Sometimes, she works with clients who are afraid to take the first steps toward easing their own restrictions; other times, she talks to people who are struggling to come to terms with what it means to have a significantly reduced social circle for what could be the rest of their lives.
Even though the rest of the world seems to have moved on, the concern is valid for those whose lives could be upended by a post-viral reaction to a COVID infection, Camins said.
“It may not be death, but it’s still disabling. You’re alive, but it’s not a pleasant way to live your life,”
While it’s more than justified to protect yourself from potentially life-changing symptoms of COVID-19, Camins said there is a potential downside for people with weakened immune systems: They could get sicker from other viruses than before.
“The only thing I worry about for this community is that because they’re being very cautious with COVID, they’re probably not being exposed to other viruses that their bodies can build immunity to,” he said. “At some point, if you let your guard down, you’re going to get sick a lot.”
There are times when Rivera wants to forgo the mask altogether, like when she attends a wedding. She still goes often and takes the time to do her makeup, even though she knows most people won’t see her face for most of the evening. She’d like to be able to take her mask off indoors, eat inside without worry, or have drinks with friends.
There could be a future for Rivera that doesn’t include the same level of precautions she’s taking now — but it comes with conditions.
“There are places where I know I will continue to wear a mask forever, like in medical settings or when traveling,” she said. “But I also know that there will be no more weddings for me if I am permanently and significantly more disabled than I already am, and that is very possible if I get infected again.”
