San Francisco Chronicle, February 17, 2022

The crisis phase of the 2-year-old coronavirus pandemic is winding down in California, and the state on Thursday announced its strategy for coexisting with COVID in the long term — relying on generally less restrictive and more fluid public health measures to tackle future surges.

The plan unveiled Thursday marks a profound shift in California’s approach to the pandemic, not so much in the details of the new strategy — which relies largely on familiar tools like vaccines and masking to deploy as needed — as in the tone of optimism about the state’s ability to manage the virus in the long run.

“We are smarter two years later; we are more adaptable,” Gov. Gavin Newsom said at a news briefing in San Bernardino County. “We are more capable to understand the nature of this disease, and we recognize with humility that we don’t know what we don’t know. But we have never been more prepared for that future. It is in that spirit of optimism that we now move into a new phase.”

California is the first large state to release a long-term COVID strategy, as pressure mounts on federal, state and local leaders to ease away from treating the pandemic as a public health crisis and lean toward a less aggressive and more sustainable approach.

Thursday’s announcement came the day after the state lifted its universal mask mandate, one of the last public health restrictions still in place — though state officials said masks will remain an important tool and could be required again if circumstances shift. They will remain mandatory in California K-12 schools through at least the end of the month, but the state said earlier this week it seeks to announce on Feb. 28 a date for lifting the school mandate.

Several European countries are dropping some of their most restrictive COVID responses, including mask, testing and vaccination requirements. In the United States, health officials have said the nation is moving out of its crisis stage in the pandemic.

Still, federal and state leaders have been plainly wary of declaring an end to the worst of the pandemic, especially after reopening much of the economy last summer only to be hammered first by the delta surge, followed closely by omicron. California dropped almost all of its pandemic restrictions on June 15, then had to reapply many of them — including mask mandates — just a month or two later.

The new strategy announced Thursday was issued “not in the pomp and circumstance of a celebration,” said Dr. Mark Ghaly, secretary of the California Health and Human Services. “We lead into this next stage with humble confidence. We move into the next stage smarter than we ever have been before.”

At the tail end of the omicron surge, California may be facing a virus that is now endemic, health officials said. The coronavirus is well established, and potentially circulating in more predictable waves and at a level that can be managed by pulling public health levers that don’t upset daily living.

The state’s new plan is called “SMARTER” — an acronym that stands for shots, masks, awareness, readiness, testing, education and Rx, which is shorthand for treatments. The plan does not describe COVID as endemic or even use that word, but addresses how California will respond to a virus that “will remain with us for some time, if not forever.”

The strategy is focused around vaccination and boosters, testing, mask-wearing, surveillance of the virus in communities, keeping resources at hand to quickly respond to new surges, keeping schools open, and improving treatments and access to them.

It calls for creating a task force to improve indoor air quality statewide, and for California to lead the nation’s first large longitudinal study to assess the long-term physical and mental health risks associated with the pandemic. It also includes a new education effort to attack misinformation and disinformation campaigns that have plagued the pandemic response; the state already has created “myth-buster” videos.

California promises as part of its endemic strategy to keep a stockpile of masks and over-the-counter coronavirus tests, and develop a surge plan to provide 3,000 additional health care workers within three weeks as needed.

The plan does not rely on specific health metrics — such as case numbers or COVID hospitalizations — to guide future responses, because those targets will probably shift over time and depending on the variant of the virus that is circulating, health officials said.

A critical piece of the state’s long-term COVID strategy will be surveillance, and in particular monitoring for variants, then quickly determining what threats they pose. Future variants may call for more or less aggressive responses, Ghaly said.

“We may need to be talking one day down the road about masks again, or about ensuring people have a test. Or we may need yet another boost in our immunity to stay protected,” Ghaly said. “We really hope that the tools in the toolbox are many, but the ones we end up having to use are few.”

Newsom, speaking Thursday from a warehouse in Fontana holding stockpiles of protective equipment, recalled the earlier, more chaotic days of the pandemic in underscoring how far the state has come.

He was the first U.S. governor to order his state to shelter in place in March 2020, and throughout the pandemic has overseen some of the most restrictive large-scale control measures. California is among only 13 states still requiring masks in all K-12 schools, Newsom noted.

The governor said he’s not yet ready to lift all of his executive emergency orders, dozens of which remain active. But the response now has shifted away from beating COVID to living with it.

“We have all come to understand what was not understood at the beginning of this crisis — that there is no end date,” he said. “There is not a moment where we declare victory.”

Dr. Robert Wachter, chief of medicine at UCSF, said California’s lead in drafting a long-term COVID response is a remarkable moment in the pandemic.

“All of our brains have been pickled with anxiety for two years,” Wachter said. “We are entering that space where we have to change our mindset, and not respond to this as an emergency, but respond to this as a new state of our normal being.

“The state is putting its nickel down that we are moving to a new phase. I think this is quite a reasonable blueprint for what comes next.”