Chicago residents are starting to see the end of yet another major COVID-19 surge, with cases dropping nearly 50% in the city in the past week. The recurring question on many minds remains: What happens next?

Health experts around the country are probing that exact question as the highly contagious omicron variant, which resembles the flu in many vaccinated adults, begins to wane.

But what a potential post-omicron world looks like, what will be expected of us and what we expect from government officials to manage future outbreaks are complicated questions, with a lot of variables and unknowns. Will we keep masking, and for how long? Are proof of vaccine mandates the way? Now that most of the city is vaccinated, what do we do next?

It’s something local leaders are looking for answers to as well. At a recent Chicago City Council committee meeting, Ald. Maria Hadden, 49th Ward, posed this question the city’s top doctor:

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Is the goal still to “stop the spread” of COVID-19? Or, are we transitioning to a new pandemic phase?

Dr. Allison Arwady’s answer pointed to the latter.

COVID-19 is expected to return “sort of consistently here,” said Arwady, the commissioner of the city’s public health department. “At some level, this is … What is it going to look like to live with COVID?”

Although Chicago is at the tail end of the peak of the omicron surge, the city is not completely yet out of the woods. On average, 137 people are still being hospitalized with COVID-19, with 18 people dying from the virus each day. And those statistics are not spread evenly. In Chicago, African Americans and older residents are still being hit hardest by COVID-19.

That makes it difficult to fathom having a conversation about a new living-with-the-pandemic phase. But Hadden contends that if we are indeed moving that way, Chicagoans need more information about what to do, aside from getting vaccinated, in order to stay safe and protect others.

“I think it’s a huge part of what we’re missing,” she said. “So this is not saying ‘Hey we shouldn’t be having this conversation.’ [But] I don’t see this conversation happening, and I think it’s causing a lot of cognitive dissonance.”

The endemic times

There is some hope, among public health experts and some physicians on the ground, that the massive surge of the omicron variant has a silver lining: increased immunity among those who have not been vaccinated.

“With people who are not vaccinated, who are not changing their mind no matter what about vaccination, getting infected with a less severe strain will get us some immunity at the community level,” said Dr. Zaher Sahloul, a pulmonologist who treats the most severe COVID-19 patients at Saint Anthony Hospital in North Lawndale and Advocate Christ Medical Center in Oak Lawn.

“So that trajectory is probably good from a public health perspective,” he said. “Although many physicians will not say that, because we’re still seeing a lot of patients who are not vaccinated in the hospital.”

“I think probably a few months from now, we’ll have a higher level of natural and vaccine-related immunity that will reduce the impact of new strains or next surges,” he said.

But there are major caveats – the obvious one being that countless people will be hospitalized and may die in the meantime.

“Those folks in the hospital, if they recover, they’ll probably have some pretty good protection for a little while here – like that’ll help, right?” Arwady said. “But that is a very dangerous way to have more protection against Chicago. And by our estimates, there’s still something like half a million Chicagoans who have neither had a vaccine, nor had COVID yet. And those folks now are at extraordinarily high risk.”

In addition, there’s no telling how long that natural immunity will last, with some research showing it may be just three months, Arwady said. Meanwhile, the longer the virus is able to circulate, new, and potentially deadlier, variants can arise.

“Omicron will not be the last variant you’ll hear us speaking about,” said Dr. Maria Van Kerkhove, with the World Health Organization in a social media post about the future of the coronavirus.

“The big question is whether or not future variants will be more or less severe,” she said, and whether vaccines will be less effective against those variants.

Plans for “flexible” mitigations

Chicago officials are preparing for what surges could look like in the future.

For instance, if the virus were to wane into a less deadly version of itself over time, officials could start tracking COVID-19 each year similar to how they track influenza, Arwady said. Currently, CDPH does not track every single case of the flu but instead analyzes samples to help understand which strains will be dominant in the upcoming season.

Keeping flexible mitigations in place – such as instituting mask mandates when surges occur – could also be a new norm, Arwady said.

“I could imagine something where when respiratory viruses of whatever kind are surging, there’s a recommendation for people with certain underlying conditions to wear masks in certain settings,” she said.

Arwady went on to allude to making other restrictions more flexible in the future, like requiring proof of vaccination for non-essential activities only when surges emerge.

“What does it look like to control surges? And that’s part of this larger conversation around what is essential? How do we protect it?” Arwady said.

Post-vaccine protections

But even as Chicago officials prepare for sporadic COVID-19 surges – surges that many hope will be less severe – everyone should keep their eyes on the prize of preventing them entirely, said Dr. Emily Landon, an infectious disease expert with the University of Chicago.

“Getting used to having regular surges like this is exactly the problem,” she said.

If we mistakenly accept surges as inevitable, she said, and do less to protect ourselves and others, but instead “blow (surges) off as something that’s just part of the ‘new normal,’ the more they’re going to come.”

On the individual level, she said, Chicagoans have more control over whether they get infected than they might think, by continuing to mask, social distance, avoid crowds and wash hands as much as possible, even when people are fully vaccinated and boosted.

And on a public health level, Landon contends officials – locally and nationally – need to do more during surges to mitigate spread. She said that doesn’t necessarily mean with a full-blown economic shutdown, but perhaps utilize updated resources and flexible mitigations, including for those who are fully vaccinated and boosted.

“I can understand not wanting to close down all businesses over omicron,” she said. “But what I don’t understand is why we don’t want to give people better masks, why we don’t want to make sure everybody has tests … I don’t understand why we don’t want to limit occupancy in places where people have to be unmasked.”

In a statement, the Chicago Department of Public Health points to multiple online resources with guidance on gathering, travel, and “managing your health” for residents who are vaccinated and unvaccinated.

And indeed, there have been more efforts from the government in just the past few weeks to distribute better masks and free home test kits. Chicago aldermen recently received a total of 1.5 million KN95 masks (proven to be more effective at preventing spread) to distribute to residents, though Chicago is home to 2.7 million people. Free COVID-19 tests are now available from the federal government through the U.S. postal service. And just on Friday, Walgreens announced it would distribute free N95 masks at some Chicago-area locations, and, the state announced a new program backed by The Rockefeller Foundation to distribute another 225,000 test kits to certain high-risk ZIP codes.

How some Chicagoans view the pandemic matters

A less tangible but perhaps equally important measure, though, is messaging to Chicago residents about how to move forward during the pandemic, aside from getting vaccinated, Landon and Hadden said.

“The more we focus on individual risk assessment … saying ‘if you’re vaccinated you’re good to go and you don’t need to worry about it anymore’ – the more we’re going to have these resurgent variants coming through,“ Landon said.

In other words, Chicagoans need to continue to care about COVID-19 rates among unvaccinated people, regardless of whether people are unvaccinated.

It’s a difficult message to continue to push, as the country faces the start of a third year of the pandemic and residents are fatigued. And officials only have so many tools to try to persuade vaccine-hesitant people to get the shot. In addition to pushing the science or cash incentives, officials have been trying to convince people to get vaccinated by allowing more freedoms for those who do it, making continued restrictions for vaccinated residents difficult.

The idea of protecting people who choose to be unvaccinated is a message some residents are simply sick of hearing.

Take Old Town resident Mary Von Goeven, who was headed to lunch on a recent afternoon, mask in tow. She said she’s doing what she needs to keep herself safe but is no longer worried about those who choose not to get a shot.

“If they’re unvaccinated they deserve [to get COVID],” she said. “It sounds heartless but I really don’t [feel bad] because they have a choice and they’re choosing to get sick.”

Lisa Klein, who said she’s still being cautious by wearing a mask and avoiding crowds was clear: her precautions were not to protect people who are unvaccinated by choice.

“I’m not worried about them, I’m wearing it for me,” she said. “There are some people who are more vulnerable health-wise even if they’ve been vaccinated, so I would wear it for them. But frankly I am not interested in spending resources – hospital resources, health care resources – on people who have not been vaccinated and are passing on conspiracy theories … at a certain point I just don’t feel sorry for them.”

Hadden said attitudes like these are the ones public officials must confront as the city moves toward an uncertain future. That’s particularly true for as long as there are people who cannot get vaccinated due to medical reasons, and kids under 5 are not eligible for the shot.

“The unvaccinated are not a monolith, right? This whole ‘crisis of the unvaccinated’ or ‘it’s mostly unvaccinated [contracting COVID]’ – it’s an othering that I think is very dangerous,” Hadden said. “People who are unvaccinated are our neighbors. Whether they’re unvaccinated by choice or by circumstance.”

Mariah Woelfel covers Chicago city government for WBEZ. You can follow her at @MariahWoelfel.