The World Health Organization (WHO) first declared the COVID-19 outbreak a public health emergency of international concern (PHEIC) on January 30, 2020, when, outside of China, there were fewer than 100 cases, and there were no deaths. This formal declaration by the WHO has been renewed 12 times, most recently last month the International Health Regulations Emergency Committee advised the WHO that the ongoing COVID-19 pandemic continues to be a public health emergency of international concern (PHEIC) but the world is in a transition point. The White House, on the other hand, announced that COVID national and public health emergencies will expire on May 11.

The reality is, SARS-CoV-2 does not care whether there’s a public health emergency declaration or not. It will just continue to infect people (and animals) and spread which means the animals can become a viral reservoir and potentially breed new variants.

With the only other devastating global outbreak that our generation knows about, the 1918 H1N1 influenza pandemic – we know that over time, those who contracted the virus and survived developed an immunity and life somehow returned to “normal” by the 1920s, but the virus did not magically disappear. The pandemic-level flu virus evolved into just another seasonal flu. Will that be the case for SARS-CoV-2? Maybe. Maybe not. We have learned so much about SARS-CoV-2, the virus that causes COVID-19 since the beginning of 2020 but there are still more things that we need to understand about the virus and the disease especially if we know that we are going to live with COVID-19 for the foreseeable future.

Besides the political polarization around COVID and the spread of misinformation and disinformation that we are still experiencing every day, one of the major challenges for understanding COVID is that all the scientific information came to us like drinking from a firehose and we were not even sure if what we were drinking was potable or lethal and all the science happened under a 24/7 spotlight. Before COVID, scientific research only reaches the public after it has gone through a series of review, scrutiny, and evaluation – this was completely the opposite for COVID.

What are the things many people still do not understand about COVID?

COVID-19 is airborne. Long-distance airborne transmission of SARS-CoV-2 happens in indoor settings such as restaurants, workplaces, and venues for choirs; therefore, good ventilation is essential. Wearing masks and washing hands matter, but ventilating indoor environments with fresh air is important too.

Masks work to reduce the risk of spreading COVID-19, despite a recent Cochrane review saying they do not. This review combined randomized controlled trials (RCTs) where face masks (cloth masks, surgical masks) or respirators (i.e., N95) were worn part of the time with RCTs where they were worn at all times (“continuous use”).

COVID-19 can cause an ongoing, sustained inflammatory response for up to 8 months following even mild-to-moderate infection. Chronic inflammation is not good; therefore, it is still important to avoid getting infected, especially if one is an older adult or with other chronic medical conditions such as diabetes, hypertension, obesity, and other diseases.

COVID-19 is associated with a 66 percent higher risk of developing new-onset diabetes. Of course, association does not mean causation. Still, we now know that even after a mild SARS-CoV-2 infection, those who had COVID-19 have a greater risk of developing diabetes compared with those who never had the disease – more research is needed on this, but this is certainly another important reason to avoid getting infected in the first place.

COVID-19 is a respiratory disease, but it is also a disease of the vascular system. The virus can inflame the lining of blood vessels in both the young and old and can cause blood clotting. COVID-19 damages the heart and can cause sudden strokes in young people.

COVID-19 increases the risk of neurological and psychiatric disorders: cognitive deficit, dementia, epilepsy, or seizures up to 2 years after the infection.

Three years after, we have come a long way – we have several safe and effective vaccines that work despite the newer variants, we have antivirals and therapeutics that cut the risk of hospitalization and death, and we understand the virus more, but COVID-19 is still a threat, over 1,000 people still die globally (a far cry from the height of over 16,500 a day) and some questions remain. Nevertheless, we can live responsibly with COVID-19.

Melvin Sanicas is an infectious disease physician.