Schedule Those Doctor's Appointments! : Short Wave The pandemic is at a turning point. Hospitalizations in this country are down. Deaths are starting to decline. Some of the states that have had the strictest COVID restrictions are starting to dial back. With fewer cases, and more tools to manage COVID, we can start putting more focus on other diseases again. Doctors are encouraging patients to get the checkups they've been holding off on.

NPR science correspondent Allison Aubrey talks about the future of masking, virus detection and routine preventive care that has been ignored during this pandemic.

Email the show at shortwave@npr.org.

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EMILY KWONG, HOST:

You're listening to SHORT WAVE...

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KWONG: ...From NPR.

Hey, SHORT WAVErs. It's me, Emily Kwong, with science desk correspondent extraordinaire Allison Aubrey. Hi.

ALLISON AUBREY, BYLINE: Hey, Emily. It's good to be here.

KWONG: We have a lot to get through. Let's start with some good news. I have learned from your reporting that the number of new confirmed coronavirus cases has dropped by about 75% since the start of February.

AUBREY: Yeah, I think we're at a real turning point. I mean, hospitalizations are also down, and deaths are starting to decline. So some of the states that have had the strictest COVID restrictions are starting to dial back.

KWONG: Yeah, but the data doesn't tell the whole story. And, of course, mask mandates are being lifted in many regions across the country. So what does this all mean? Are we going to see a huge drop in infections this spring? What are you looking out for?

AUBREY: That is certainly the direction we're headed at the moment, so hopefully this trend continues. And with fewer and fewer cases and more tools to manage COVID - not just vaccines, but also medicines - we can start putting more focus on other issues again, such as preventing lifestyle diseases and paying attention to preventive health. Doctors are really encouraging patients to get those checkups they've been holding off on.

KWONG: So today on the show, Allison and I talk about the future of masking, virus detection and routine preventive care that you may have ignored during this pandemic. You're listening to SHORT WAVE, the daily science podcast from NPR.

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KWONG: OK, let's rip the Band-Aid off and start with masks. Allison, the CDC just advised people to wear N95 masks, to, like, up their mask game. Now they're considering loosening or lifting mask recommendations. What gives?

AUBREY: I just think the landscape is changing so quickly. I mean, as we said, cases are down by about 75%.

KWONG: Yeah.

AUBREY: That's just since the start of February. And perhaps more importantly, the number of people hospitalized with COVID around the country is down by about 40%. CDC Director Rochelle Walensky says this is a key metric. This is beginning to see that hospitals are no longer overwhelmed. So as these trends continue to move hopefully in the right direction, the agency's reevaluating.

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ROCHELLE WALENSKY: We want to give people a break from things like mask-wearing when these metrics are better and then have the ability to reach for them again should things worsen.

KWONG: Ability to reach for them again - sounds like she's saying that masking could come back if there is another, let's say, variant or just a big rise in cases.

AUBREY: You know, I think that's the seed that's being planted. I mean, the agency and all public health officials and infectious disease experts want us, the American public, to understand that COVID isn't going away. We're going to have to...

KWONG: Yeah.

AUBREY: ...Learn to live with it. So, you know, again, in the future, if there is some kind of outbreak, mask-wearing might be advised again. You know, but many cities and states have already lifted their mask requirements for now. And given the high level of pandemic fatigue two years into this, polls show only about half of Americans say they're masking regularly. So governors and local leaders are in this tough spot of kind of having to stick to the science, but also meeting people where they are.

KWONG: Yeah. One place where the people meet that's been marked by controversy is schools. What is the CDC saying about mask-wearing in schools?

AUBREY: Dr. Walensky has said, for now, the CDC is sticking with the recommendation to keep masks on in schools...

KWONG: OK.

AUBREY: ...Though some states have already lifted or set dates to lift requirements. And there really are some differing opinions among infectious disease experts about this. I mean, some say there's not much benefit of kids masking if the wider community is not, especially if children aren't wearing high-quality masks. Other experts say, hey, with so many kids unvaccinated, keep the masks on, given the virus is still circulating.

KWONG: OK, so what are teachers and pediatricians saying about this debate?

AUBREY: I think there are varying opinions. In California, a teacher's union pushed back against the idea of lifting masking in schools. The state has lifted its broader indoor mask mandate, but for now, the masking remains in schools, and state authorities say they're going to reevaluate this at the end of the month.

KWONG: OK. And like you said, among kids, the vaccination rate is still pretty low, right?

AUBREY: That's right, especially among younger kids. Only about 24% of kids 5 to 11 are fully vaccinated now. It's higher...

KWONG: OK.

AUBREY: ...For older children and teens. And then for kids under 5, parents are still waiting for vaccines. New clinical data from a trial is expected sometime this spring. But given this slower timeline, some experts say it's another reason masking is still helpful in young children.

KWONG: And, of course, we still have a federal mask mandate in place in places like airports - obviously, if you get on a plane, you still got to wear a mask - trains, other transportation hubs.

AUBREY: That's right. I mean, the TSA mask mandate is in effect through March 18.

You know, it's unlikely that masks will completely disappear after this. I mean, though masks have become kind of one of the fault lines in the culture war in the country, if you take away the politicization and you just look at the science, there's a lot more evidence on just how effective high-quality masks, such as N95s, can be against the spread of COVID and other respiratory diseases, too. That's why Dr. Judy Guzman of Oregon Health & Science University says, going forward, seasonal masking could become the norm in certain situations.

JUDY GUZMAN: Before the pandemic, we would see outbreaks in classrooms for all sorts of viruses and actually even bacteria - like, things like strep throat. So maybe during outbreaks of things like strep throat in a classroom, adding masking to the response plan could certainly be very effective.

KWONG: OK, so masking in some form may stick around. What about other systems that were put in place early in the pandemic to slow the spread of the virus?

AUBREY: You know, I think the way that we are alerted to outbreaks or exposures in our own communities will be forever changed by this pandemic. I mean, early on, the term contact tracing was brand-new to most people - this idea that public health workers would reach out to people who tested positive and then to their contacts to try to contain the spread. You know, at one point in the pandemic, the U.S. had about 70,000 people doing contact tracing. For instance, in Teton County, Wyo., contact tracers were actually able to reach out to every person who tested positive, and this county has had a pretty low COVID death rate.

KWONG: It's cool hearing about what happened in Teton County because it really shows what can result when you prop up a contact-tracing program in a community.

AUBREY: I agree. I mean, that was a big success story there. And, you know, right now, many contact-tracing programs are scaling back or coming to an end just because of the stage of the pandemic that we're in at the moment. But now there's an infrastructure in place, so it'd be possible to bring this back in some form in the event of another outbreak.

KWONG: Absolutely. And speaking of systems used to detect outbreaks, there is another way scientists have in their arsenal for detecting the virus that's been kind of fine-tuned during the pandemic. Tell us about that.

AUBREY: That's right. It involves our collective sewage.

KWONG: Gross, but cool.

AUBREY: Amid the pandemic, scientists have turned to surveilling wastewater because, A, everyone goes to the bathroom and, B, it's a way scientists can detect if the amount of virus is rising or falling within a community.

KWONG: So are they basically, like, taking samples of community wastewater?

AUBREY: Yes, everything from literally going down manholes to get samples at specific locations in cities to using samples collected at wastewater treatment facilities. I spoke to Aaron Packman. He's an engineer at Northwestern. And he told me that the pandemic has really ushered in a really big investment in wastewater surveillance, which has helped public health officials standardize the data coming from sewage.

AARON PACKMAN: This is a really efficient way to get kind of a quick snapshot or an approximate snapshot of infections that may be prevalent in a community.

AUBREY: He says this really should and could be expanded even further.

KWONG: And is anyone using wastewater surveillance to look for new variants?

AUBREY: Absolutely. I mean, this is - as we just said, this has taken off. So, you know...

KWONG: Yeah.

AUBREY: ...From Chicago to San Diego to Houston, I mean, scientists have been able to start keeping an eye on, you know, new strains, new variants of concern. Right now, the variant of concern is the BA.2, which is a relative of omicron. It's said to spread about 30% more easily than the original strain, which was already highly contagious. So this strain - there's some concern that it could slow down the declines that we're seeing now.

KWONG: Yeah. Yeah, that new variant is concerning. I do like the idea that flushing for the pandemic could be a uniting force for all of us.

So just switching gears, Allison, I wanted to talk about preventive health care. You'd be very proud of me. I went to the doctor to get my annual physical the other day. Hadn't gone in a while because, I think like a lot of people, with all the focus on COVID for the last two years, I've kind of fallen out of the habit. And I think that's true for a lot of people. It's easy to let cholesterol checks and even cancer screenings go by the wayside.

AUBREY: That's absolutely the case. I'm glad to hear that you made it, that you went in for that well check.

KWONG: I did.

AUBREY: That's great. But the pandemic really has had a chilling effect on prevention measures. And there's some new data showing the impact of this delayed care. Take mammograms, for example. Fewer people have had them, and now when breast cancers are detected, they're more likely to be detected at a later stage.

KWONG: That's a problem because detecting breast cancer later puts patients at a risk of worse outcomes.

AUBREY: That's exactly right. I mean, just looking at a new study from the University of California San Diego, they found that prior to the pandemic, 64% of breast cancer patients were diagnosed at stage 1. That's the earliest stage. But that dropped down to only about half, to 51%, in 2020.

KWONG: Oh, that is a big drop in those earlier detections. Is this trend of later cancer detections being seen nationwide?

AUBREY: Yes, it's been seen in a lot of places. I spoke to Connie Lehman. She's director of breast imaging at Massachusetts General Hospital. And she said they have seen the same trends, both delays in imaging and finding cancers at later stages, which she says is very concerning.

CONNIE LEHMAN: The very good news about breast cancer is when we detect it early, we cure it, which is why we have so many women that are breast cancer survivors. However, when we diagnose breast cancer late, it's a very different story. The treatment is much more aggressive. And unfortunately, the percentage of women that will die goes up dramatically when the disease is diagnosed at a late stage.

KWONG: And what about other cancers? Has the pandemic led to a similar effect when it comes to early detection?

AUBREY: Well, screenings are way down nationwide. I mean, one of the largest studies using this huge medical record database found a decline in screenings for colon cancer, lung cancer, prostate, bladder cancer. For instance, compared to pre-pandemic levels, colonoscopies, the key way to detect colon cancer, dropped off by 45% early in the pandemic.

KWONG: Whoa.

AUBREY: Now this has rebounded some, but this can explain fewer diagnoses.

KWONG: Well, if you're out there listening, no more waiting. Make those appointments. Get those mammograms. Get those colonoscopies. Because I care about you. So...

AUBREY: That's right. I mean, I should probably just point out, cancer screening typically starts around age 40. Colonoscopies are now recommended at beginning at age 45. And, yes, I agree. Make those appointments.

KWONG: This is why we have you on the show. Thank you so much for coming on, Allison.

AUBREY: Thank you, Emily. It's good to be here.

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KWONG: This episode was edited by Jane Greenhalgh and Stephanie O'Neill. Eva Tesfaye produced, and Katherine Sypher checked the facts. The audio engineer was Patrick Murray. Gisele Grayson is our senior supervising editor. Neal Carruth is our senior director of on-demand news programming. And Anya Grundmann is our senior vice president of programming. I'm Emily Kwong, and you're listening to SHORT WAVE, the daily science podcast from NPR.

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