Despite what we had hoped, the pandemic rages on. Here’s what you need to know for the coming months…

More variants on the way. As they replicate, viruses frequently undergo structural changes, most of them harmless but some of which make the virus more contagious or more severe. The World Health Organization (WHO) monitors the variants that potentially pose an increased risk to global health. There now are more than a dozen such variants—not just Alpha, Beta, Gamma and Delta, but also Eta, Iota, Kappa, Lambda and several more that haven’t yet been labeled with Greek letters. And there’s one called Delta Plus, recently found in Texas, which has a different spike protein than the original. This is no surprise, but rather evolution in action. Viruses always mutate, and new strains develop when they are not sufficiently kept in check.

Vaccines are safe. Many among the anti-vax crowd have been loud in their claims that the COVID vaccines are dangerous. But we now have a robust, well-reviewed study of nearly two million people, published in The New England Journal of Medicine, that concludes this vaccine is extremely safe.

Herd immunity appears out of reach. Viruses are opportunistic and behave like parasites, needing human bodies to survive. Imagine a party where some of the guests are vaccinated and some are unvaccinated. If any of the guests are infected, regardless of their vaccination status, they can potentially spread the virus to other party guests. But in an infected guest who is vaccinated, the virus is more likely to be inhibited from replicating enough to either cause clinical disease in that person or to spread to others. We had hoped that once enough people received the vaccine, the virus would effectively run out of opportunities to spread and largely disappear. Sadly, not enough people are getting the shot, nor does it look like they will. Result: The virus will continue to circulate, mutating as it goes.

We’ll all be getting boosters. It appears that the effectiveness of the vaccines begins to dwindle after about eight months, so you can expect a rollout of booster shots similar to the way the vaccines were first distributed last spring. Bear in mind that the first boosters, like the original vaccines, will be aimed at the Wuhan strain from last year, not at the Delta variant. Pfizer and Moderna both are working on next-­generation boosters to target Delta—they likely won’t be ready until next year. Meanwhile, be assured that the current vaccines do provide considerable protection against the variant.

Your vaccination card will be important. Don’t just stash it away. For now, keep it with your passport and get ready for a time when you will need to show it to enter many public places and events. (Depending on where you live, you may already be required to do so.) The cumbersome paper cards used in the US don’t fit well in wallets and are embarrassingly low-tech, but unless and until the government develops an electronic version, you’ll have to care for your card as best you can. Caution: Don’t laminate it—it’ll need to be updated with booster information. You might consider a plastic sleeve to protect it. If you lose your card, the place where you received your vaccination is the most likely place to get a replacement.

Schools will struggle. We’re already seeing fights over mask mandates, even as we’re seeing lots of sick kids and quarantining. There appears to be little appetite for a return to virtual learning, but the debate over masks will continue. The irony is that, if masks were a good idea last year, they’re an even better idea now, since the Delta variant is so much more contagious than the original. We’ll likely see masks return in the localities where Delta hits the hardest but not until the worst damage has been done.

New treatments may prove effective. A drug treatment called EXO-CD24, developed in Israel, has made it through a Phase II clinical trial in which 93% of seriously ill patients were discharged from the hospital within five days. That’s encouraging, but we’ll need more and larger studies. A placebo trial could be completed by the end of the year.

A note about ivermectin: The WHO says the studies that we have now  about ivermectin, dismissed by many as “horse pills,” are not as large and rigorous as they would need to be to conclude that ivermectin is safe and effective against COVID. Currently, most of the medical establishment thinks it is not.

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