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California is officially shifting gears when it comes to statewide COVID-19 protection measures, becoming the first US state to announce an endemic-based approach. Centered on prevention and rapid response to outbreaks rather than mandates and shutdowns, the new plan could be a look into the future of COVID-19 measures across the US. So what’s different about it, and what does it mean for the rest of the country?

Announced on Feb. 18, California’s endemic plan is called SMARTER, which stands for Shots, Masks, Awareness, Readiness, Testing, Education, and Rx (forms of treatment for COVID-19) — the pillars of the state’s evolving approach to the virus. Specifically, goals include increasing vaccination rates (especially among children); stockpiling tests, masks, and personal protection equipment (PPE); tracking cases and quickly identifying new variants; and using education to combat pandemic misinformation. With these initiatives, the state will begin “moving past the crisis phase into a phase where we will work to live with this virus,” California governor Gavin Newsom said in a press conference on Thursday. Along those lines, California recently lifted indoor mask requirements and plans to set a date for ending mask requirements for children in schools.

Rather than simply removing these measures, California seeks to replace them with a forward-thinking plan that addresses the virus as a less powerful but still active threat. In other words, it seeks to treat COVID-19 as an endemic disease — still present in the community but increasingly manageable as collective immunity increases. During the press conference, Mark Ghaly, MD, MPH, California’s secretary of health and human services, explained that California will adjust its approach based on how the virus changes over time. If the virus’s symptoms become more severe, the state will monitor infection rates; if the virus begins spreading more quickly, it will keep an eye on hospitalization rates and respond accordingly.

This endemic plan is the first of its kind in the US, but it also feels like the logical next step, experts say. With California’s case numbers dwindling, “the timing is right on,” said Jeffrey Klausner, MD, MPH, an epidemiologist at the University of Southern California, in an interview with NPR. Strict testing and surveillance of the virus, along with advanced vaccination and treatment measures, “make it appropriate to shift our response from a pandemic response of trying to do everything possible, to a more rational response to try to implement things that we have strong evidence that work,” said Dr. Klausner.

It’s no secret that approaches COVID have varied across state (and sometimes city and county) lines since the start of the pandemic, but California’s plan may offer a glimpse at a sustainable way forward. The state was the first to implement a lockdown in March 2020 and has maintained a “thoughtful approach” to the pandemic, said Robert Wachter, MD, professor and chair of the Department of Medicine at UC San Francisco, in an interview with the San Jose Mercury News. While Newsom has been criticized for the state’s aggressive approach to the pandemic and his own maskless outings, Dr. Wachter noted that California has the “lowest per-capita death rate of any large American state.” He said he was “impressed” by the plan, which applies lessons learned in the past two years to create “the smartest possible approach to this rapidly evolving threat.” NPR reports that other countries are beginning to take an endemic approach to the virus as well.

As the shape of the COVID-19 crisis continues to evolve, we may see more plans that similarly maintain guidelines and remove mandates one by one while aiming for a shift back to some degree of normalcy. “We move out of the pandemic phase, and we move into a phase which should allow confidence that we are not walking away,” Newsom said during the press conference. “That we’re taking the lessons learned, and we’re leaning into the future.”

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