At Kaiser Permanente Moanalua Medical Center we recently held a ceremony to commemorate the third anniversary of the start of our COVID-19 experience in Hawaii. We thanked the many hospital staff who’ve cared warmly for so many sick patients and memorialized the people we’ve lost to this still-evolving virus despite our best efforts.

As another milestone approaches — the official end of the COVID-19 national public health emergency is on May 11 — it’s an important time to take stock and anticipate what the future might bring.

As an infectious disease physician who has spent much of the last three years caring for COVID-19 patients, it’s striking how much more manageable things are now at our hospital relative to the heights of the delta and omicron waves.

From a scientific standpoint, there’s a growing consensus that COVID-19 has evolved from a global pandemic to become endemic in the U.S. — a part of our lives, going forward. Thankfully, a wall of widespread population immunity (a mixture of vaccination, boosters and prior infection) has held up well since the omicron surge in early 2022, preventing significant spikes of COVID-19 hospitalizations and death in Hawaii over the past year.

However, as eager as we are to declare the pandemic “over” and collectively move on from the virus, several areas of genuine concern remain.

First and foremost, it’s vital to acknowledge the lingering debility experienced by the growing number of patients with long COVID, a collection of difficult conditions we’re only beginning to understand. At Kaiser Permanente Hawaii we have an excellent clinic dedicated to helping patients with long COVID, though it has been a challenge to keep up with the demand. It’s increasingly clear that we’ll be dealing with the serious clinical consequences of this virus long after it has faded from the headlines and our collective consciousness.

Secondly, it’s crucial to recognize that while deaths from COVID-19 are less common now, SARS-CoV-2 remains a particularly lethal virus and continues to kill 300-400 Americans per day at a steady clip. The fact that most of these deaths from COVID-19 are now in the elderly and immunocompromised make them no less necessary nor urgent to prevent.

Lastly, there remains the very real possibility of SARS-CoV-2 making a sudden evolutionary leap in coming months or years, sidestepping our collective immunity and causing new waves of severe infection. The currently circulating subvariants differ from the original Wuhan strain of the virus by only around 1% of their genomes, leaving lots of room for SARS-CoV-2 to maneuver. Being ready to respond requires working on improved vaccines and treatments along with substantial investments in our public health infrastructure.

As a physician, father and son, I’m grateful for where we are now in our COVID-19 experience relative to where we’ve been. But this virus remains formidable despite its growing familiarity. So — if you haven’t received a booster since last September when the new bivalent boosters were released, please do so; it might mean the difference between a manageable flu-like illness and something much worse.

Also, please remain thoughtful around kupuna and those with weakened immune systems; they remain at real risk for severe COVID-19. And if you become infected yourself, reach out promptly to your doctor to see if treatment makes sense, even if your symptoms are mild — don’t wait until you’re very sick, as you may have missed the window for effective treatment.

We’ve come a long way in three years, and I’m proud of how well Hawaii has fared during the pandemic. Let’s stay smart, remain ready for whatever may come next, and take care of one another.

Tarquin Collis, M.D., is chief of infectious disease at Kaiser Permanente Hawaii.