COVID-19 case numbers are declining, but some who are most vulnerable to infection say conditions are getting more dangerous for them.
Governments and businesses are dropping mask requirements across the country, and the Centers for Disease Control and Prevention is relaxing its masking guidance — moves welcomed by many who yearn to return to life as it was before the pandemic.
But the pandemic is far from over for people with weakened immune systems and chronic conditions that make them susceptible to serious complications caused by COVID-19.
To them, it doesn't make sense to abandon mask requirements as a preventive measure when the virus is still circulating and a new variant could fuel another surge in cases.
"I think we have this notion that just because the numbers are getting a little bit lower or businesses are hurting for money that now we can be more relaxed and we don't have to wear a mask," said Kimberly Shoemate, whose daughter Raelen has sickle cell disease. "Whatever decision we make not only affects us today, it will affect our future."
An estimated 7 million to 10 million Americans have weakened immune systems, including transplant recipients, cancer patients and those with autoimmune disorders in which the body's immune system attacks healthy cells. Many others with chronic conditions, including sickle cell disease, kidney disease, heart disease and diabetes, also are at risk for COVID-19 complications.
Mike Zontelli, who was born with kidney disease, received a kidney transplant four years ago at 50. He always has been careful about his health and became a vegetarian 20 years ago.
Like other transplant recipients, he takes medicine that suppresses his immune system. Without it, his body would attack and reject the donated organ. So even before the pandemic began, he had to pay attention to hygiene, prepare his food in a way that didn't make him sick and limit his exposure to others during flu season.
"I have this terrible immune system so you always have to be careful," he said.
When COVID-19 arrived, he limited contact with others to "a very small bubble." His daughter quarantines before she visits his home. He's had some socially distanced small gatherings with friends in his driveway and even bought a film projector so they could have movie nights.
When he has to visit Mayo Clinic for two days of tests, he asks the hotel to give him a room that has not been occupied recently. He brings air filters, switches them on and leaves the room for 15 minutes before re-entering.
"You have to think about all this crazy stuff that you never would have thought of before."
He's been vaccinated against COVID-19 four times. Because he is enrolled in a study, his antibody levels are checked after every shot. There were no antibodies after his first two shots, and he loses about 50% of antibodies about three months after subsequent shots.
"Really my only risk factor is if my wife got it," Zontelli said. She is an eye doctor and "is taking every precaution possible," including eating lunch in her car and installing air filters in her office and exam rooms.
With little protection from the vaccine, Zontelli said he and his wife will be more at risk without indoor masking requirements that prevent transmission of the virus.
"It is crazy that it turned into something political," he said. "I had someone give me an organ and people complain about having to wear a mask. It is just hard to understand."
Dr. Dorry Segev, a professor and transplant surgeon at Johns Hopkins University in Baltimore, faulted authorities for ending mask requirements without considering risks to those who do not "have fully intact immune systems."
"Scientists are saying let's proceed with caution slowly with cautious optimism while the policymakers are completely throwing caution to the wind," he said. "It almost feels worse and more dangerous than it did a year ago because everyone now has this false sense of safety and security."
Segev said the risk of a COVID-19 breakthrough infection in a fully vaccinated transplant patient is 82 times higher than in the general population, while the risk of hospitalization or death in a transplant recipient is 485 times higher.
"For most people they don't see this as something that might kill them but for the immunocompromised it very well might," he said. "That is why people are worried. That is why we should care."
Janice Eason's daughter Kali received a double-lung transplant when she was 10 months old. She's now 15 years old and has "beaten the odds."
"She is doing incredibly well, which is one of the reasons we always have been and especially now with COVID, are extremely careful," Eason said. "Because we were given this gift of life, we don't want to be reckless."
Although Kali has had four doses of the COVID-19 vaccine, it still is not enough to prevent a COVID-19 infection. So, Eason and her daughter live most of their life together in quarantine.
"Unfortunately [the vaccine] is really not offering her the protection that it is offering the rest of us," Eason said.
Friends and neighbors, even people she doesn't know, have been supportive, picking up prescriptions, delivering groceries and even raising money to cover Eason's lost wages and health insurance costs.
Now she hopes that generosity extends to wearing masks.
"Masking was at least a barrier, putting one on her will help but putting it on other people will at least be another layer," she said.
"It is all about trying to do what is best for your child and also having empathy about others. What would you do if this was your own child?"
