Remember the spring of 2020‚ 18 months ago, when the word Covid had just entered our vocabulary. Many of us did not work or attend school, isolated ourselves from friends and sanitized our groceries. The future was unclear and the lack of information was frightening.

While we are still not living in normal times, things have evolved. We are less fearful. We work, attend school and see family and friends. The great majority of us over the age of 12 are vaccinated. But if our fear is perhaps lessened, our uncertainty is not. The question before us now is how should we think about the next months? How do we keep ourselves and the most vulnerable members of our community safe? To what degree can we return to our “lives as normal”? Fundamentally, what can and should we, as individuals and community members on Martha’s Vineyard, do?

How optimistic should we be by the weekly case rates of 20 or lower these last weeks especially in comparison to the case rates in August and September? We should be encouraged by the positive changes, but unfortunately these lower case numbers are not guaranteed to continue in the face of both the natural flux of the disease and anticipated upcoming holiday gatherings.

Let’s first examine the nature of the virus. In looking at a graph of weekly cases on Martha’s Vineyard it is clear that weeks of low cases are followed by significant and persistent increases. This same pattern has been seen all over the United States and much of the world. We do not really know why the cases decline and then increase again. It is as if Covid has a mind of its own. If we can lower our present rate of disease to a few per week, immunize more of us including children ages 5 to 12, and maintain adherence to masks indoors maybe the surge we fear after the holidays will not happen or be minimal. But we should also prepare ourselves for the possibility of a more challenging outcome — we can hope for the best, but be prepared for worse.

Of all of the factors to be considered, immunization is the most important. Studies now show the immunized are six times less likely to be infected if exposed and many more times less likely to become seriously ill. State statistics show immunization rates for Martha’s Vineyard of 98 per cent, but this is incorrect because those statistics use a population of 17,000 which is too low. The 2020 census of Martha’s Vineyard is 20,000 and I am quite sure that the actual population is even higher if we include those not counted by the census and those who have recently moved to the Island as year-round residents. That suggests that there are still a few thousand residents eligible for vaccination. This means that many of us are still at high risk of becoming seriously ill and infecting others.

With the new CDC approval of childhood vaccination it is likely that we will vaccinate most of the 1,200 children ages 5 to 11 years old. But how can we encourage the remaining unvaccinated adults to be immunized? The most effective mechanism to get a high percentage of an adult population vaccinated is employer mandates. Nobody likes mandates, but they work. While it is understandable that those who have declined vaccination so far do not wish to be compelled to do so, these vaccines are remarkably safe. They protect the person vaccinated, their families, friends and the elderly.

Along with vaccination, masking is protective of both the wearer and those around that person. To be frank, wearing a mask all day is unpleasant, but masking makes a difference. Great Britain which has a high vaccination rate but at present no requirement for masking has had a new resurgence of Covid. Martha’s Vineyard has mandated indoor masking as have many other places throughout the world. Leaving it up to the individual is not effective. Many have noticed that off-Island, even on the Cape, fewer people wear masks in stores. Most people will follow a norm and if the expectation is that one wears a mask in a store, it will generally be followed. The signs on the doors of our grocery stores do make a difference. Wearing a mask protects those who work in the stores and restaurants and not just the customers. Our children are required to mask everyday in school. They are doing their part to keep their classmates, their teachers and their families safe.

On the topic of schools, as the school year began we all worried about spread within the schools, but so far this has not occurred, which is not true for many communities throughout the country where schools have become Covid hotspots. We may have been lucky so far but the school requirement of wearing a mask as well as programs of asymptomatic testing, and “test and stay” of exposed students appears to be working. The Massachusetts Department of Education has wisely extended their mask mandate until Jan. 15.

The theme here seems to be that by being willing to do difficult things — vaccinating and masking — we have been able, at least for now, to stem the tide of Covid on the Island. To continue the trend we need to increase our vaccination levels. If you or someone you love is not vaccinated, please consider doing so for yourself and those around you. If you have questions or uncertainties, please reach out to your doctor or nurse or your town board of health agent.

Unfortunately Covid is not going away, but the last six weeks are encouraging. Islanders have worked hard to get us to this point, and I believe that with continued community-minded action we may be able to further reduce our rates of infection and limit the impact of future surges.

Dr. Henry Nieder is the former chairman of primary care at the Martha’s Vineyard Hospital. He retired in 2018.