California Gov. Gavin Newsom (D) on Thursday announced the state's "SMARTER" strategy, the first state-issued plan that aims to take an endemic approach to the coronavirus.

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Covid-19 restrictions continue to be lifted at the state level

Following the easing of Covid-19 restrictions around the country, on Thursday, New Mexico Gov. Michelle Lujan Grisham (D) announced the state would be immediately lifting its indoor mask mandate, including its mandate for schools.

Also on Thursday, Washington Gov. Jay Inslee (D) announced the state would be lifting its mask mandates, including for schools, at the end of March.

With those two announcements, Hawaii is the only state left in the country that has yet to issue a plan to lift any Covid-19 restrictions, the New York Times reports. Puerto Rico, the United States' largest territory, has also not announced any plans to lift its mask mandate.

California issues plan for endemic approach to coronavirus

As cases continue to drop in California, Newsom announced the state's plan to move towards an endemic approach to the coronavirus, called the "SMARTER" strategy, which stands for "shots," "masks," "awareness," "readiness," "testing," "education," and "Rx."

While the plan doesn't explicitly describe the coronavirus as "endemic," it outlines how the state will handle a virus that "will remain with us for some time, if not forever."

As part of the plan, the state will maintain the ability to administer at least 200,000 Covid-19 vaccines and 500,000 Covid-19 tests each day, and it will stockpile 75 million high-quality masks. The plan also promises to develop a strategy to provide an additional 3,000 health care workers within three weeks, if necessary.

The state will also continue its wastewater surveillance and  analyze at least 10% of all positive Covid-19 tests to track potential new variants and emerging trends. School-based vaccination sites will also be expanded by 25%, the plan states.

The plan also calls for the creation of a task force to improve indoor air quality, a large longitudinal study to determine the long-term health risks associated with the pandemic, and an education effort aimed at dispelling misinformation and disinformation regarding Covid-19.

California Health Secretary Mark Ghaly said specific health metrics used to determine future responses to the virus will vary, as some variants may require focusing on case rates while others may require focusing on hospitalization rates.

If a surge of Covid-19 cases occurs in an area, the plan says officials will analyze test samples to determine whether a new variant is present, and if so, determine whether the variant is more likely to infect vaccinated people or those with natural immunity.

Then, state officials would deploy tests to areas seeing surges in cases as well as medical workers to hard-hit areas, and work to ensure people in surging areas are aware of what's happening and how they can best protect themselves. Ghaly and other health officials also suggested it may be appropriate to reimplement restrictions, such as mask orders, again in the future to keep hospitals from becoming overwhelmed.

"We are moving past the crisis phase into a phase where we will work to live with this virus," Newsom said.

"We move out of the pandemic phase and we move into a phase which should allow you confidence that we are not walking away, that we're taking the lessons learned and we've leaning into the future," he added.

Jeffrey Klausner, an epidemiologist at the University of Southern California, said he believes the timing of Newsom's announcement "is right on."

"Surveillance, testing, vaccination, and treatment make the context very different and 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," he said. (Falconer, Axios, 2/18; Allday, San Francisco Chronicle, 2/17; Money/Lin II, Los Angeles Times, 2/17; Colliver, Politico, 2/17; Thompson, Associated Press, 2/18; McCarthy, New York Times, 2/18)