William Miller, MD
Dialing Back COVID Restrictions
On February 15th, the California wide mask mandate is expiring. This allows people whose vaccinations for COVID are current to be indoors in public without a mask. Unvaccinated persons still must be masked. This does not apply to grade schools, nursing homes, hospitals, clinics, jails/prisons or on public transportation where all persons will still need to be masked regardless of vaccination status.
Because the case rate in Mendocino County is still high and our hospitals in the county are near capacity, although not from COVID, Dr. Andy Coren, the county health officer, issued an order on February 10th stating that the lifting of the masking requirement will not apply to Mendocino County and that the masking requirements for indoor public spaces will remain in effect for all persons. Several other counties in California, including Los Angeles County, have decided to maintain their full masking requirements.
In the past week, ten state governors have joined with Gavin Newsom in announcing that they will end their state’s mask mandates. This will bring the total states without masking mandates to 45. Many states have even gone so far as to enact legislation banning mask requirements.
Our communities remain fiercely divided between those who believe that we should never have implemented any restrictions and those who believe that we have reopened our schools too early to in-person learning. Similarly, the vaccination debate continues to rage. There are those who want everyone to be required to get vaccinated and those who believe that vaccines are not safe and that no one should be vaccinated.
While we still have a way to go before we can put this pandemic fully in the rearview mirror, now is a good time to start having more discussion around how to safely dial back restrictions and other public health measures. We need to loosen these restrictions in a thoughtful way that is neither too quick nor too slow. While some elements of our government may have been sluggish to respond to the pandemic initially, public health and government agencies are now fully mobilized. That much bureaucratic momentum may take time to turn around.
Key to this discussion is to have a clear understanding of where we are in the pandemic, even if we cannot agree on how to respond to it. Here is what we know. COVID is real. Many thousands of Americans have died of the infection and millions have died worldwide. Masks and other measures do reduce the risk of transmission. Immunity is helpful, both from vaccination as well as from prior infection. Omicron is more contagious, but less harmful than previous variants.
At this stage of the pandemic, we need to re-examine how we are reporting statistics around COVID so that we have a more accurate way of looking at our actual situation. COVID has always been an infection with 80% experiencing only mild to moderate illness. Due to the lower virulence of Omicron as well as mounting immunity, both natural and vaccine induced, we are seeing less people with serious illness requiring hospitalization. Hospitalization rates have always been the most important indicator of our situation and that remains true. Furthermore, the justification around most public health measures, especially those at the beginning that were most restrictive, the “lock downs”, were always about avoiding having our healthcare systems overwhelmed.
Thus, nationwide we need to look more carefully at how we are counting COVID hospitalizations. As we have greater spread in the community with less serious illness, we are seeing more people who are being admitted for other reasons and coincidentally found to be positive on screening at admission. These are still being counted as “COVID cases” even if being positive is irrelevant to the reason the patient was admitted. We know that PCR testing can pick up remnants of the virus out to 90 days after an infection, long after a person is no longer contagious. Contrary to a rumor going around, hospitals do not get paid extra for COVID patients and do not inflate the numbers. In fact, the opposite is true, it is more costly to have a COVID case due to the impact on staffing and the requirements surrounding isolation.
The need for accurate case tracking and reporting also applies to people who die of some other cause but who may get counted as a COVID death simply because they tested positive at the time. To be sure, the majority of COVID deaths are from COVID. Nonetheless, we need to refine our way of tracking and reporting these details so that we can make better decisions on how and when to roll back COVID related public health measures.
Anne Molgaard, Director of Public Health for Mendocino County, agrees that our reporting must be both accurate and relevant to where we are at in the pandemic. She and others are working on refining the county dashboard to reflect this. She acknowledges that there needs to be a distinction between hospitalizations for COVID versus with COVID and that the same is true around death reporting. “None of us wants to see public health restrictions go on any longer than they are needed,” she said. “Yet, we also don’t want to remove them until it is safe to do so.” She added that the goal has always been to protect the public’s overall health.