The Biden Administration Killed America’s Collective Pandemic Approach

“Coronavirus case numbers are in free fall; vaccines and, to a lesser degree, viral infections have built up a wall of immunity that can blunt the virus’s impact overall. Several experts stressed that certain aspects of the CDC’s new guidelines are genuinely improving on the framework the country was using before. “The timing feels right to make some kind of change,” Whitney Robinson, an epidemiologist at Duke University, told me.

But protection against SARS-CoV-2 isn’t spread equally. Millions of kids under 5 are still ineligible for shots. Vaccine effectiveness declines faster in older individuals and is patchy to begin with in many immunocompromised people. The chances of serious illness go up in high-exposure settings, too, and the CDC’s list of COVID-risky health conditions remains long. The pandemic has also, since its early days, disproportionately pummeled communities of color and people in low-income brackets—structural inequities that big, nationwide trends can easily obscure. [..]

By the old metrics, nearly all American counties should be masking; under the new standards, that recommendation applies to only about 37 percent, designated orange on the agency’s map, at a “high” COVID-19 community level. In another 23 percent of counties, at the “low,” green-colored level, no one needs to mask. Smack in between, in the 40 percent of American counties currently at the “medium,” yellow-tinted level, some people—if they’re “high risk” or immunocompromised—maybe should? The CDC’s best advice to those people: “Talk to your healthcare provider about whether you need to wear a mask and take other precautions (e.g., testing).” [..]

About a quarter of U.S. residents don’t have a primary-care provider; millions are uninsured. And plenty of people with coverage don’t have the time or funds to seek professional advice on masking, especially if it requires an in-person visit. Plus, health-care workers, already overwhelmed, can’t afford to be inundated by requests for bespoke masking plans. Bertha Hidalgo, an epidemiologist at the University of Alabama at Birmingham, also points out that “a lot of people don’t trust the health-care system,” about masking or anything else, and will simply decide not to ask. Medical opinions can’t be treated as universal gospel either: She’s seen physicians in her state advocate against masking in crowded settings. [..]

Where the CDC leaves us now feels especially disorienting when we consider where most mask-up messaging began: with the idea that masking was an act of communal good—“my mask protects you, your mask protects me.” Now masking is about, as the CDC puts it, “personal preference, informed by personal level of risk.” [..]

A better system was possible, experts told me—one that could have allowed us to stretch our pandemic-weary legs while developing strategies to unite communities and better shield them as a cohesive unit. For starters, the categorization scheme could have loosened far less. The new model recommends universal masking at more than double the community case count of the old one, and only if the virus is starting to fill a consequential number of hospital beds. That pushes higher-risk people to mask solo for much longer before anyone else is expected to join in; the vulnerable, in other words, must bear the brunt of the pathogen’s burden at the front end of every surge. “Asking people to take individual measures to protect themselves is much less effective than whole-community interventions,” Andrea Ciaranello, an infectious-disease physician at Massachusetts General Hospital, told me. Even close contacts of people who are at high risk are told to merely consider testing or wearing a mask until the health-care system is once again feeling the coronavirus’s crush. The focus on super-serious disease also neglects the many consequences of infection that can happen outside of, or prior to, hospitalization, including long COVID; massive amounts of less severe disease, too, can overload the health-care system until it buckles. The goal of blocking transmission, Robinson told me, seems to have fallen off the map. “It looks like reducing hospital overwhelm is all we’re trying to do,” she said.

[..] it’s impractical to use the same thresholds on the downswing and the upswing. When cases are hurtling upward, waiting until hospitalizations are shooting up means waiting “way too long,” she said. One recent analysis, for instance, found that by the time “high”-level protections turn on, it would be too late to stop the nation from hitting 1,000 deaths a day. Donning masks—an explicitly preventative measure—earlier, at the new low-to-medium transition, for instance, perhaps even before, has a much better chance of dampening a surge. Early action would also better safeguard people in high-exposure jobs or living situations, who can end up imperiled on a wave’s leading edge, [Boston University policy expert Julia] Raifman said. [..]

“We should not be moving forward until everyone has the same opportunity to get vaccinated,” [Oak Park, Illinois Department of Public Health director Theresa] Chapple-McGruder, who has a 3-year-old daughter, told me. In her version of the playbook, her community would also need to meet a vaccination rate of at least 80 to 85 percent. Studies modeling infection mitigation in schools, including one led by Ciaranello, have found that fewer on-campus measures are needed to keep transmission under control when vaccine uptake is high. There’s no explicit vaccination-rate requirement in the CDC’s new guidance, [Tufts University infectious disease physician and epidemiologist Ramnath] Subbaraman said. That makes it tough to emphasize the importance of vaccine equity as another marker of a community’s resilience, he added: Disproportionate dosing runs the risk of concentrating harm in vulnerable groups.

There’s nothing technically stopping individual cities, counties, or states from shooting for higher goals themselves. But now that the CDC has slackened its grip, it’s gotten that much harder for everyone else to go stricter, Chapple-McGruder said. Her community—Cook County, Illinois—was marked at “high” transmission last week. Now it’s a calming, green “low,” and no one has to mask. Most local schools are no longer requiring face coverings either, as of this week. That means the risk to a vulnerable person, including her unvaccinated child, is that much higher.”

Full article, KJ Wu, The Atlantic, 2022.3.2