Why some health experts see less value in an L.A. mask mandate right now

As successive waves of COVID-19 swept across the Southland, Michael Matteo Rossi, a 35-year-old filmmaker who lives in Los Feliz, has playfully masked himself when he’s been shopping, eating out or visiting his parents, who are in their 70s .

“I’ve never been like someone who goes into a Walmart without a mask and tries to make a big stink,” said Rossi, who is vaccinated. “I care about respect.”

But now that Los Angeles County may be on the verge of a renewed indoor masking mandate, his feelings have changed. With hospitalizations and deaths well below the peaks of the winter Omicron surge, Rossi said he feels safe mingling maskless indoors with his parents and friends.

His surgical mask, once a ubiquitous accessory, is somewhere in his car. He hopes it doesn’t come back.

It might not have to. Support for renewed mask mandates has also waned among medical and public health professionals. Despite plans by LA County Public Health Director Barbara Ferrer to reinstate a mask mandate as early as Friday if coronavirus conditions don’t improve, others say the value of widespread masking is no longer what it once was.

Thanks to a combination of widespread immunity, effective COVID-19 treatments and a more benign virus, there is less reason to use whatever means necessary to quell the spread of the virus, said Dr. Monica Gandhi, infectious disease physician who conducts public health research at UC San Francisco.

“We are in a very different place in the pandemic,” Gandhi said. “Right now, I don’t think there’s a need for full-scale masking.”

Nothing captures Americans’ complex responses to the pandemic like the strip of cloth we’ve worn off and on for the past 2½ years to cover our noses and mouths.

Constantly changing in its design and effectiveness, the face mask was initially a tool to “flatten” the infection curve until vaccines arrived. It became a condition for schools to reopen and was touted as a measure to protect the elderly and vulnerable. It was a wordless signal of community determination and a vocal touchstone of the fight against government austerity.

On the faces of children, grocery shoppers, politicians and medical professionals, masks have done more than just block the spread of airborne viruses. They muddled our words, darkened our facial expressions, fogged up our glasses and left us with sweaty chins.

In this third summer of the pandemic, it looked like we could finally ditch our masks.

Then came the Omicron subvariant known as BA.5, which sent infections in California to their third-highest peak of the pandemic.

For the past week, Los Angeles County has averaged about 6,000 official coronavirus infections per day. (The number of additional cases identified when using at home is unclear.) That works out to 417 new infections per 100,000 population per week. For this metric, anything over 100 is considered high.

But what a mask mandate brought back to the table was a steady rise in the number of newly hospitalized patients who have tested positive for coronavirus infections.

Two weeks ago, that number jumped to 10.5 per 100,000 residents, which is high enough to label LA County as having a “high” level of COVID-19 community based on criteria established by the Centers for Disease Control and Prevention. A week later, the number had risen further to 11.4 per 100,000.

Should the release of new weekly numbers stay above 10 today, Ferrer’s stated plan is to introduce an indoor mask mandate for everyone ages 2 and up in restaurants, gyms, schools, shared offices, retail stores and a range of other publics would venues.

LA County Department of Health Director Barbara Ferrer at a free rapid COVID-19 testing site in Los Angeles.

LA County Department of Health director Barbara Ferrer announced plans to reinstate an indoor mask mandate if the county’s COVID-19 community levels remain high for two consecutive weeks.

(Genaro Molina/Los Angeles Times)

In recent days, Ferrer has raised the possibility of suspending the mandate if “we see a sustained drop in cases or the hospitalization rate nears the threshold for intermediate” COVID-19 community levels.

Hospitalized patients with coronavirus infections are less burdensome in the BA.5 era, although their numbers remain high. At the Los Angeles County-USC Medical Center, the largest of the county’s four public hospitals, about 90% of infected patients were admitted for something other than COVID-19 — and “virtually none of them entered the ICU,” according to Dr Brad Spellberg, Chief Medical Officer of the hospital.

“It’s just not the same pandemic it was before,” Spellberg said in a virtual town hall for hospital workers this month. “A lot of people have bad colds, we can see that.”

Gandhi said that even a sharp increase in new infections is no longer a reliable indicator of hospital admissions for severe cases of COVID-19.

“We’ve started to see a ‘decoupling’ of cases and hospitalizations,” she said.

This is mainly due to the COVID-19 vaccines. Their ability to prevent infection has diminished as new variants have become less recognizable to the immune system, but they still offer solid protection against hospitalization and death. For the roughly 71% of Americans ages 5 and older who have received at least two vaccinations, vaccination reduced their risk of death six-fold, according to the CDC.

An ever-increasing majority of Americans also have some immunity conferred by a previous infection. In February, the CDC estimated nearly 60% of Americans were infected by that point, months before BA.5 was discovered here in May.

In addition, using the antiviral Paxlovid for the first five days after a positive test can reduce the chance of hospitalization or death by up to 88%. For people with compromised immune systems — an estimated 3% of Americans — prophylactic use of a monoclonal antibody called Evusheld reduced the risk of COVID-19 by 83% over six months; When taken after the onset of an infection, it reduced the risk of serious illness by 88%.

Also, the Omicron variant now dominating the US is less dangerous than previous strains of coronavirus. The CDC has observed that the Omicron variant “generally causes less severe disease than infection with earlier variants.” In fact, a recent study in the medical journal Lancet suggests that the risk of developing long-term COVID after being infected with Omicron is less than half that of Delta.

“The threat Has declined,” said Dr. Jeffrey Duchin, Chief Health Officer of Seattle and King County. “And for that reason, it is less comfortable and less desirable to take steps that are considered inconvenient or costly or philosophically offensive.”

In some cases, health officials still turn to mandate masking out of instinct, Gandhi said.

When new infections increase, “it feels scary for a public health official, and it feels like there’s something they can do,” she said.

But when mask mandates no longer deliver on the promise of reducing hospital admissions and reducing deaths, they will be difficult to defend — especially to an increasingly restless public.

“At this point, we really need to think about public health confidence,” which has been severely eroded during the pandemic, Gandhi said. “That’s a real concern.”

When Rossi heard that LA County had a mask mandate back on the table, he didn’t take the health officials’ words at face value. Instead, he complained to the LA County Board of Supervisors.

“I’m asking as someone who’s from LA [and] done everything to stay safe, DO NOT go back “to mask requirement,” he told them.

Michael Matteo Rossi on a hiking trail in Malibu.

Los Feliz’s Michael Matteo Rossi diligently wore a mask for more than two years but firmly believes that a mask requirement is unjustified at this point in the pandemic.

(Courtesy of Michael Matteo Rossi)

Rossi insists his newfound mask skepticism is shared by friends across the ideological spectrum. He describes himself as an “apolitical person” who respects science and rejects conspiracy theories.

But at this point in the pandemic, he is confident that his age, hybrid immunity to the vaccine and a previous infection, and Omicron’s milder nature protect him from severe COVID. He takes comfort in the fact that his parents are vaccinated and refreshed and are therefore at least six times less likely to become seriously ill or die compared to unvaccinated people.

“This is not summer 2020. It is not winter 2021,” Rossi said. “This is the summer of 2022. This time it’s different.”

https://www.latimes.com/science/story/2022-07-28/why-some-health-experts-see-less-value-in-a-new-l-a-mask-mandate-at-this-stage-of-the-pandemic Why some health experts see less value in an L.A. mask mandate right now

Russell Falcon

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