This afternoon the CDC provided on- and off-ramps for public health mitigation measures (like masks) going forward. The CDC made it clear that the sole purpose of the new framework is to prevent severe disease and, thus, not overwhelm hospital systems at the local level.
I just feel so consistently let down by the CDC's (and our country as a whole's) clearly expressed view that people at high risk -- like me and my family -- are disposable. I have no idea how effective my 3x vaxxed and N95-wearing self will be against more and more people unmasking (especially since I work directly with the public) and I just feel so left behind.
I'm not high risk and I feel also kicked aside by the mob stampeding to the "It's over!" exits. It's not over, but good fitting N95 masks will protect you. The harder part is that as more and more infected people are around, you really have to be super careful with hand hygiene and mask handling so that you don't infect yourself. The bright side is that all of these overly optimistic people are going to be getting infected at rates high enough that we might all end up protected as the virus runs out of new hosts. I thank these people in advance for their service.
Thank you, as always. As a higher risk person, I was dismayed at the acceptable level of community transmission that served as their cut off, and I so appreciate your acknowledgement that high risk people deserve consideration prior to serious illness.
I'm astounded at the very high level of infection that the CDC found acceptable. Especially knowing that many people are using home test kits, it is outrageous to use 200 cases/100k as their criteria for not masking. I would have thought that would be no more than 50 cases/100k. I've been very frustrated with the CDC throughout the entire pandemic and have lost the respect I had for the organization. I liked the framework that you developed in an earlier post. I have high risk kids, so I'm very cautious anyway.
Mostly on the same page as you, but one quibble. Do home tests really result in undercounting? It seems like this requires making counterfactual assumptions about what people would be doing if they didn't have access to rapid tests. Would they be investing the time (and risk of being quarantined) if they didn't have access to rapid tests? My hunch is that they wouldn't. So it would end up being a wash.
Of course. I think mainly I bristle at the way the speculation is directed at individual home testers themselves, rather than the system as a whole. I also think there should be options available to people who want to be able to share their results for statistical purposes, without being required to disclose them to employers, airlines, etc. People who go through the trouble of getting home tests, when it's not required, should be presumed trustworthy.
When I consider all that we have gone through as health care workers over the past two years - our patients and friends often struggling with illness and sometimes dying, being revered and reviled for our advice, being trusted and suspected when we urge caution, and the deferred reckoning with how awful these two years have been on the front lines - wearing a little mask is such a small issue for me.
As always I appreciate your cogent updates, and sample them along with a smattering of my own insights for my patients (and a few extra readers along the way).
Thank you for reminding us all to take a breather when we need it. We've been head down, trucking, without a lot of joy.
I too am quite hopeful for a great Spring in comparison!
I will not be following much of anything uttered by CDC unless it happens to coincide with common sense. They have been such a disappointment. The mask stays on until the fire is out. There's no meal, no gym, no yoga experience worth long covid or the preceding "mild" or asymptomatic case. I can wait. In fact, that is my plan. I'm going to let everybody else go ahead and take off their masks. At some point, their infections are going to leave the virus with no place to go. That's when I'll take off the mask. Not a moment before.
I'm not sure I'm comfortable going unmasked with cases at, say, 150+ per 100k in a week (as they were here last week). I still very much like the "Riding the waves" framework that you developed last week. Are you abandoning that in favor of the new CDC guidance, or do you think that your proposal still has a place among those risk-adverse and lucky enough to have the flexibility to implement it?
I've thought about the guidelines for a day, and from my interpretation (primary care MD), they now do not prioritize decreased transmission, but rather health care system capacity. And when applied to Omicron wave, they "kick in" very late. I care about health care systems, but my priority is health of the individual and populations--especially the most vulnerable. I'll keep masking.
Clear guidance doesn't force people to consult your PCP to explain--as is on the guideline.
Most people will just see green/yellow/red and skip the nuance. Now the CDC is aligned with the pandemic fatigue that has led to the back to normal movement. Is this really good public health?
I'm in the SF Bay Area CA, we're "masks not required," and green on this map (as are our surrounding counties. I just got back from the supermarket and there's 100% mask compliance. I think there's a component of "look, it's no big deal, I'm in public, why NOT wear a mask?" that is a social norm here. I really don't understand the rush to unmask.
One of the earlier commenters hit the nail on the head describing my discomfort with the new guidance: "they now do not prioritize decreased transmission, but rather health care system capacity." I am a Union official in the Forest Service and I have been the lead negotiator on our safety and re-entry negotiations. I spent yesterday in negotiations urging that in places where workers have regular, indoor contact with members of the public, those visitors should still be required to mask, as long as community transmission is above the "low" level. Management kept saying they were expecting new guidance from CDC, and the agency was just going to follow the CDC guidance. And now, CDC has effectively reduced protection for federal workers, because agencies are all deferring to CDC. They have also made it so confusing, given that they now have "Levels of Community Transmission" and "COVID-19 Community Levels." (Links below).
So here we are. The Union is fighting to ensure that workers do not have needless exposure. Management, by following the CDC guidelines, is willing to throw frontline workers to the proverbial wolves in the effort to return to "normal." Wearing a mask is such a small thing, and CDC has just made it so much harder.
For nearly 20 years CDC has been headed by a Senate-approved appointee. Before that, the director was always a trained scientist and expert. The differences are stark today and have been since Redfield’s appointment: it’s now a political tool. I keep hoping Walensky can drag it back to its original purpose.
I'm in a green county, but a lot of people in my township have had either confirmed or suspected covid within the last couple of weeks.
However, I believe that many of those cases went unreported, either due to home testing or to families refusing to test because they insisted it was "just a cold."
I understand your critique on "lack of evidence" to change how an area reacts to "cases", but there wasn't a ton of evidence based work for the current situation. We simply have structural limits on the data quality since we can not do designed experiments. We have no mechanism to randomly sample as any high end factory (think FABS or bio manufacturing) would do.
Yes, part of "vaccination" status is absorbed in new hospitalization and covid impacted hospitalization. However keeping it as separate metric facilitates the ability to use models to project the future state and avoid just reacting. IF we assume "full vaccination" substantially reduces the needs for "serious medical attention", then as the hospitalization numbers rise, we can estimate the size of upcoming surge based on available to get seriously ill. Essentially a CPE concept from demand supply networks (DSN) for covid. Completely lacking is a discussion of how much surge capacity is needed.
"We simply have structural limits on the data quality since we can not do designed experiments". But maybe there are some ways around that. What about covid test results for people who come to the hospital for reasons clearly unrelated to covid (accidents, childbirth). What about paying a small, representative subset of the population to do daily testing and report results? What about wastewater? What about levels of viral fragments in airfiltration systems?
Thanks, it’s great to have you back! I wonder how you feel about this change as a parent of young children? As a grandmother of a child too young to vaccinate and part of an extended family pod with several such, I feel once again as though we don’t quite count in this decision. Where is the guidance for young parents? Is it safe for them to bring these little ones into public spaces with unvaccinated maskless adults?
this is a tough one. I’m a little nervous with the current high levels of transmission. that’s why i’m deciding to mask in the “yellow” still. and i will plead that my girls’ teachers still mask (if their childcare allows masks optional). but once transmission levels get low, i would be okay with no masks. vaccines will be coming for them (hopefully) before the next surge too.
Thank you, for all your work. I wanted to ask you more about this. I was surprised to see my county in yellow... as prior to this change we were a high transmission area. Our family plan was to continue masking until the youngest could get vaccinated. Hearing that you would be comfortable going without if your county is in green before that happens is helpful. Thank you.
I'm going to stock up on masks. Pretty soon, there will be a ton of overstock as demand tanks. Prices will plummet and that will be the time to buy. I don't know the shelf life of every brand, but Honeywell and 3M are 5 years. Even 3 years would be fine by me.
Belated welcome back. I agree that CDC update is most welcome and I live in a green county, and yes, my mask is off! Your review and critique - spot on!
CDC's approach with weekly updates certainly embraces your "ride the waves" concept and while we have a respite (hopefully a long one). This does not mean that Covid is eliminated but rather we are now in a place of reasonable safety allowing relaxation of some of the mitigation tools that were used to help us get here. Clearly vaccination and other steps are still important as we may be witnessing in real time the transition from pandemic to endemic enabling us to live with and manage Covid-19 (masking for short periods of time when surges occur).
Lastly, I think there was an inadvertent oversight/error in a note at the end of their chart "What precautions should you take at an individual- and household-level?" The note states "At all levels, people can wear a mask based on personal preference, informed by personal level of risk. People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask." Clearly masks are not the primary issue for "people with symptoms, a positive test, or exposure to someone with COVID-19" - when isolation or quarantine is indicated and essential. This may be misinterpreted that isolation or quarantine guidance has been relaxed to simply wearing a mask and needs correction.
Any suggestions as how this comment can be quickly directed to the correct office at CDC for ASAP review/correction?
I agree with you regarding the surprise verbiage in the notes "at the end of the chart". This practice of adding stuff in fine print (or in obscure footnotes) is a common parlor trick with our CDC. And it is sad evidence of -- once again -- the careless disregard for one of the most crucial aspects of public health activity during any pandemic, viz. Communication With Accuracy And Clarity. To accomplish these two goals requires an *empathic state of mind* by those who control the machinery of official Advice Dispensing. Under the present CDC Director this particular species of empathy at the agency (i.e. the ability to think creatively during drafting of advisory material and to wonder how lay folks will either misread or miss completely what is being put out) has consistently been lacking. Time for top-down change at the CDC dumpster fire.
Thanks for your comment J Lee. I could not find any contact coordinates on the CDC website, so I will call the communications or director's office on Monday and hopefully get this error corrected as misinterpretation can potentially have serious consequences. Thanks again.
So nice of you to offer your help. I now have messages left with Director’s office and the directors of communications and policy. If I don’t get a response by tomorrow, I will definitely get back to you for your assistance. Thanks again.
I just feel so consistently let down by the CDC's (and our country as a whole's) clearly expressed view that people at high risk -- like me and my family -- are disposable. I have no idea how effective my 3x vaxxed and N95-wearing self will be against more and more people unmasking (especially since I work directly with the public) and I just feel so left behind.
I'm not high risk and I feel also kicked aside by the mob stampeding to the "It's over!" exits. It's not over, but good fitting N95 masks will protect you. The harder part is that as more and more infected people are around, you really have to be super careful with hand hygiene and mask handling so that you don't infect yourself. The bright side is that all of these overly optimistic people are going to be getting infected at rates high enough that we might all end up protected as the virus runs out of new hosts. I thank these people in advance for their service.
Thank you, as always. As a higher risk person, I was dismayed at the acceptable level of community transmission that served as their cut off, and I so appreciate your acknowledgement that high risk people deserve consideration prior to serious illness.
I'm astounded at the very high level of infection that the CDC found acceptable. Especially knowing that many people are using home test kits, it is outrageous to use 200 cases/100k as their criteria for not masking. I would have thought that would be no more than 50 cases/100k. I've been very frustrated with the CDC throughout the entire pandemic and have lost the respect I had for the organization. I liked the framework that you developed in an earlier post. I have high risk kids, so I'm very cautious anyway.
Mostly on the same page as you, but one quibble. Do home tests really result in undercounting? It seems like this requires making counterfactual assumptions about what people would be doing if they didn't have access to rapid tests. Would they be investing the time (and risk of being quarantined) if they didn't have access to rapid tests? My hunch is that they wouldn't. So it would end up being a wash.
If we had a coherent system to collect home-administered testing, we wouldn’t be asking that question.
Of course. I think mainly I bristle at the way the speculation is directed at individual home testers themselves, rather than the system as a whole. I also think there should be options available to people who want to be able to share their results for statistical purposes, without being required to disclose them to employers, airlines, etc. People who go through the trouble of getting home tests, when it's not required, should be presumed trustworthy.
When I consider all that we have gone through as health care workers over the past two years - our patients and friends often struggling with illness and sometimes dying, being revered and reviled for our advice, being trusted and suspected when we urge caution, and the deferred reckoning with how awful these two years have been on the front lines - wearing a little mask is such a small issue for me.
As always I appreciate your cogent updates, and sample them along with a smattering of my own insights for my patients (and a few extra readers along the way).
Thank you for reminding us all to take a breather when we need it. We've been head down, trucking, without a lot of joy.
I too am quite hopeful for a great Spring in comparison!
I will not be following much of anything uttered by CDC unless it happens to coincide with common sense. They have been such a disappointment. The mask stays on until the fire is out. There's no meal, no gym, no yoga experience worth long covid or the preceding "mild" or asymptomatic case. I can wait. In fact, that is my plan. I'm going to let everybody else go ahead and take off their masks. At some point, their infections are going to leave the virus with no place to go. That's when I'll take off the mask. Not a moment before.
I'm not sure I'm comfortable going unmasked with cases at, say, 150+ per 100k in a week (as they were here last week). I still very much like the "Riding the waves" framework that you developed last week. Are you abandoning that in favor of the new CDC guidance, or do you think that your proposal still has a place among those risk-adverse and lucky enough to have the flexibility to implement it?
I've thought about the guidelines for a day, and from my interpretation (primary care MD), they now do not prioritize decreased transmission, but rather health care system capacity. And when applied to Omicron wave, they "kick in" very late. I care about health care systems, but my priority is health of the individual and populations--especially the most vulnerable. I'll keep masking.
Clear guidance doesn't force people to consult your PCP to explain--as is on the guideline.
Most people will just see green/yellow/red and skip the nuance. Now the CDC is aligned with the pandemic fatigue that has led to the back to normal movement. Is this really good public health?
I'm in the SF Bay Area CA, we're "masks not required," and green on this map (as are our surrounding counties. I just got back from the supermarket and there's 100% mask compliance. I think there's a component of "look, it's no big deal, I'm in public, why NOT wear a mask?" that is a social norm here. I really don't understand the rush to unmask.
One of the earlier commenters hit the nail on the head describing my discomfort with the new guidance: "they now do not prioritize decreased transmission, but rather health care system capacity." I am a Union official in the Forest Service and I have been the lead negotiator on our safety and re-entry negotiations. I spent yesterday in negotiations urging that in places where workers have regular, indoor contact with members of the public, those visitors should still be required to mask, as long as community transmission is above the "low" level. Management kept saying they were expecting new guidance from CDC, and the agency was just going to follow the CDC guidance. And now, CDC has effectively reduced protection for federal workers, because agencies are all deferring to CDC. They have also made it so confusing, given that they now have "Levels of Community Transmission" and "COVID-19 Community Levels." (Links below).
So here we are. The Union is fighting to ensure that workers do not have needless exposure. Management, by following the CDC guidelines, is willing to throw frontline workers to the proverbial wolves in the effort to return to "normal." Wearing a mask is such a small thing, and CDC has just made it so much harder.
Links:
Community Transmission: https://covid.cdc.gov/covid-data-tracker/index.html#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Risk
Community Levels: https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html
CDC seems like a dinosaur with a brain the size of a teacup.
For nearly 20 years CDC has been headed by a Senate-approved appointee. Before that, the director was always a trained scientist and expert. The differences are stark today and have been since Redfield’s appointment: it’s now a political tool. I keep hoping Walensky can drag it back to its original purpose.
I'm in a green county, but a lot of people in my township have had either confirmed or suspected covid within the last couple of weeks.
However, I believe that many of those cases went unreported, either due to home testing or to families refusing to test because they insisted it was "just a cold."
I'll be wearing my mask for a while.
You are…simply the BEST! Thank you, thank you, thank you, once again, for your level headed approach and data! 💕💕💕🙌🙌🙌
I understand your critique on "lack of evidence" to change how an area reacts to "cases", but there wasn't a ton of evidence based work for the current situation. We simply have structural limits on the data quality since we can not do designed experiments. We have no mechanism to randomly sample as any high end factory (think FABS or bio manufacturing) would do.
Yes, part of "vaccination" status is absorbed in new hospitalization and covid impacted hospitalization. However keeping it as separate metric facilitates the ability to use models to project the future state and avoid just reacting. IF we assume "full vaccination" substantially reduces the needs for "serious medical attention", then as the hospitalization numbers rise, we can estimate the size of upcoming surge based on available to get seriously ill. Essentially a CPE concept from demand supply networks (DSN) for covid. Completely lacking is a discussion of how much surge capacity is needed.
Your writing is always fantastic.
"We simply have structural limits on the data quality since we can not do designed experiments". But maybe there are some ways around that. What about covid test results for people who come to the hospital for reasons clearly unrelated to covid (accidents, childbirth). What about paying a small, representative subset of the population to do daily testing and report results? What about wastewater? What about levels of viral fragments in airfiltration systems?
Thanks, it’s great to have you back! I wonder how you feel about this change as a parent of young children? As a grandmother of a child too young to vaccinate and part of an extended family pod with several such, I feel once again as though we don’t quite count in this decision. Where is the guidance for young parents? Is it safe for them to bring these little ones into public spaces with unvaccinated maskless adults?
this is a tough one. I’m a little nervous with the current high levels of transmission. that’s why i’m deciding to mask in the “yellow” still. and i will plead that my girls’ teachers still mask (if their childcare allows masks optional). but once transmission levels get low, i would be okay with no masks. vaccines will be coming for them (hopefully) before the next surge too.
Thank you, for all your work. I wanted to ask you more about this. I was surprised to see my county in yellow... as prior to this change we were a high transmission area. Our family plan was to continue masking until the youngest could get vaccinated. Hearing that you would be comfortable going without if your county is in green before that happens is helpful. Thank you.
Something conspicuously absent in the green column: what you can do right now to be ready for surges, like:
- Address any comorbidities
- Schedule any medical appointments you've been delaying
- Make sure you've got an adequate supply of well-fitting masks (and maybe have some masks fitted by a professional)
- Put money in a rainy day fund should you need to escape from a "red" area
It reminds me of the skit about the Arkansas Traveler and the Squatter:
T - Why don't you put some shingles on your roof?
S - It's been rainin' all day.
*
T - Why don't you fix it in dry weather?
S - It don't leak then.
I'm going to stock up on masks. Pretty soon, there will be a ton of overstock as demand tanks. Prices will plummet and that will be the time to buy. I don't know the shelf life of every brand, but Honeywell and 3M are 5 years. Even 3 years would be fine by me.
Belated welcome back. I agree that CDC update is most welcome and I live in a green county, and yes, my mask is off! Your review and critique - spot on!
CDC's approach with weekly updates certainly embraces your "ride the waves" concept and while we have a respite (hopefully a long one). This does not mean that Covid is eliminated but rather we are now in a place of reasonable safety allowing relaxation of some of the mitigation tools that were used to help us get here. Clearly vaccination and other steps are still important as we may be witnessing in real time the transition from pandemic to endemic enabling us to live with and manage Covid-19 (masking for short periods of time when surges occur).
Lastly, I think there was an inadvertent oversight/error in a note at the end of their chart "What precautions should you take at an individual- and household-level?" The note states "At all levels, people can wear a mask based on personal preference, informed by personal level of risk. People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask." Clearly masks are not the primary issue for "people with symptoms, a positive test, or exposure to someone with COVID-19" - when isolation or quarantine is indicated and essential. This may be misinterpreted that isolation or quarantine guidance has been relaxed to simply wearing a mask and needs correction.
Any suggestions as how this comment can be quickly directed to the correct office at CDC for ASAP review/correction?
Thanks again.
Alan
I agree with you regarding the surprise verbiage in the notes "at the end of the chart". This practice of adding stuff in fine print (or in obscure footnotes) is a common parlor trick with our CDC. And it is sad evidence of -- once again -- the careless disregard for one of the most crucial aspects of public health activity during any pandemic, viz. Communication With Accuracy And Clarity. To accomplish these two goals requires an *empathic state of mind* by those who control the machinery of official Advice Dispensing. Under the present CDC Director this particular species of empathy at the agency (i.e. the ability to think creatively during drafting of advisory material and to wonder how lay folks will either misread or miss completely what is being put out) has consistently been lacking. Time for top-down change at the CDC dumpster fire.
Thanks for your comment J Lee. I could not find any contact coordinates on the CDC website, so I will call the communications or director's office on Monday and hopefully get this error corrected as misinterpretation can potentially have serious consequences. Thanks again.
If you do find a point of contact, let me know and I’ll connect with you to get it!
So nice of you to offer your help. I now have messages left with Director’s office and the directors of communications and policy. If I don’t get a response by tomorrow, I will definitely get back to you for your assistance. Thanks again.
Still a parent of an Under 5, still no consideration in these guidelines... 🫤