If we’re trying to prevent Covid surges and end the pandemic, then we need to center the population in our thinking. Health authorities need to get tools like rapid tests and better masks to as many people as possible, especially those who are more likely to spread disease, even if they’re at low risk themselves. People need to be persuaded or incentivized to vaccinate to protect others.
If you are sick, even with severe Covid, you want someone with a doctor’s viewpoint caring for you. America, however, is not a patient. And we’d all be better off, as a society and as individuals, if those in control of our country’s health stopped thinking of it that way.
San Juan County, Colorado, can boast that 99.9% of its eligible population has received at least one dose of covid-19 vaccine, putting it in the top 10 counties in the nation, according to data from the Centers for Disease Control and Prevention.
If vaccines were the singular armor against covid’s spread, then on paper, San Juan County, with its 730 or so residents on file, would be one of the most bulletproof places in the nation.
Yet the past few months have shown the complexity of this phase of the pandemic. Even in an extremely vaccinated place, the shots alone aren’t enough because geographic boundaries are porous, vaccine effectiveness may be waning over time and the delta variant is highly contagious. Infectious-disease experts say masks are still necessary to control the spread of the virus.
1. If a large share of hospitalised people are vaccinated, that’s a sign of success. It has been common to see headlines noting that a substantial minority of people who have been hospitalised or even killed by Covid have been fully vaccinated. These numbers suggest vaccine failure is alarmingly common. The fallacy only becomes clear at the logical extremes: before vaccines existed, everyone in hospital was unvaccinated; if vaccines were universal, then everybody in hospital would be vaccinated. Neither scenario tells us whether the vaccines work.
So try this. Imagine that 1 per cent of the unvaccinated population will end up in hospital with Covid over a given time period. In a city of a million people, that would be 10,000 hospital stays. Now let’s say that 950,000 people get fully vaccinated, that the vaccine is 95 per cent effective against hospitalisation, and that the vaccine doesn’t reduce transmission (although it does). Here’s the arithmetic: 500 of the 50,000 unvaccinated people end up in hospital. A total of 9,500 of the vaccinated people would be at risk of a hospital visit, but the vaccine saves all but 5 per cent of them. These unlucky 475 still go to hospital. The hospital contains 500 unvaccinated and 475 vaccinated people — almost half and half — which makes it seem as though the vaccine barely works. Yet when 95 per cent of people take a 95 per cent effective vaccine, hospital visits fall from 10,000 to fewer than 1,000.
Representatives from 169 (11.6%) of 1,461 schools in 51 (32.1%) of 159 Georgia counties (median = two schools per county) completed the survey and also had available COVID-19 case data (Figure).¶¶¶ Schools reporting 100% virtual learning were excluded. Among the 169 schools, 162 (95.9%) were public, representing 47 (26.0%) of 181 public school districts in Georgia (median = two schools per district). Schools had a median of 532 enrolled students (attending virtually and in-person), 91.1% were publicly funded, 71.0% were located in metropolitan areas, and 82.2% used hybrid learning (Table 1). Median class size was 19.0 students (interquartile range [IQR] = 15.0–21.0); median cohort size was 20.0 students (IQR = 15.0–21.0). Among all schools, the proportion of students receiving at least some in-person instruction ranged from 8.5% to 100% (median = 84.7%); 3.0%–100% (median = 64.0%) were eligible for free or reduced-cost meal plans, and approximately one half of students were White (median = 55.1%), followed by Black (median = 17.0%), Hispanic (median = 9.0%), multiracial (median = 4.5%), and Asian (median = 1.0%).****
Prevention strategies implemented at participating schools included requiring masks for teachers and staff members (65.1%) or students (51.5%), flexible medical leave for teachers (81.7%), improved ventilation (51.5%), spacing all desks ≥6 ft apart (18.9%), and using barriers on all desks (22.5%). Schools reported a median of 9.0 (IQR = 8.0–9.0) locations with handwashing stations (Table 1).
Author(s): Jenna Gettings, DVM1,2,3; Michaila Czarnik, MPH1,4; Elana Morris, MPH1; Elizabeth Haller, MEd1; Angela M. Thompson-Paul, PhD1; Catherine Rasberry, PhD1; Tatiana M. Lanzieri, MD1; Jennifer Smith-Grant, MSPH1; Tiffiany Michelle Aholou, PhD1; Ebony Thomas, MPH2; Cherie Drenzek, DVM2; Duncan MacKellar, DrPH1
New research released Friday by the Centers for Disease Control and Prevention reinforces an old message: COVID-19 spreads less in schools where teachers and staff wear masks. Yet the study arrives as states and school districts across the country have begun scaling back or simply dropping their masking requirements for staff and students alike.
The new study comes from Georgia and compares COVID-19 infection rates across 169 K-5 schools. Some schools required teachers, staff and sometimes students to wear masks; some did not.
Between Nov. 16 and Dec. 11, researchers found that infection rates were 37% lower in schools where teachers and staff members were required to wear masks. The difference between schools that did and did not require students to wear masks was not statistically significant.
During March 1–December 31, 2020, state-issued mask mandates applied in 2,313 (73.6%) of the 3,142 U.S. counties. Mask mandates were associated with a 0.5 percentage point decrease (p = 0.02) in daily COVID-19 case growth rates 1–20 days after implementation and decreases of 1.1, 1.5, 1.7, and 1.8 percentage points 21–40, 41–60, 61–80, and 81–100 days, respectively, after implementation (p<0.01 for all) (Table 1) (Figure). Mask mandates were associated with a 0.7 percentage point decrease (p = 0.03) in daily COVID-19 death growth rates 1–20 days after implementation and decreases of 1.0, 1.4, 1.6, and 1.9 percentage points 21–40, 41–60, 61–80, and 81–100 days, respectively, after implementation (p<0.01 for all). Daily case and death growth rates before implementation of mask mandates were not statistically different from the reference period.
Author(s): Gery P. Guy Jr., PhD1; Florence C. Lee, MPH1; Gregory Sunshine, JD1; Russell McCord, JD1; Mara Howard-Williams, JD2; Lyudmyla Kompaniyets, PhD1; Christopher Dunphy, PhD1; Maxim Gakh, JD3; Regen Weber1; Erin Sauber-Schatz, PhD1; John D. Omura, MD1; Greta M. Massetti, PhD1; CDC COVID-19 Response Team, Mitigation Policy Analysis Unit; CDC Public Health Law Program
When the CDC issued new guidelines recently on when people still need to wear masks, the guidelines were seen as so conservative that they prompted a primetime rant on “The Daily Show.”
“I know science is difficult … but who’s running messaging at the CDC?” asked the show’s host, Trevor Noah.
Some public health experts are asking the same question. Most experts interviewed for this story say the agency has struggled to take advantage of the latest scientific findings to communicate as rapidly as possible with the American public. And when the guidance is issued, it tends to be overly cautious.
Still, public health officials say the conservative nature of the agency’s approach to Covid is a marked departure from how it deals with other major public health issues, like HIV and opioid use disorder.
Multiple experts told STAT that they fear the CDC’s recommendations are becoming irrelevant for most Americans. They worry, too, that guidelines, like the CDC’s advice on masking, so seriously underplay the benefits of getting vaccinated that they risk dissuading people from getting a shot in the first place.
Most businesses in Texas had been allowed to operate at 75 percent of capacity since mid-October, when Abbott also allowed bars to reopen. It was implausible that removing the cap would have much of an impact on virus transmission, even in businesses that were frequently hitting the 75 percent limit.
While Abbott said Texans would no longer be legally required to cover their faces in public, he urged them to keep doing so, and many businesses continued to require masks. At the stores I visit in Dallas, there has been no noticeable change in policy or in customer compliance.
Conversely, face mask mandates and occupancy limits did not prevent COVID-19 surges in states such as Michigan, where the seven-day average of newly confirmed infections has risen more than fivefold since March 1; Maine, which has seen a nearly threefold increase; and Minnesota, where that number has more than doubled. Cases also rose during that period, although less dramatically, in other states with relatively strict COVID-19 rules, including Delaware, Maryland, Massachusetts, New Jersey, Pennsylvania, and Washington.
Florida, a state often criticized as lax, also has seen a significant increase in daily new cases: 34 percent since mid-March. But Florida, despite its relatively old population, still has a per capita COVID-19 death rate only a bit higher than California’s, even though the latter state’s restrictions have been much more sweeping and prolonged.