For two years, governors across the country have issued orders to businesses, schools, and public services, including vaccination and mask mandates. With the precipitous drop in Omicron cases, virtually all states (including blue state governors) are lifting most, or all, COVID-19 restrictions. Under political pressure to return to a semblance of normality, the White House announced that the CDC will significantly ease federal mask-wearing guidelines. (CDC requirements to mask on mass transport including air travel will stay intact). The White House is also overhauling its pandemic response strategy to step down from crisis response, although President Biden has informed Congress he will extend the federal emergency declaration due to expire on March 1st. The President is expected to announce the COVID-19 overall in his State of the Union address.
Under CDC’s “COVID-19 Community Levels” framework released today, most Americans will no longer be advised to wear masks in public indoor settings. The CDC is shifting from counting COVID-19 cases to focusing on hospitalizations and hospital capacity. The CDC is right to change focus given that 93 percent of the population has vaccine- or disease-induced immunity. But it is wrong to lift most COVID-19 risk mitigation measures now.
Politicians and the public talk about ending the pandemic and entering an endemic phase of COVID-19. But they misunderstand what an endemic disease is, such as influenza. “Endemic” is a stable period of low overall infection. We are not there yet. On February 24, 2022, cases totaled 78.7 million, with 73,392 new infections and 2,908 deaths reported that day. We are just coming off historic levels of COVID-19 cases, hospitalizations, and deaths. While infections have declined substantially from over 800,000 daily cases during the peak of the Omicron variant surge in December 2021-January of 2022, to what we see at present, cases remain high, and transmission is considered moderate in many states.
If the new CDC focus is on preventing serious disease and hospitalizations, then now is not a good time to get COVID-19. The US vaccination rate is now approaching 68 percent, which is far below peer nations. The US vaccination rate doesn’t even come within the top 20 nations. Moreover, emerging variants such as Omicron have shown the limitations of these vaccines in preventing infection. The beneficial effect of vaccinations on decreasing severity of illness is based on population level data showing marked disparities in hospitalization with rates among unvaccinated individuals far exceeding that of vaccinated persons.
Vaccination is the success story and it will likely lead to a return to near normal in the coming months. To prevent serious disease, hospitalizations, and deaths among unvaccinated populations, we need effective treatments. They actually exist but are in extremely scarce supply. Monoclonal antibodies are effective at preventing infection among those who are most at risk for severe disease. Oral antiviral agents further add to the toolbox for preventing progression to severe disease and can be used in the outpatient setting. While this provides a measure of reassurance, the demand outweighs supply by a long margin. In other words, most of the vulnerable in the nation won’t get access to effective treatments until supply can be ramped up, probably not until the summer or beyond. Caution, therefore, is still needed to prevent unnecessary infections.
Antiviral treatment and immunomodulatory medications are also useful in the hospital setting for those with severe disease, but there is continued morbidity and mortality, even if patients can access these agents. Hospitals also have backlogs from the height of the Omicron outbreak. The experience of healthcare professionals in managing severe SARS-CoV-2 infections remains vital. Currently, over 59,000 persons are hospitalized due to SARS-CoV-2, with over 11,000 in intensive care units.
As we have seen repeatedly during this pandemic, patterns of infection have shown surges and lulls, and emergence of new variants that re-ignite cases. With most of the world unvaccinated, SARS-CoV-2 is rapidly mutating and new, dangerous variants could emerge, including variants that escape immune protection from prior infection or vaccination.
So why then are we now abandoning the use of masks despite ongoing moderate-to-high transmission of SARS-CoV-2 in the U.S.? The pandemic has caused disruptions to the social and economic wellbeing of the nation, while substantially altering health and life expectancy. Mandates are antithetical to the liberties that are foundational to our way of life. The ravages of the pandemic led to acceptance of limits to liberty in the name of public health, but the tensions between individual versus community have been apparent from early on. But mandates do not win politicians elections. The CDC is changing its guidance now, not because of the science, but because it is politically expedient.
What should not be lost in the politics is the message that prevention methods do work and should continue to be embraced. The lifting of state mandates and CDC guidance is not related to the safety of being maskless in indoor settings.
Masks have been, and will, remain life-saving until the pandemic can truly be declared over. That day will come, and hopefully soon. But let us not conflate the lifting of mandates with permission to share our air –it is still too early for that.