Why some health experts see less value in the state of the LA mask right now

As successive waves of COVID-19 spread across Southland, Michael Mateo Rossi, a 35-year-old film director living in Los Feliz, was bravely disguising himself when he was shopping, eating or visiting his parents, who are in their 70s. .

“I’ve never been like someone who walks into a Walmart without a mask, looking to cause a stink,” said Rossi, who was vaccinated. “I’m all about respect.”

But now, with the possibility that L.A. County is about to receive a renewed mandate to hide underwear, his feelings have changed. With hospitalizations and deaths well below the peak of the Omicron winter wave, Rossi said he felt safe socializing, maskless, indoors with his parents and friends.

His surgical mask, once a permanent accessory, was abandoned somewhere in his car. Hope it won’t come back.

You may not need to. Support for renewed mask mandates has eased among medical and public health professionals, too. Although Los Angeles County Director of Public Health Barbara Ferrer plans to reauthorize the mask as soon as Friday if coronavirus cases do not improve, others say the value of widespread concealment has not been what it used to be.

Thanks to a combination of circulating immunity, effective COVID-19 treatments and a more benign virus, there is less reason to suppress the spread of the virus by any means necessary, said Dr. Monica Gandhi, an infectious disease physician who conducts research in public health at the University of California, San Francisco. .

“We are in a completely different place in the pandemic,” Gandhi said. “At this point, I don’t think widespread masking is necessary.”

Nothing exemplifies Americans’ complex responses to a pandemic quite like the tape of stuff we wear, put on and close for two and a half years, to cover our noses and mouths.

The face mask, always changing in its design and efficacy, was the first tool to “flatten the curve” of infection until the arrival of vaccines. It became a requirement for schools to reopen, and was promoted as a measure to protect the elderly and the vulnerable. It was a silent sign of society’s determination, and a vociferous touchstone of the struggle against government restrictions.

On the faces of children, shoppers, politicians and medical workers, masks have done more than prevent the spread of airborne viruses. They muddled our words, blurred our facial expressions, put on our steaming glasses and left us with sweaty chins.

In this third summer of the pandemic, it seemed we could ditch our masks for good.

Then an Omicron variant known as BA.5 emerged, sending the infection in California to the third-highest peak of the epidemic.

Over the past week, Los Angeles County has averaged about 6,000 official coronavirus cases per day. (The number of additional cases identified using home is anyone’s guess.) This works out to 417 new infections per 100,000 residents per week. Using this scale, anything over 100 is considered high.

But the thing that has put the mask mask back on the table has been the steady increase in the number of newly hospitalized patients who have tested positive for the coronavirus.

Two weeks ago, that number rose to 10.5 per 100,000 residents, high enough to classify Los Angeles County as having a “high” COVID-19 community level based on criteria set by the Centers for Disease Control and Prevention. A week later, the number had risen to 11.4 per 100,000.

If it stays above 10 when new weekly numbers are released today, Ferrer’s stated plan is to implement an indoor mask mandate that applies to everyone age 2 or older in restaurants, gyms, schools, shared office spaces, retail establishments and a host of other public places.

Barbara Ferrer, director of the Los Angeles County Department of Health, has announced plans to reauthorize the indoor mask if the county’s COVID-19 community level remains high for two consecutive weeks.

(Ginaro Molina/Los Angeles Times)

In recent days, Ferrer has raised the possibility of deferring authorization if “we see a sustained decline in cases, or the rate of hospitalizations approaching the mid-level threshold” of COVID-19 community levels.

Hospital patients with coronavirus are less burdensome in the BA.5 era, even if their numbers remain high. At Los Angeles County-USC Medical Center, the four largest public hospitals operated by counties, about 90% of infected patients have been admitted for something other than COVID-19 — and “nearly none of them went to the intensive care unit,” according to Dr. Brad Spielberg, the hospital’s chief medical officer.

It’s not the same epidemic as it was, Spielberg said this month at a virtual town hall for hospital staff. “A lot of people have colds, that’s what we’re seeing.”

Gandhi said that even sharp increases in new infections are no longer a reliable indicator of hospitalizations for severe cases of COVID-19.

“We are starting to see a ‘separation’ between cases and hospitalizations,” she said.

This is largely due to the COVID-19 vaccines. Their ability to prevent infection has waned as new variants become less recognizable to the immune system, but they still provide powerful protection against hospitalization and death. For the nearly 71% of Americans age 5 and older who had at least two injections, vaccination reduced the risk of death sixfold, according to the CDC.

The growing majority of Americans have some immunity conferred by a previous infection, too. In February, the CDC estimated that nearly 60% of Americans had contracted this point, months before BA.5 was discovered here in May.

Furthermore, using Paxlovid antiviral 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 contracting COVID-19 by 83% within six months; When taken after an infection appeared, it reduced the risk of serious illness by 88%.

In addition, the Omicron variant that now dominates the United States is less dangerous than the strains of the coronavirus that preceded it. The CDC notes that the Omicron variant “generally causes less severe disease than infection with the previous variants.” A recent study in the medical journal The Lancet reports that the risk of long-term COVID infection after an omicron infection is less than half what it was with Delta.

“the threat she has Jeffrey Duchenne, chief health officer for Seattle and King County, said. “For this reason, taking steps that are seen as inappropriate, costly, or philosophically objectionable is less palatable and less desirable.”

Gandhi said that in some cases, health officials still resorted to hiding mandates out of instinct.

And when new infections rise, she said, “the public health worker feels that it’s scary, and it feels like it’s something they can do.”

But if mask mandates no longer hold the promise of fewer hospital admissions and fewer deaths, they will be harder to defend — especially for an increasingly restless public.

“At this point, we really have to think about trust in public health,” Gandhi said, which has been severely eroded during the pandemic. “This is a real concern.”

When Rossi heard that mask authorization was back on the table in Los Angeles County, he didn’t accept health officials’ words at face value. Instead, he complained to the Los Angeles County Board of Supervisors.

“I’m asking as someone from Los Angeles [and] They did everything to keep themselves safe, don’t go back” to ask for masks, he told them.

Michael Matteo Rossi on a hiking trail in Malibu.

Michael Matteo Rossi of Los Feliz has worn a mask diligently for more than two years but feels strongly that the mask mandate is not justified at this point in the pandemic.

(Courtesy of Michael Matteo Rossi)

Rossi insists that his newfound suspicion of the mask 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 feels confident he’s protected from severe COVID because of his age, his hybrid immunity to the vaccine and previous infection, and Omicron’s milder nature. He is relieved that his parents have been vaccinated and boosted, so they are at least six times less likely to become seriously ill or die than unvaccinated people.

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

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