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

As successive waves of COVID-19 swept through the Southland, Michael Matteo Rossi, a 35-year-old filmmaker living in Los Feliz, has playfully disguised himself whenever he is shopping, eating out or visiting his parents, who are in their 70s . .

“I’ve never been like someone walking into a Walmart without a mask trying to create a big stink,” said Rossi, who is vaccinated. “I’m for respect.”

But now that Los Angeles County is potentially on the verge of renewing its indoor mask mandate, his feelings have changed. With hospitalizations and deaths far below the peaks of the winter Omicron surge, Rossi said he feels safe to socialize indoors without a mask with his parents and friends.

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

Maybe not necessary. Support for updated mask-wearing requirements has also softened among medical and public health professionals. Despite plans by Los Angeles County Public Health Director Barbara Ferrer to restore the mask mandate as early as Friday if coronavirus conditions don’t improve, others say the value of universal mask-wearing is no longer what it used to be.

With a combination of widespread immunity, effective treatments for COVID-19, and a milder virus, there is less reason to suppress the spread of the virus by any means necessary, he said. Dr. Monica Gandyan infectious disease physician who conducts public health research at the University of California, San Francisco.

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

Nothing captures the complex American response to the pandemic like the strip of cloth we wear for two and a half years to cover our nose and mouth.

The face mask, constantly changing in its design and effectiveness, was first a tool for “smooth the curve” or infections until vaccines are available. It became a condition for the reopening of schools and was touted as a measure to protect the elderly and vulnerable. It was a silent signal of community determination and a touchstone in the fight against government restrictions.

On the faces of children, grocery shoppers, politicians and healthcare workers, masks have done more than block the spread of the airborne virus. They messed up our words, clouded our facial expressions, fogged up our glasses, and left us with sweaty chins.

In this third summer of the pandemic, it seemed like we could throw off our masks forever.

Then came a sub-variant of Omicron known as BA.5, bringing infections in California to the third-highest peak of the pandemic.

Over the past week, Los Angeles County has averaged about 6,000 official cases of coronavirus infection per day. (Number of additional cases detected using one can only guess.) It turns out 417 new infections per 100,000 inhabitants per week. With this metric, anything above 100 is considered high.

But what has brought the mask requirement back into consideration is the steady increase in the number of newly hospitalized patients who have tested positive for coronavirus infection.

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

If it remains above 10 today when new weekly data is released, Ferrer’s stated plan is to introduce an indoor mask-wearing mandate that will apply to all persons aged 2 and over in restaurants, gyms, schools, general office premises, retail establishments and many other public places. places.

Barbara Ferrer, director of the Los Angeles County Department of Health, at a free rapid COVID-19 test in Los Angeles.

Barbara Ferrer, director of the Los Angeles County Department of Health, has announced plans to restore mandatory indoor masks if the county’s COVID-19 infection rate remains high for two consecutive weeks.

(Genaro Molina/Los Angeles Times)

In the last days of Ferrer raised the opportunity or delay the mandate if “we see a sustained decline in cases or hospitalization rates near the threshold for the average” level of the COVID-19 community.

Hospitalized coronavirus patients are less of a burden in the BA.5 era, even if their numbers remain high. At Los Angeles County-USC Medical Center, the largest of the four county public hospitals, about 90% of infected patients were hospitalized with something other than COVID-19, and “virtually none of them ended up in the intensive care unit,” according to Dr. Brad Spellbergchief doctor of the hospital.

“This is not the pandemic it used to be,” Spellberg said this month on virtual town hall for hospital staff. “A lot of people have bad colds, that’s what we see.”

Gandhi said that even a sharp increase in new infections has ceased to be a reliable predictor of hospitalizations in severe cases of COVID-19.

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

Much of this has to do with COVID-19 vaccines. Their ability to prevent infections has weakened as the new variants have become less recognizable to the immune system, but they still provide strong protection against hospitalization and death. For about 71% or Americans 5 years of age or older who have received at least two vaccinations, vaccination reduced the risk of death by six timesAccording to the CDC.

An ever-increasing majority of Americans also have some immunity from past infection. In February, the CDC calculated that almost 60% or the Americans were infected by then, months before BA.5 was found here in May.

In addition, the use of the antiviral Paxlovid in the first five days after a positive test result may reduce the chance of hospitalization or death by up to as much as 88%. For people with weakened immune systems – approximately 3% of Americans – prophylactic use a monoclonal antibody called Evusheld reduced the risk of contracting COVID-19 by 83% in six months; when taken after the onset of infection, it reduced the risk of severe illness by 88%.

In addition, the Omicron variant that now dominates the US is less virulent than the strains of coronavirus that preceded it. CDC observed that the Omicron variant “generally causes less severe disease than infection with previous variants.” BUT recent training the medical journal Lancet even suggests that the risk of developing pulmonary COVID after infection with Omicron is less than half that of Delta.

“The threat It has decreased,” he said. Dr. Geoffrey Duchin, Chief Medical Officer of Seattle and King County. “And for this reason, taking steps that are considered inconvenient, costly, or philosophically unacceptable are less pleasant and less desirable.”

In some cases, health officials still instinctively mask mandates, Gandhi said.

When the number of new infections rises, “it scares the public health staff and it looks like they can do something,” she said.

But if mask-wearing requirements no longer promise fewer hospitalizations and fewer deaths, they will be difficult to defend, especially in front of an increasingly restless public.

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

When Rossi heard that a mask-wearing mandate was reintroduced for Los Angeles County, he didn’t take the words of health officials at face value. Instead, he complained to the Los Angeles County Board of Supervisors.

“I ask as a person from Los Angeles. [and] did everything to keep yourself safe, DO NOT go back” to the requirement of masks, he told them.

Michael Matteo Rossi on the hiking trail in Malibu.

Michael Matteo Rossi of Los Feliz has been diligently wearing a mask for more than two years, but is adamant that at this stage of the pandemic, the mandatory use of masks is not justified.

(Contributed by Michael Matteo Rossi)

Rossi insists that his newfound masked 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 stage of the pandemic, he is confident that his age, his hybrid immunity from the vaccine and past infection, and the milder nature of Omicron will protect him from severe COVID. He takes comfort in the fact that his parents are vaccinated and revaccinated, and therefore at least six times less likely to get seriously ill or die compared to unvaccinated people.

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