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Mandates may be lifting in California, but many people remain vulnerable to COVID-19

Juan Avellan, center, and others wear masks while working out in an indoor class at a Hit Fit SF gym amid the coronavirus outbreak in San Francisco on Nov. 24, 2020.
Jeff Chiu
AP Photo
Juan Avellan, center, and others wear masks while working out in an indoor class at a Hit Fit SF gym amid the coronavirus outbreak in San Francisco on Nov. 24, 2020.

Saying the pandemic is over isn’t as simple as taking off a mask.

Studies have shown masks slow the spread of COVID-19, which has made mask mandates a major part of public health strategies to slow the virus. California’s mask mandate expired Feb. 15, and Sacramento County lifted its local mask mandates to follow the state’s lead.

Last week, California Gov. Gavin Newsom introduced what it's calling the SMARTER Plan to follow through on a more flexible approach that emphasizes prevention over mandates, along with quick mobilization during surges and monitoring of COVID-19 spikes to determine if they are linked to a new variant. SMARTER is an acronym for the plan’s focus areas: shots, masks, awareness, readiness, testing, education and Rx treatments.

Similarly, Sacramento County announced it was scaling down its community testing locations from 13 to seven at the end of the month, citing a decline in cases and testing demand.

But even with regulations relaxing in California and locally, some caution jumping to the conclusion that the pandemic is over, and stress that many people remain vulnerable to COVID-19 even as case rates fall.

Has the pandemic really become 'endemic'?

Original messaging about the SMARTER plan used the word “endemic,” but notably, Newsom, California Health and Human Services secretary Dr. Mark Ghaly and others who announced the plan did not use “endemic” with reference to the plan or the pandemic during the press conference Thursday.

While Centers for Disease Control Director Dr. Rochelle Walensky said in December on MSNBC that COVID-19 was “likely to become an endemic disease”, health experts say using “endemic” to describe COVID-19 may not be a useful descriptor.

On CapRadio’s Insight Feb. 9, Atlantic staff writer Katherine J. Wu, who along with Jacob Stern interviewed several experts for a story about the word’s emptiness, said relying on “endemicity” as an end goal isn’t particularly helpful.

“I think the idea that we’re going to reach endemicity or that this virus is going to reach endemicity, it oversimplifies just how difficult things are going to be,” Wu said.

One of the best examples of an endemic virus is influenza, said Dr. Mark Henderson, professor of internal medicine at UC Davis. He described endemicity as a state where a virus or pathogen circulates through a population in such a way that people learn to live with and have developed immunity to it.

But Henderson said likening COVID-19 and flu endemicity is a problematic analogy, especially given the differing severity of the viruses.

“If 2,500 people a day are dying every day from COVID-19 in the United States, it’s not far enough in the rearview mirror to begin to think about calling that endemic unless we are okay with that number,” he said. “I think people have become complacent — the numbers almost don’t matter to them. But again, 3,200 people died at 9/11 and we still talk about that one day. That’s happening almost every day with COVID-19.”

Newsom told the Associated Press that there would be “no finish line” to the pandemic. And California remains under a state of emergency, which it has been since Newsom mandated the first stay-at-home order in March 2020.

Masks still recommended by health experts

Public health experts continue to recommend wearing masks — even those repealing their local mask mandates. The state is still requiring masks in schools at least through the end of this month. And masks are still required in all indoor settings for unvaccinated individuals (More on current rules here).

Sacramento epidemiologist Dr. Flojaune Cofer, who is also the policy director for Public Health Advocates, said mask-wearing remains a good idea in part because it’s still too early to confirm whether the winter omicron surge has fully peaked.

“Right now, we’re beginning to treat it that way, but the challenge is, of course, that you don’t get to determine what a peak is until you’ve gotten through it,” she said. “This virus [COVID-19] is still new. Even though we’ve had it for several years, we don’t know what the annual ebbs and flows are going to be.”

Kasirye with Sacramento County said she will be continuing to use a mask.

“I have full confidence in the vaccine and I am vaccinated and boosted, but I will still use a mask, especially when going into certain public places because each layer of protection that we use increases our confidence in being able to avoid getting COVID,” she said at a Feb. 16 press briefing.

Henderson said in his ideal world, public health officials would have more patience, especially getting deaths and hospitalizations to drop and stay down, before relaxing mitigation measures. But meanwhile, mask-wearing remains one of the best ways that people can continue to protect themselves from COVID-19, he said.

“Wearing at least a well-fitting mask when they are indoors with other individuals whom they do not know — that’s probably the most [they can do] as well as be fully vaccinated,” he said. “We know that it works.”

And even though the CDC has begun recommending a well-fitting N95 or KN95 respirator (tips on how to find a good one here), a CDC study conducted across California counties found that even wearing a well-fitting cloth mask indoors reduced the odds of contracting COVID-19 by over half.

Masks can be protective against more than just COVID-19, Cofer added.

A chart showing findings from a CDC study on how mask wearing indoors impacted the chances the wearer contracted COVID-19.
Centers for Disease Control and Prevention
A chart showing findings from a CDC study on how mask wearing indoors impacted the chances the wearer contracted COVID-19.

“Just because it’s not required doesn’t mean it’s not helpful — masks help to prevent infectious diseases, which can include COVID but are not just limited to COVID,” she said.

While Cofer said she empathizes with the difficulty that wearing masks can pose for communicating, especially for those who rely on lip reading and facial expressions, “we also have saved lives by this practice.”

“My calculation is, I’d rather cover my face when I’m around 17,000 strangers at the Sacramento Kings game so that I can uncover my face when I’m hanging out with my mother or my siblings or other loved ones,” Cofer said. “I’m hoping that’s the calculation that we do begin to think about … modifying our behaviors at times when, let’s be honest, showing our face probably isn’t that important for our social interactions or is not going to markedly change our lives.”

Many people remain vulnerable to COVID-19

It’s particularly important not to assume that the pandemic is over just because vaccines are available, Henderson said, because people’s immunity — not just against COVID-19 but other infectious diseases — wanes over time. How quickly that is depends on the individual, he said.

“It’s been established that people with such [autoimmune] conditions or with transplants, let’s say a kidney transplant, don’t have enough native immunity for two doses of the vaccine to work,” he said. “Additional doses given to those individuals turns out to be effective … jumpstarting the immune system for someone who doesn’t have native immunity.”

During his announcement of the SMARTER Plan Feb. 17, Newsom said California would prepare to address waning immunity by stockpiling more masks, supplies and boosters, but added that developing other treatments was essential to continuing to fight COVID-19.

Ghaly reframed the current situation as “keeping up immunity,” rather than “getting to immunity.”

There are still large segments of the population who remain more vulnerable to COVID-19:

  • unvaccinated individuals, who Henderson said made up over 90% of the seriously ill in the hospital where he worked 
  • individuals 65 and over
  • people with underlying conditions treated by immunosuppressing medications 
  • those with chronic respiratory illnesses 
  • and children under 5.

The full list from the CDC is here.

“Probably the most common and familiar disease that puts people at higher risk is diabetes,” Henderson, with UC Davis, said. “It affects so many individuals and also impairs your body’s immune system and its ability to fight infection, not just COVID-19.”

Kids under 5 continue to remain without a vaccine. While the CDC Advisory Committee was set to review data from Pfizer about its developing vaccine on Feb. 15, that meeting was postponed on Feb. 11.

Additionally, the CDC has begun recommending an additional dose of either Pfizer or Moderna for people who received the Johnson & Johnson vaccine, along with another booster. For those who are immunocompromised, the CDC has shortened the time needed between the original vaccination series and a booster dose from five months to three months.

Details of Newsom’s plan will continue to be announced over the next few weeks.

The Central Valley is something that is incredibly personal to me. Having grown up, studied and worked in the valley, I’ve learned that there are stories in every corner of every city here: stories about intergenerational organizing, environmental (in)justice and the labor that feeds much of California, among others.
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