As CDC Holds the Line, Doctors Debate Over Mask Lifting Mandates

February 10, 2022 — The number of new COVID-19 cases in the United States has fallen by nearly two-thirds from just weeks ago, and the decline has sparked heated discussions in the United States about when and whether mask mandates should end.

On Monday, governors of four states — Connecticut, Delaware, New Jersey and Oregon — said they would end mandatory masking in schools by the end of February or March. Pennsylvania decided last month to revoke its statewide mandate.

In Illinois, Governor JB Pritzker is fighting in court to keep his mask mandate for schools in place. New York Governor Kathy Hochul on Thursday allowed a statewide mask or proof of vaccination mandate for all indoor public locations to expire.

Some doctors are saying now is the right time and adults and children have held up the mandates long enough and the nation needs to get used to living with COVID-19 rather than fighting it every day.

But the CDA disagrees.

At a White House briefing Wednesday, CDC Director Rochelle Walensky, MD, said the agency still recommends masking indoors in public settings.

“We are currently working to follow the trends. However, what I’m saying is that our hospitalizations are still high, our death rates are still high… While we’re encouraged by the current trends, we’re not there yet,” she said,

Not everyone is on board.

Leana Wen, MD, an emergency room physician and professor of public health at George Washington University in Washington, DC, said on Twitter on Wednesday that the “CDC should change their school mask mandate guidelines as soon as possible. Pandemic restrictions have always been intended to be temporary. – there needs to be a clear exit point that is realistic and takes into account the widespread availability of vaccines for 5+.”

Nicole Saphier, MD, radiologist and director of breast imaging at Memorial Sloan Kettering in Monmouth, NJ, tweeted“The mask and vaccine mandates are doing a lot more harm than good. It’s time to let anyone who wants to put the pandemic behind them” do so. I was criticized for saying this when Omicron started. Now I’m doubling as millions have gotten more natural immunity and got a boost.

In an interview, Saphier says that “parents and children are traumatized by fear-based tactics that manipulate data.”

“The bottom line is that there is no good quality data showing that cloth masks in schools offer any benefit,” she says. “The science about masks has not changed. There has never been reliable data to support mask mandates in schools to reduce the pre-existing low-risk in the lowest-risk population.”

What has changed, she says, “is that there is now a less severe variant in circulation and the majority of children have some degree of vaccine, natural, or combination hybrid immunity.”

Amesh Adalja, MD, senior scientist at the Johns Hopkins Center for Health Security in Baltimore, said schools must have pathways to get out of the COVID-19 restriction.

“This is especially true as more and more people are getting vaccinated, antivirals are available, and rapid tests are becoming ubiquitous,” he says. “Children have the lowest risk of serious illness. In Europe and the UK, masking at school is not the norm.”

Adalja says COVID-19 will eventually be treated like other respiratory infections without specific mitigation measures, as people become accustomed to the fact that “it will always be with us and much tamer because of our immunity and medical countermeasures”.

As to whether dropping masks could make it more difficult to put on a mask again if there is another outbreak, Adalja says: “When the risk of serious illness is greatly reduced, due to a high level of immunity and availability of antivirals, masks will not have the same importance.”

“For those who want to wear masks, no one can stop them, and one-way masking works,” he says. “There will never be a time when there is no degree of COVID-19 circulation.”

The timing is wrong

However, other experts agree with the CDC, saying it is not time and it would be reckless to drop the mandates.

Maxine Dexter, MD, an Oregon State Representative, tweeted, “I understand (VERY clear) that people are done with mask mandates. I have no control over making a decision about when that will end. What I do know is that I just spent the weekend in ICU worrying for very sick people, most with COVID and more who are admitted. This is not over yet.”

Mercedes R. Carnethon, MD, of Northwestern University’s Feinberg School of Medicine, says mask mandates “shouldn’t be driven by impatience or politics.”

Instead, she says, a re-evaluation should be based on statistics, including the extent of community spread, the proportion of the community vaccinated, and hospital capacity in a given region.

She says the timing isn’t right to scrap masking requirements for schools.

“COVID-19 hospitalization rates remain high and our experience over the past 2 months with Omicron shows that it can even evade our vaccine protections,” she says. “While most cases are mild, especially in children, the effects are still significant for community members who contract the disease.”

Carnethon noted that vaccination rates are low in 5- to 11-year-olds and even 12 to 17-year-olds.

“We are a long way from where we need to be to be able to rely on vaccination alone to stop transmission,” she says.

Stanley Weiss, MD, professor of biostatistics and epidemiology at the Rutgers School of Public Health in Newark, NJ, says the rush to drop the mask mandate is partly due to pressure on politicians from a public teetering with COVID-19 fatigue and a audiences frustrated with changing guidelines as scientific information evolves.

He says the decision must be based on science and that science says it is too early to end the mandates.

“There’s hopeful thinking that it’s gone, when clearly that’s not true,” Weiss said. “In places like New Jersey, new cases have fallen, but the number of clusters of cases in schools had not yet decreased.”

Lindsay Kalter contributed additional reporting for this story.

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