CDC resists pressure to change mask guidelines

WASHINGTON — The White House has met with outside health experts to plan a pandemic exit strategy and a transition to a “new normal,” but behind-the-scenes efforts collide with a very public reality: A string of blue states governors are President Biden by suddenly giving up their mask mandates.

Two of the government’s top doctors – Dr. Anthony S. Fauci, the president’s chief medical adviser to the pandemic, and Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, both expressed qualified optimism on Wednesday about the direction of the pandemic. If the number of cases continues to fall and new variants do not emerge, “the country could be moving towards what we would consider more normal,” Dr. Fauci said in an interview.

But dr. Fauci warned the situation “is still unpredictable”, saying any transition out of the current crisis would be gradual. and dr. Walensky emphatically said that while her agency is working on new guidelines for the states, it is too early for all Americans to take off their masks in public places indoors.

“Our hospitalizations are still high, our death rates are still high,” she said at a news conference from the White House’s Covid response team. “So, as we work towards that and as we are encouraged by current trends, we are not there yet.”

The gubernatorial frenzy to drop mask mandates comes as White House Covid Response Coordinator Jeffrey D. Zients and top government doctors seek advice from a wide range of public health experts, including some former Biden advisers who very publicly attend. have urged the president to change course. Mr. Zients briefly referred to the sessions on Wednesday, saying the White House is also reaching out to governors and local public health officials to discuss “steps we should take to move the country forward.”

The talks, according to many participants, are focused on re-planning for the delicate next phase of the pandemic, when the threat of the coronavirus is likely to wane, but the possibility of a new variant and another deadly wave remains very real. They are tackling a range of issues beyond masking and mitigation, from getting new antivirals to people testing positive for the virus to upgrading or not upgrading ventilation systems in schools.

But the slow deliberations, both within the CDC and within Mr. Zients, put the White House in a difficult position. As officials examine the science and chart a careful course, they risk making the Biden administration look irrelevant if governors go on their own.

“The government needs to read the room and see that almost all elected leaders move on without them,” said Dr. Leana Wen, a former Baltimore health commissioner who has often been critical of the government, adding: “No one expects the CDC to tell everyone to go maskless now. What they’re looking for are clear statistics on when restrictions can be lifted. and when they may need to return.”

That’s what the governors themselves said. Last week, after a bipartisan group of governors met with Mr. Biden, Arkansas Governor Asa Hutchinson, a Republican, told reporters that he had stressed to the president that the nation must “get away from the pandemic” and asked him to provide “clear guidelines about how we can return to a greater state of normalcy.”

It is now clear that the states have decided not to wait. On Wednesday, the governors of New York, Rhode Island, Massachusetts and Illinois joined a growing list of Democrats who have either dropped a statewide mask mandate or a mandate to apply to schools.

Asked about the steps, Jen Psaki, the White House press secretary, said the president was determined to keep his campaign promise to listen to scientists and follow the data.

“It doesn’t happen at the speed of politics,” she added. “It moves at the speed of data.”

The internal debate comes as the latest wave of Covid-19, fueled by the highly contagious Omicron strain, is waning across much of the country. The seven-day average of new cases was about 253,000 on Wednesday, up from an average of 800,000 in mid-January, according to a New York Times database. Hospital admissions are also declining, although deaths, a lagging indicator, continue to rise.

If the drop in cases and hospitalizations continues, as many experts expect, Mr. Biden himself will soon have to make some tough decisions: Should he end the national emergency that his predecessor, President Donald J. Trump, announced in March? 2020 proclaimed ? Should Mr Biden lift the mask mandate he has imposed for travel on planes, trains and buses?

Mr. Biden must be careful to avoid a “mission accomplished” moment. Last June, as the number of cases plummeted, his advisers began forecasting a “summer of joy” and Mr. Biden himself stated on July 4 that the United States was “closer than ever to declaring our independence from a deadly virus.” goods. Then the Delta variant made a huge flight across the country. In the late fall, the emergence of the even more contagious Omicron variant also surprised the administration.

Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said any new strategy should take that into account.


February 14, 2022, 8:10 PM ET

“It must recognize that we are entering a new phase of virus transmission in our communities, always being aware that today we were in exactly the same place a year ago, where the number of cases has been declining since a peak in January, the vaccines flowed,” he said. said. “And look what that got us.”

The CDC’s concealing decisions are particularly fraught: It’s difficult, experts say, to issue a one-size-fits-all prescription for a country as vast and varied as the United States.

“It’s a challenging situation because, of course, people really want to get back to feeling normal,” said Dr. Celine Gounder, an infectious disease specialist who recently joined Kaiser Health News as an editor. “It’s highly variable across the country — how much transmission there has been, what vaccination uptake has been — but the CDC is producing guidelines for the entire country, so it makes sense that they would be cautious.”

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NYC’s vaccine mandate. New York City has laid off about 1,430 workers for failing to adhere to its vaccine mandate. The figure represents less than 1 percent of the city’s workforce, but it is arguably the largest mass termination of municipal workers in the country in response to such a mandate.

A spike in pedestrian deaths. Two years after the pandemic, pedestrian fatalities are rising amid a nationwide flare-up of reckless driving. Authorities have cited factors such as rising anxiety levels and fraying social norms, which have been exacerbated by the pandemic.

Masking is one of the most controversial issues of the pandemic. Many Republican governors set aside their mask mandates long ago. Some, like Florida Governor Ron DeSantis, even banned mask mandates and threatened to punish school officials who defied them. The actions drew strong criticism from Mr. Biden, who instructed his education secretary to introduce federal civil rights actions to stop states from banning masks in classrooms.

But White House officials have not criticized their fellow Democrats for ending rule-masking. Ms. Psaki said there is “a distinct difference between standing in the way, what Ron DeSantis did,” and “allowing local school districts to make choices, which some of these states are doing.”

Public health experts agree that school mask mandates shouldn’t last forever, but are divided on whether it’s time to drop them. The CDC’s current masking recommendations advise state and local officials to enact indoor masking policies in areas of the country where transmission is high.

A color-coded map on the agency’s website shows the entire country in red; 99 percent of all counties are in a high transmission zone — a point Dr. Walensky Wednesday underlined.

The public is understandably confused. Several weeks ago, with the rise in Omicron infections, the CDC clarified its stance on different types of masks, recognizing that the cloth masks commonly worn by Americans do not offer as much protection as surgical or respiratory masks. A few days later, Biden announced that his government would provide 400 million high-quality N95 masks to the public for free.

Now, several experts said, the agency must quickly come up with statistics for when masking and other restrictive measures should be relaxed — and when they should be reinstated. dr. Talking about an “off ramp” and an “on ramp” for mitigation measures, Wen said two factors are critical: whether hospitals and intensive care units have adequate capacity, and whether vaccines and boosters provide good protection against serious illness.

“The ramp for restrictions should be their top priority because this is what individuals, businesses, state and local officials think about every day,” she said.

drs. Wen, Gounder and Osterholm are on a long list of experts with whom the White House has recently consulted. None of the participants would describe the discussions, except to say that the board officials who attended — including Dr. Vivek H. Murthy, the Surgeon General; dr. Fauci; and dr. David A. Kessler, the scientific advisor for the Covid response – did more listening than talking.

The meetings with outside experts appear to have been prompted by a trio of articles published in January in the Journal of the American Medical Association in which six former Biden transition advisers urged the administration to take a longer stance and begin preparing a pandemic scenario aimed at “the new normal.”

The effort was led by Dr. Ezekiel Emanuel, an oncologist and medical ethicist who advised former President Barack Obama. In the first article, Dr. Emmanuel, Dr. Gounder and Dr. Osterholm, an epidemiologist at the University of Minnesota, said the United States must avoid being trapped in “a perpetual state of emergency.”

To better prepare for unavoidable outbreaks — including new coronavirus variants — they suggested the administration set goals and specific benchmarks, including the number of hospitalizations and deaths from respiratory viruses, including flu and Covid-19, should lead to emergency relief. and other measures.

Mr Biden has already indicated that he is looking beyond the pandemic. Commenting at a press conference in mid-January, he said the nation is “moving towards a time when Covid-19 will not disrupt our daily lives, where Covid-19 will not be a crisis, but something to protect against. † But the president also said that “we are not there yet”.

Adeel Hassan contributed from Boston and Amelia Nierenberg from New York.

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