Comment: When we lower our masks we can’t lower our guard

Especially in schools a combined focus on vaccination, testing and ventilation will need to continue.

By Syra Madad and Saad B. Omer / Special To The Washington Post

A growing number of states that had adopted strict mitigation measures during the omicron surge have announced plans to lift indoor mask mandates, including in schools. Citing declining case counts and hospitalizations, governors in California, New York, New Jersey and elsewhere say they intend to leave the question of whether to require face coverings up to local governments.

While many of us in the public health community think it’s premature for this, with hospitals still stretched and deaths hovering around 2,500 a day, it’s clear many Americans are ready to move on. In a country as diverse as the United States, where approaches to covid-19 have differed dramatically based on geography and political affiliation, there’s merit to leaving it up to local officials to decide what’s best for their communities. Now is the time to take a nuanced approach and lean on the other tools at our disposal to slow the spread of the coronavirus; even without masks.

As local officials in states where mask mandates are falling contemplate whether to lift them, part of the calculation will be epidemiological: how much virus is circulating in the community, local hospital capacity, and county and school-level vaccination rates. But they will also have to take into consideration access. Do schools have a cache of high-quality masks for those who want them, and sufficient testing supplies? Are effective anti-viral therapeutics available for those at high risk of severe outcomes; a particular challenge since allocation of antivirals to states is still limited?

In addition, as we have witnessed over the last two years, the virus is not the great equalizer. Certain populations, such as communities of color, not only have borne the disproportionate impact of the death and severe disease, they also have less access to mitigation measures such as air filtration and rapid tests. When thinking about the impact of lifting mask mandates, it’s not enough to consider the effect on the average person; it matters how these decisions resonate in the most vulnerable communities.

One place to focus is schools, because the benefits of reduced transmission in school settings tend to ripple into a community, including its most vulnerable corners. We have discovered in school environments that, when it comes to covid-19, risk reduction is additive. That means vaccines, masking, routine testing, isolation and quarantine, improved ventilation and filtration all layer together to reduce the spread of the virus, prevent outbreaks and ensure a safer and healthier environment.

If local leaders peel back masking, they’ll have to ensure the other layers are strong. Unfortunately, some communities are lagging on this front. The American Rescue Plan has offered billions of dollars to schools to improve ventilation and filtration systems, but some communities haven’t been able to take advantage of these funds. State health departments and education agencies can step in here to ensure this money is used as it was intended and lessen the impact of lifting mask mandates.

The truth is, it doesn’t make sense to lift school mask mandates in most parts of the United States right now, when the seven-day national average for cases is more than 400 per 100,000, and multiple states are still experiencing high levels of community transmission.

Some experts have suggested lifting mask mandates when cases begin to decouple from hospitalizations, and local hospitalization rates with covid-19 have reached five or 10 cases per 100,000. Currently no state meets this mark; even after assuming that a proportion of hospitalizations are from non-covid causes, with covid-19 being discovered in routine screening.

The good news is that epidemiological trends are improving. Cases of omicron have decreased by nearly 65 percent and hospitalizations by 30 percent over the past two weeks nationwide. Many places may be in a position to lift the mandates soon. These locations can still encourage voluntary masking, especially for adults and children who are vulnerable due to underlying health conditions, normalizing it as seen in many Asian countries. Jurisdictions can also make it clear that if the local metrics indicate the need for ramping up preventive measures, mask mandates can be reimposed.

While immunization rates in the United States are far from optimal, they continue to tick up and hopefully will soon be available to those younger than 5. Access to effective antiviral therapies is likely to improve. In short, many developments on the horizon could decrease our reliance on masks. Even without statewide mask mandates, we don’t need to capitulate to the virus.

Syra Madad is faculty at Boston University’s Center for Emerging Infectious Diseases Policy & Research and fellow at the Harvard Belfer Center for Science and International Affairs.

Saad B. Omer is director of the Yale Institute for Global Health and a professor at the Yale University schools of medicine and public health.

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