New guidelines for COVID-19 masks focus on individual assessment of mandates
New guidelines for COVID-19 masks focus on individual assessment of mandates

New guidelines for COVID-19 masks focus on individual assessment of mandates

New federal guidelines for community levels of COVID-19, and whether and when people should wear protective masks, are forcing public health providers to reconsider recommendations for individuals and communities.

The new guidelines emphasize individual decisions rather than public health injunctions. Nevertheless, they can still be used to encourage communities and groups to adopt common rules of protection, such as masking, according to Dr. Ryan Westergaard from the State Department of Health Services (DHS).

Dr. Ryan Westergaard, Wisconsin Dept. of Health Services

“It is a step away from where we have been in the last few years, where many decisions to wear masks were made by governments and organizations,” Westergaard, chief physician at the DHS Bureau of Communicable Diseases, said during an online briefing with reporters Wednesday. .

At the same time, Dr. Geoffrey Swain of the Wisconsin Public Health Association that the new guidelines complicate the lives of people who may be more vulnerable to the disease.

The new guidelines from the Centers for Disease Control and Prevention (CDC) combine data on how fast the virus spreads and how much it depletes hospital resources to assess the societal level of COVID-19 [see table].

Below the new guidelinesthe CDC does not believe that universal masking is necessary where the level of society is low (green).

Where the societal level is rated as medium (yellow), the guidelines advise people at greater risk of serious coronavirus disease to “talk to your health care provider about whether or not to wear a mask and take other precautions.”

And where the community level is high (orange), the CDC recommends masks for everyone indoors in public places.

The level of a Community is assessed as low if three conditions are met:

  • There are fewer than 200 new cases of COVID-19 per year. 100,000 people in seven days, or between 28 and 29 new cases per 100,000 people a day.
  • There are fewer than 10 people admitted with COVID-19 in one week.
  • Less than 10% of hospital beds are used by COVID-19 patients.

As the number of people admitted with COVID-19 and the percentage of beds occupied by COVID patients increases, the level of society may increase to medium or high.

Where there are more than 200 new cases in seven days per. 100,000 people, the level of society will at best be assessed as a medium and could be assessed highly if there are higher hospitalization rates.

In Wisconsin, Westergaard said, the risk of illness is now “relatively lower than it has been for some time,” and hospital capacity is not being taxed as it was at the height of the pandemic, even as late as mid-January.

Under the CDC’s new system, adjacent counties can have very different assessments – often reflecting differences in the capacity of their local health systems, he explained.

By including local hospital capacity, he said, the new classification system is designed to encourage people to consider COVID-19 prevention “in a way that not only affects our health, it affects our community – and that it is not in our interest, in everyone’s interest, for our healthcare systems to be overwhelmed. “

Dr. Geoffrey Swain, Wisconsin Public Health Assn.

The Wisconsin Public Health Association’s Swain says one concern about the CDC’s new approach is that tying the indicators to hospital admissions and capacity “makes them too slow to respond to facts on the spot.”

A case is typically diagnosed about a week after exposure, and it can take another two weeks before a person is sick enough to go to the hospital. If it becomes the factor that increases a society’s rating from low to medium or medium to high, triggering a decision to wear a mask, “many people would say it’s three weeks too late,” Swain says.

Ideal public health practices would introduce new health protection more quickly, he says. At the same time, the CDC is likely to respond to concerns that the agency’s policy makers, due to repeated warnings, may have concluded that they “do not want to be accused of calling wolves all the time,” Swain says. “People will not listen.”

With the new CDC rating system, a large selection of counties through the middle part of Wisconsin is now rated as “low” – including Dane County, the only one in the group that had a county-wide mesh requirement until this week. About 20 counties are currently rated as “medium,” with masking potentially recommended for people at greater risk.

And a spread of 18 counties, from Racine and Kenosha in the southeast to Douglas in the northwest, is rated “high” – which the CDC says will justify universal masking in public.

Westergaard said Wednesday that DHS has been in contact with local health departments weekly or more frequently and has provided the CDC’s latest guidance to local officials. Local public health staff “also tell us what they encounter in communities and the issues they get, and often the setbacks they get from community members” about public health recommendations, he added.

Despite the CDC’s guidelines recommending universal masking in communities with a high COVID-19 rating, Westergaard said it does not necessarily mean prescribing a county-wide masking order. ‘I do not think it was the spirit it was in [developed]he said of the guide. “I think this is really meant for individual decisions, to know what COVID is doing in my community, in my county.”

At the same time, Westergaard added, just as individuals may decide based on the CDC’s assessments to wear a mask, “organizations and communities will also continue to make rules for themselves or standards for themselves.” It can extend to school districts or businesses. “We live in a civil society, but then you have those conversations and make those decisions collectively and respectfully.”

On social media and elsewhere, some advocates for people with disabilities and other medically vulnerable people have questioned the CDC’s recent guidance.

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“It’s a challenge for people who are immunocompromised, for someone who has a medical condition or a disability,” Swain says. “We put the whole burden on them individually.”

“I think this is an important question,” Westergaard said in response to a briefing on such concerns. Communities and organizations, he added, “can agree on mask rules and standards that are not just about protecting an individual’s health, but protecting vulnerable other people in society.”

The risk from COVID-19 is not uniform, but “very focused on certain groups of people,” Westergaard said. “When we get together, we can be aware of that – and we should incorporate that perspective into decisions about groups sharing an indoor space and wearing masks.”

Both Swain and Westergaard said that another resurgence of COVID-19 is likely in the coming months – and that it is possible that another new variant will develop, against which current vaccines will be less effective. Even without a new variant, immunity to coronavirus appears to decline over time, both among people who have been vaccinated and among people who have developed antibodies from having survived a COVID-19 infection, Swain notes.

Westergaard said the disease could follow a seasonal pattern that flu and other respiratory viruses do – possibly returning in the fall when children return to school and cooler weather sends people indoors. While it may be predictable, variants of the virus will not be.

“It will be an ever-present risk,” Westergaard said. “The way we can guard against is through a local and global effort for vaccination – because the less infection and transmission there is, the less likely a new variant is to emerge.”

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