The pandemic was only a few months old when I sat on the shady lawn of a Williamsport office building where my wife was at a medical appointment. People passing on the street were wearing masks, something I’d often seen in television images from crowded Hong Kong or smog-choked India, but rarely here in central Pennsylvania. This was new. I still felt a little silly wearing a mask; seeing so many masked people still felt surreal. (The opposite would come later.)
“Ch-ch-ch-ch-changes,” David Bowie sang, “turn and face the strange.” It seems like we have been doing that forever.
That’s the nature of pandemics.
They change our lives in so many ways. We fall ill. Some of us recover; too many of us don’t. There’s little we can do at first – stay apart from others who may infect us, wash our hands often, sanitize everything we can.
Much like the antibodies, B-cells, and T-cells that rise to defend us when germs invade our bodies, doctors and scientists rush to study the new pathogen. As they learn what it is, how it affects our bodies, and how we pass it to each other, they give us the best advice they can.
That advice has changed often over the past two years. That’s how science works. New research builds on previous research and yields in turn to newer research. Limited knowledge gives way to more complete understanding, practical recommendations to superior advice.
When, where, and whether to wear masks has been contentious. The fact is, numerous studies have proven that masks help to reduce the spread of respiratory infections, including flu and COVID-19. NIOSH-approved N95 and the similar KN94 masks provide the best protection because they filter the most respiratory particles when properly worn. Your mask must cover your nose, mouth, and chin with no gaps anywhere.
The Centers for Disease Control and Prevention (CDC) issued new mask guidance on February 25.
Previously, masking was recommended when case counts reached a certain level in an area or a community, because so many people who tested positive became seriously ill, overwhelming hospitals and overworked nurses and doctors. A surge in cases brought a real danger that the health system would be unable to cope, the virus would rage out of control, and millions more would die.
The hope of reaching herd immunity, so the virus couldn’t keep finding people to infect, faded due to the Delta variant surge, widespread resistance to getting vaccinated, and waning vaccine effectiveness over time. However, the vaccines have reduced the number of severe COVID cases, as they were designed to do, and the overall level of immunity from vaccination and/or previous infection is high enough now to keep the pandemic manageable.
The new guideline considers three factors: “new COVID-19 admissions per 100,000 population in the past 7 days, the percent of staffed inpatient beds occupied by COVID-19 patients, and total new COVID-19 cases per 100,000 population in the past 7 days.” (https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html). Somewhat arbitrary thresholds for each factor define three risk levels, low, medium and high.
When the number of new COVID cases over 7 consecutive days is fewer than 200 per 100,000 population, new admissions are below 10 per 100,000, and COVID patients occupy less than 10% of staffed inpatient beds the community risk is low. If either admissions or percentage of occupied beds is higher, the risk level becomes medium or high depending on the amount of increase. When the number of new cases per 100,000 people is more than 200 the risk level is either medium or high.
The CDC’s color-coded chart shows the thresholds for each level. A second chart indicates the precautions and mitigation measures recommended at each level, including protections for people at high risk, for individuals and communities.
A strength of the new guidance is that it maps out the response needed if a new variant or some other factor causes a significant surge in cases. The risk levels are revised weekly so it’s easy to keep track of your own county or to check one you may want to visit. You don’t need to remember formulas or perform calculations. To find your area’s risk level, just click your location on the map at the CDC link above or select your state and county at https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html.
The pandemic is ebbing now, but we still need the layered approach to mitigation — keeping up to date on vaccines, ventilation, testing when symptomatic, isolating after possible exposure, and wearing masks — to help limit severe disease and reduce strain on the healthcare system.
Vaccinations remain our best defense and this community still has room for improvement. If you feel safer masked, wear one. Please do everything you can to protect yourself and your neighbors.
We really are in this together.
Michael Heyd, a retired medical librarian from Fairfield Township who spent more than forty years searching the literature for professional hospital staff, is a member of Let’s end COVID!