It's getting to the point when infectious disease experts may start diverging in their levels of relative caution when it comes to public safety mandates. And while two UCSF doctors don't necessarily disagree in some recent statements, one is urging a lifting of SF's mandate on wearing masks at all times outdoors in public.
Dr. Monica Gandhi has advocated for double-masking in public spaces to slow the spread of COVID variants, but earlier this year she provided some relief in her prediction that the Bay Area wasn't likely going to have to lock anything down again. Now, as she said on Twitter over the weekend, Gandhi says that cities should begin deciding what the threshold will be for lifting the mandate about masking outdoors — and she posted a link to this Slate piece in which she's quoted that argues that people passing each other on sidewalks simply isn't risky, and all the panic about pulling our masks back up when we encounter others needs to stop.
"I predict as cases fall with vaccination in each state/city, public health officials will look at data and remove masks mandates in the outdoors first (unless in crowded places)," Gandhi writes. "Given the low risk of transmission outside, makes a lot of sense."
The Slate piece notes that masks have, unfortunately, become symbols of one's political beliefs and trust in science — even though once one is vaccinated, wearing masks outdoors isn't really that necessary. "What I’m saying is really heterodoxy in San Francisco," Gandhi told Slate. "Here, if you don’t wear a mask, everyone glares at you."
She suggests that once states have fewer than 10 COVID hospitalizations per 100,000 residents, and upwards of 40% of the population at least partially vaccinated — which California has — mandates about masks outdoors should be lifted. Indoors, of course, masks are still necessary.
Dr. Bob Wachter, the chair of the School of Medicine at UCSF who has long been a cheerleader for SF's pandemic response, was quoted by the Washington Post last week encouraging the fully vaccinated to keep wearing their masks on planes and in indoor settings.
Specifically, Wachter stresses the fact that "breakthrough" infections are still happening among the vaccinated, and to bring infection rates down we can't just have maskless free-for-alls on planes and in restaurants.
"When [planes] turn into a flying restaurant, the dynamics of spread become very different," Wachter tells the paper, referring to people pulling off masks to eat and drink on a flight. "I would not eat at an indoor restaurant at this point, even being fully vaccinated, and so the time during which the plane is, in fact, an indoor restaurant is a time when it is somewhat less safe."
He further tweeted about the 5,800 "breakthrough" infections the CDC has seen out of 75 million fully vaccinated Americans — almost 400 of those patients did end up hospitalized, and 1% of them died. So while the vaccines certainly lower your risks of COVID infection and hospitalization, they do not fully eliminate the risk.
"I’m happy to get together in San Francisco in a home w/ vaccinated & even unvaccinated friends/family," Wachter says. "Why? The activity is meaningful to me, & SF is a pretty 'cool' (Covid-wise) place." He cites SF's 1% test positivity rate and low prevalence of the UK variant, and says that he'd rather dine outdoors than indoors still because indoor dining is still one of the riskiest things you can do and it's "just not that important" to him.
Per CDC, indoor dining has been among highest risk activities. Masks are off most of the time. And, while I know my tablemates, I don’t know the folks at other tables. I like eating in restaurants, but it’s just not that important to me. Ergo: outdoor dining OK, no indoor.(14/25)
— Bob Wachter (@Bob_Wachter) April 18, 2021
Some have called this stance out as over-cautious, especially as restaurants struggle to claw back from the brink of collapse and need to fill all the tables they can.
And Wachter's comment about masking up and keeping one's mask on throughout a plane ride caught the attention of statistician Nate Silver, who tweeted, "Maybe these columns on 'what can you do after you're vaccinated?' need to come with a dial where you enter your level of risk-aversion/neuroticism and the advice changes accordingly."
The U.S. continues to record an average of 63,000 new COVID cases daily, even though case rates are steadily going down in California — California still sees an average of about 2,400 new cases per day, despite the widespread vaccination effort. And as we learned last month, there are even parts of California (*cough* Riverside) where less than 50% of residents said they intended to get vaccinated.
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