The case rate and percent positivity declined dramatically again this week. What welcome news! At this point, we can feel assured that there is light at the end of the (omicron) tunnel. I expect we'll continue to see declining cases and percent positivity, indicating that there truly is less virus circulating in our community. At some point, I expect the decline to slow. Overall, I feel really hopeful about the upcoming weeks and months. The trend in city cases is depicted in the visual this week. I also provided two statistics that illustrate the situation well. First, the pie chart shows the proportion of active cases according to the vaccination status of the case. As you can see, 62% of active cases in Easthampton are among the vaccinated. HOWEVER, please note the table below with the case rate per 100,000 population - the case rate is lowest among those who are fully vaccinated and boosted. Those who are fully vaccinated have about double the case rate of those who have a booster dose. And those who are unvaccinated have a case rate that is 7x higher than the case rate among the boosted and 3x higher than the case rate among the fully vaccinated but not boosted. These may seem like contradictory pieces of information! I assure you, they are both true and accurate depictions of the data this week. They reflect the "denominator issue" that I've discussed before. Easthampton is 80% vaccinated - the population that those vaccinated cases come from is much larger than the population those unvaccinated cases come from. Just 57 people out of 14,322 vaccinated people in Easthampton were positive this week, while 34 of only 1,797 unvaccinated people in Easthampton were positive this week.
I've written at great length about how well the vaccines protect against severe disease and death. Last week I wrote a comprehensive summary of adverse events as a result of the vaccines. I hope that information was helpful in getting real information about risks and benefits, and I hope these reports are interpreted as intended: I have no personal or financial stake in vaccines or masking. I am trained in epidemiology and biostatistics, which is the science of public health and the "evidence" of evidence-based health care. I analyze publicly reported data, as it is collected, and report to you the results of those analyses. The cases reported are confirmed or probable - that means the case was discovered via a PCR test (confirmed) or via a rapid-test given by a health-care provider (probable). The results of at-home rapid tests are not included in these numbers. With 100% certainty, I can tell you that the numbers reported are an underestimate of the true number. No alterations are made to the data, however - there is no effort to estimate the true number and no attempt at "correction." The data reported is the data in the system, which is the result only of confirmed and probable cases, as described above. The goal of these reports is to provide you with local, real information, and to help interpret data being presented in the media.
The topic on many minds this week is masking. The state-level mask mandate in schools in MA will be lifted at the end of February, leaving decisions about masking to each school district. There are so many questions about the mask mandates and incredibly strong feelings on both sides. On one hand, the science of masking is clear - they are safe for the wearer and a high quality mask that fits well provides a high level of protection against infection. On the other hand, masks are not without drawbacks - many find them inconvenient or uncomfortable, many have difficulty getting a good fit, and many find there to be communication difficulties associated with wearing a mask (related to hearing or inability to see lips moving), particularly among the most vulnerable. Unfortunately, there's not a clear line to draw in that risk / benefit analysis.
Here are some things to consider:
- Vaccination rates: Vaccines provide personal protection, and also the higher the community rates are, the lower the risk of a significant community surge. This is something to consider on a community-wide level, but also within a particular population. This is a tough one, because the vaccines are incredibly helpful on a personal level - if we were in the situation where anyone can access that personal level of protection, I'd feel more comfortable with lifting mask mandates. But an entire group of our community - those ages 0-4 - cannot get the vaccine yet and are months away from being fully vaccinated. The risk of severe disease and death is lower in that age group than older age groups, but the risk is not nothing. Last week I shared the high rate of pediatric hospitalizations. These are children! In the hospital! And I know there is much discussion of if they are there with or for COVID-19, and frankly, it doesn't matter. Most children with COVID-19 are fine. Some are not. We've had moderate-severe pediatric cases right here in Easthampton. Lifting mask mandates will feel a whole lot better when vaccines are available for ALL.
- Case rate and percent positivity: High case rates are alarming, but high case rates are no longer a direct representation of the burden on the health care system, which is a more important metric to consider. The trend in cases is an important piece of focus on - an increasing trend in cases isn't a great time to relax mitigation strategies.
- Burden on the health care system, including testing: If local hospitals are full and health care providers are exhausted, no one can get as high a level of care as they would during a more "regular" time in the system. This is dangerous for everyone, not just those with COVID-19. If hospitals are full of any kind of patient, it's a bad time to have a health issue of any kind, related to COVID-19 or not. Our health care providers are working selflessly in incredibly challenging conditions, and our community policies should respect their efforts and certainly not set them back. Finally, a burdened health care system can't readily provide the COVID-19 treatments that we know are so incredibly helpful. Anytime hospitals are full or close to full, community risk mitigation measures should be in place.
Testing: Are testing lines hours long and are folks getting turned away? Are at-home rapid tests nearly impossible to find? This is not a great time to relax mitigation measures. If folks can get tested when they need it - we're in a much better place to maintain control.
- Consequences of masking: Does the mask mandate mean that folks have to wear the mask for under an hour, or an hour or two? Or does the mandate mean that folks have to wear the mask for eight hours? Is the ability to see lips and read facial expressions a critical aspect of interactions in that setting?
Whew. Those are the things on my mind, as I'm considering the discussion on the "end" to masking. The other thing I'm really conscious of in this discussion is that masking may need to come back, if there is another highly transmissible variant that causes issues like the omicron variant has. Public health has to "bank" goodwill about masking - not in a calculated way, but in the sense that we need to keep mask fatigue low and use masks when we really need them and then stop when we don't, so that if we need them again - we're all likely to pivot back to masking without too much fanfare. In other words - we need it to be an on / off switch, with the knowledge it might come back on.
We also need to remember that high-quality masks that fit well provide the wearer with a high level of protection. An infectious disease expert recently said that a person with a well fitting KN95 is quite well protected, regardless of if people around them are masking. The example given was that a person wearing an N95 mask and talking to an unmasked person is at lower risk for infection than a person wearing a surgical mask talking to another person wearing a surgical mask. If you are high risk / vulnerable / worried, keep your high-quality masks handy. They really work.
Finally, speaking of pediatric vaccines: last week I reported that the FDA was preparing to review Pfizer data on the two-dose vaccine series for children ages 0-4 years, with the knowledge that a third dose would be needed. Disappointingly, at the end of last week we learned that the meeting would NOT happen, and that it would be at least a month before any vaccine manufacturer is ready to submit pediatric vaccine data to the FDA. Pfizer and Moderna trials are ongoing.
Why did this happen? I was optimistic last week that the FDA was taking this step to get children started on the two-dose series if their guardians wanted that option. The FDA requested the data from Pfizer (rather than Pfizer submitting their data spontaneously). Experts suspect that the FDA looked at the data and confirmed that it was not going to be an easy "yes" approval, that authorizing two-thirds of a vaccine series was an incredibly unusual step, and that the risk of public distrust was too great to continue with FDA review this week. In other words - the FDA agreed with Pfizer: The vaccine is safe, but it's not effective enough to warrant getting started, and no one is willing to compromise on high efficacy standards. And let me be clear - there was no question of harm for children - the issue of public trust is about delivering a vaccine that really protects kids super well, rather than just "eh" level protection. There are no safety concerns with the pediatric vaccines.
Personally - I was crushed. I have a child under 5 years old. I am really looking forward to the day when he can be vaccinated and can have the same level of personal protection that his brothers have. But I respect the FDA and Pfizer decision to stay the course on both safety and efficacy standards. I think it was the right decision. I hope the Pfizer or Moderna pediatric trials conclude soon and we can get to FDA approval for a full, super effective vaccine.
Stay well. Be kind.
Best,