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CDC's New Mask Guideline Says Vulnerable People Are Expendable

Judy Stone, MD

Disclosures

October 14, 2022

Friday night news dumps seem to be a favorite of administrations trying to bury news that they know will infuriate people. The CDC and Biden administration did this, announcing in new guidelines that masking will now be optional in hospitals, nursing homes, and other healthcare facilities where community transmission is not considered high.

This declaration is hardly fitting for an organization that is supposed to be concerned about disease prevention. The CDC has lost its mission. It is throwing the elderly, immunocompromised, and disabled under the bus in their buying into the "urgency of normal" crowd. They are ignoring that (as of September 1), 500 people in the US were still dying each day of COVID.

Just this past week, there were more than 400,000 cases and almost 3000 deaths. The cases are undoubtedly grossly underestimated probably because most patients are testing at home with rapid antigen test kits rather than being tested at a healthcare facility that might capture this data. The Institute for Health Metrics estimates that only 4%-5% of COVID cases are being reported.

While the guidance claims that it is to update "to reflect the high levels of vaccine-and infection-induced immunity and the availability of effective treatments and prevention tools," this is also deceptive. Yes, many people are getting milder infections. Yet, thousands die each week. Are they just expendable? A cost of doing business? And in terms of treatments, social media is still full of horrifying stories of people unable to access Paxlovid — and these are knowledgeable people who know better than many how to access care.

Prevention? It's not easy getting an appointment if you are not persistent and computer savvy. I spent hours online and on the phone trying to schedule an Omicron booster appointment. I wanted to find out which vaccine is being offered. Walgreens was the most infuriating, both online and by phone. Their website and agent would not provide any information without me giving my birthdate and previous vaccine history. I have had problems with them previously. I learned that there is a month's wait for a vaccine at a relatively nearby supermarket chain called Hannaford. By calling other branches, I was able to score an appointment in 10 days, although I'll have an hour's drive each way. The pharmacist was friendly, immediately gave me the information, and helped me make an appointment when their website initially said that I was too young (I wish!). Their site specified that you did not have to have insurance, and no insurance info was requested.

Access to vaccination is also difficult if you lack a car. In my hometown, there is minimal public transportation. The county health department set up vaccine clinics at the fairgrounds, inaccessible to many. Private volunteer groups set up some other clinics in neighborhoods where people could walk to them.

There are reports of increasing COVID cases again in the northeast as well as respiratory syncytial virus. Pediatric units are full in entire regions.

Dr Megan Ranney, dean of the Brown University School of Public Health, tweeted:

The logic of the @CDCgov here escapes me:

  • society's most health-vulnerable ppl

  • higher than average risk of +Covid

  • universal masking decreases transmission of #covid19

But allowing some hospitals & NHs to not mask?

Oh — and my hospital, like many, is experiencing increasing staff absences due to #COVID19.

Just the time to put patients and staff at higher risk of transmitting the virus to each other in the healthcare setting.

But …that means that places with substantial transmission can unmask sick patients who haven't yet been tested for COVID, right next to the elderly, chemo patients, people with pulmonary disorders, and pregnant women?

My kid could identify the flaws with this plan.

Jeremy Faust, MD, editor-in-chief of Medpage Today, was even more pointed,  saying, "CDC drops masking in many nursing homes. We've learned nothing." He continues, "This is terrible policy, and represents a life-threatening change for at-risk individuals…To do so in nursing homes is a hostile act towards a vulnerable population, given current ground conditions."

Faust offers some good solutions, such as providing transparent masks to facilitate communication, especially in nursing homes. Testing before visitations could allow families to opt out of masking for that visit.

The White House and the CDC should also focus on improving ventilation in public spaces and data (such as displays from CO2 monitors). In Belgium, such monitors are recommended in all public areas. They are mandatory in hotels, restaurants, bars, and fitness centers. Why aren't HEPA units or Corsi-Rosenthal boxes in widespread use, especially in closed, windowless spaces like many medical exam rooms and waiting rooms, or theaters and auditoriums?

Another reason CDC's relaxing masking is unconscionable is because of long COVID. As I noted previously, the CDC estimates that 20% of adults have long COVID. This translates to enormous losses for individuals who may no longer be able to work and support themselves or have a normal life, and to society, with 3 million FTEs, or 1.8% of the workforce, being lost due to long COVID,

We have so far to go. Particularly as we go into flu season, this announcement from the CDC seems incredibly short-sighted. It again sends the message that the elderly and vulnerable people are expendable and a burden on society.

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About Dr Judy Stone
Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family's Story of Hope and Triumph over Evil and Conducting Clinical Research: A Practical Guide.

She survived 25 years in solo practice in rural Cumberland, Maryland, and now works part-time. She especially loves writing about ethical issues and advocating for social justice. Follow her at drjudystone.com or on Twitter @drjudystone.

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