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Coronavirus

To mask or not to mask? Here’s where we are in the COVID pandemic.

Two years and multiple waves into the coronavirus pandemic, and state and local leaders now say most Marylanders can reenter society and do it without a mask.

Some 90% of the country now falls in the low to moderate categories for levels and spread of COVID-19 under new calculations by the U.S. Centers for Disease Control and Prevention, also sufficient to ditch the masks.

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“COVID-19 need no longer control our lives,” President Joe Biden said Tuesday during his State of the Union speech.

While some with vulnerable family members or unvaccinated young children have no plans to wade in, others are jumping with both feet. A swath in the middle is left considering how many toes to dip in and how close at hand to keep the KN95.

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For Kim Cross, a Howard County veterinarian and mother of three, it’s mostly status quo until her two children under age 5 can be vaccinated. Federal authorization of shots for the youngest children has been delayed.

“Some people have, mental health-wise, been waiting to remove masks and feel like the pandemic is over,” she said. “We just want all family members vaccinated first.”

For now, visits to out-of-state family and a lot of indoor activities will wait, her vaccinated 6½ year old will continue to wear a mask to school, and both parents will wear masks at work.

Cross’ decisions are indicative of the stage in the pandemic Marylanders and Americans find themselves in, experts say. With cases and hospitalizations way down in most places, the collective response is now officially one of individual choice.

Some experts think the move is slightly premature, but others believe so long as the government still is monitoring the situation, providing protective tools and treatments, this can work — until the next dangerous variant emerges.

The Biden administration laid out in recent days a new COVID-19 preparedness plan. It’s unfunded as yet, but includes a focus on surveillance and tools, including vaccines, tests, the most protective masks and antiviral medications. It also calls for vaccine distribution globally and for schools and businesses to remain open locally.

“Let’s allow people to enjoy this time, while infection rates are relatively low and vaccines protect well against the dominant omicron variant,” said Dr. Leana Wen, a former Baltimore health commissioner and a public health professor at George Washington University. “With the understanding that mitigation measures like masking may need to return if there is a new, more dangerous variant in the future.”

The message resonates with some, though not all, according to a survey by the Kaiser Family Foundation from late February. People were ready to get back to normal, but also were nervous about the consequences.

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There was a partisan divide on whether the concern was more about keeping measures or stopping them. But overall, close to two-thirds fretted about the mental health of kids from keeping restrictions in place, just over 60% worried that lifting restrictions would put immune-compromised people at higher risk, and about half were concerned there would be more deaths and hospitals would be overwhelmed.

Just over a third of those surveyed thought it was safe for most people to resume normal pre-pandemic activities, while half thought it would be by late spring when that occurred. Parents were split about continuing mask requirements at school.

“The conventional wisdom seems to be that Americans are ready to throw off all COVID restrictions and be done with it, but the survey shows that reality is much more complicated,” said Drew Altman, Kaiser Family Foundation’s president and CEO, in a statement. “Much of the public is sensibly both anxious and eager about returning to normal.”

That can make individual decision-making tough, said Meagan Fitzpatrick, an epidemiologist and assistant professor with the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health.

Infections reported nationally are way down after reaching their pandemic high in January. Maryland looks particularly good, with reported COVID-19 cases now logged in the hundreds and not thousands (382 reported Saturday) and hospitalizations a small fraction of the beds in use at the peak (334 reported Saturday). Fewer than 2% of tests are positive.

But, Fitzpatrick said there still are substantial levels of infection, particularly around the country, which likely aren’t all being reported, and tools to protect or treat people are far from equitably accessible. And while Maryland beats the national average vaccination rate, a quarter of the state’s population isn’t fully vaccinated and the majority are not boosted, a measure that which offers protection from severe illness.

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Measures maintained by the CDC that focused on infections found cases still were considered high or substantial in most of Maryland in the past week. The calculations were revised in late February to better reflect the risk of severe illness that could threaten the health care system.

The new calculations focused more on hospitalizations and bed capacity in addition to the rate of infection. That moved nearly all Maryland counties to the low-risk category in recent days. The exceptions were three Western Maryland counties at moderate or high risk, like their neighbors in other states, including West Virginia and parts of Virginia.

Fitzpatrick said her concern with the CDC’s new measure is that by emphasizing people in hospital beds, which lags infections, it would be hard to reinstitute masking and other measures in time to stave off a crisis.

“I get that everybody is exhausted and wants to be done, but declaring it over doesn’t mean it’s done. Getting cases and hospitalizations and deaths down makes it over,” she said. “The CDC put out this new metric and everything looks rosy.”

She said people now may need to more carefully consider their individual and family’s risk and make decisions on an event-by-event basis. And she said to make sure everyone eligible is vaccinated and boosted.

Dr. Lisa Carey, a Baltimore County mother of two and a primary care physician, said her family is remaining cautious.

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“I am happy that the omicron surge is over,” she said. “However COVID is still out there. Many viruses have long-term effects — measles, HPV to name a few — and we already know what COVID can do short term and how it affects people differently. I am not ready yet to pretend COVID doesn’t exist.”

She’s relieved most kids are faring well with infections. But a small percentage don’t and “seeing a small child hooked up to machines and a ventilator in the ICU is one of the worst sights I’ve seen in my medical career.”

That said, she does plan to “reintroduce” her 3-year-old daughter to more normal activities outside and some indoor activities while masked, after keeping her out of preschool this year. Her 6-year-old son will continue to mask at school and she and her husband will continue to mask in stores and elsewhere until the youngest can be vaccinated.

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Other experts agree that vigilance is needed, by public health officials and individuals.

That includes Wen, also an emergency department doctor, who believes the CDC guidance is helpful at capturing the real risks in a specific community.

She cautioned that nothing related to COVID-19 is zero risk and people need to weigh the value of the activity and the cost of mitigation measures. Mask may come off in some less-crowded situations or in schools where the majority of people have been vaccinated or infected. Others with vulnerable family members need to be more cautious.

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People who are vaccinated and boosted and have no underlying medical conditions are at low risk for severe illness if they are infected, Wen said. It would be reasonable, she said, “to decide to resume all pre-pandemic activities.”

“People should keep in mind that just because masks are no longer required, that doesn’t mean they shouldn’t wear masks or that it’s suddenly safe to go unmasked,” she said. “Rather, the changing guidance reflects a shift from government responsibility to individual responsibility.”

The collective responsibility returns if there is another substantial wave, she said.

“It’s precisely because of this that I believe people need a break now.”


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