Checking the COVID Weather

Those of you with kids in New York may have heard the news by now - school masking requirements are going away this week! The exact timing and details vary by region and the relevant authorities (i.e. public schools vs. independent schools). But the rapid drop-off in COVID case numbers, hospitalizations and deaths have moved much of the US map from the sea of red we saw in January to an early Spring of green patches, many of which cover of our area.

So what should you do at this point? For a lot of the country, this question is meaningless - masking has either long been abandoned or actively resisted as a culture war wedge issue. In New York city, the Omicron surge had the opposite effect. Masks were everywhere, even outdoors where most experts say they are generally unnecessary. I know that plenty of New York City families are ready to drop school masking in a heartbeat, regardless of their political orientation. But other families are more risk-averse and hesitant to unmask.

In my own practice, I have heard from a number of parents who aren’t quite sure what to do. Keep masking? Stop masking? Mask in some situations? What’s important is that parents and kids understand that the decision to mask should never be seen as picking a “team”. It should never be seen as a permanent choice. And it CERTAINLY shouldn’t be a way of judging each other - you may never know why someone chooses to mask.

Most kids seem to get this intuitively, often much better than their parents. My daughter’s school is planning on “flexible masking” - empowering students and staff to mask or unmask based on their comfort level in any given situation. This is a great effort to follow the science while respecting the fact that many New Yorkers are traumatized by the last two years and need a slower return to “normal”.

From a personal point of view, my immediate household is fully vaccinated, the adults are boosted and we have all recently recovered from COVID. So I may make different decisions than some of you in terms of masking and activities. But I still mask in my office, since I am following the CDC recommendations for health care facilities, and I want to make ALL of my patients and their parents feel as safe and comfortable as possible. I also mask in places where it may not be strictly required, but where someone requests it, just to be considerate.

So that’s what I’m doing right now, right here. But what about in the future? What if there are new variants, or if I travel to an area with a higher rate of COVID, or if I am in regular contact with someone at risk for severe illness? I’m going to need a way to make these decisions intelligently.

I don’t always take an umbrella when I leave home in the morning. And I don’t refuse to take an umbrella on principle. I look at the weather forecast, I think about my plans for the day, and I make a decision. That’s how it should be with COVID, because it’s going to be with us in one form or another for the foreseeable future.

Going forward, we need a simple and reliable way of determining what the COVID “weather” is at any time and place, and use that information to make decisions about things under our individual control (like masking, travel or event attendance). We also need to understand that our overall risk of infection and of serious illness is going to depend on a lot of factors. These are going to continually change, especially if new strains emerge with varying degrees of transmissibility, vaccine evasion and lethality.

Last week, the CDC revised the way that it monitors the levels of COVID, and published guidelines for linking these to recommendations on masking and other things. The old “community transmission risk” was based on the number of new cases and the percentage of positive tests in an area. The new framework - “COVID-19 community levels” - includes factors beyond case numbers (which are now significantly undercounted, since home testing has become so common). Low, medium and high levels are based on the number of cases, but also on COVID hospital admissions per 100,000 population and the percentage of hospital beds occupied by these patients.

You can use the tracker tool on my website to check the local COVID weather in your area. You can make decisions based on current data. You can support other people who may make different decisions, but who are still operating in good faith. You can take care of your family and your community. You can be kind.

And you can still #stopthespread.