If the CDC is going to recommend that mask-wearing be based on "your personal preference, informed by your personal level of risk," then it needs to level with the public about what exactly those risks are -- in particular, the significant danger of long COVID. I worry that we're inviting a massive wave of disability that neither our healthcare system nor our social welfare programs are really equipped to handle.
I also worry that, in practice, things won't be left up to people's personal preferences. Some employers will prohibit employees from wearing masks. I'm not sure there shouldn't be legislation protecting people who continue to wear masks in the workplace from being terminated for that reason.
I actually think the CDC guidelines are a good compromise. With so many people now testing at home, we can't necessarily trust the case numbers. Hospital admissions may be a lagging indicator but for public health purposes they let us know when we are heading into trouble. As a healthcare provider with an insatiable desire for knowledge, I would often go to NIH and CDC sites to see what viruses were out there so I could have a sense of what to expect. With the breakdown in the sentinel lab system this doesn't work as well but it helps. Managed care insurance plans use similar data to help predict when they need to deploy more resources on-line or into the community.
If there were no other solution for the breakdown in the value of case numbers, perhaps this would be a reasonable move. But there is a solution--random sampling. This has been proposed by several epidemiologists and is used to surveil other diseases. We don't need to fly blind on this.
I disagree wholeheartedly that hospital admissions will let us know when we are "heading into" trouble. By the time hospital admissions begin to tick up, it is too late to stop the spread. This is a virus that can generate as many at 10 cases for every positive case, and it does that within days of initial infection--often before symptoms have appeared. Meanwhile it can take 5-14 days for the disease to become serious enough to lead to hospitalization. With an infectious window of 3-5 days shortly after infection, by the time a single case gets to the hospital, they could have caused anything from hundreds to tens of thousands of downstream cases. We have not seen this kind of unrestrained spread so far because we have been working early enough to restrain the spread, on at least some level.
In the course of the pandemic, politicians have consistently underestimated the meaning of exponential growth. It happens faster than we can comprehend. Using a lagging indicator that takes a week or more to realize changes in the community means many deaths that could have been avoided--and a great deal of personal risk to individuals.
If we had a robust public health system throughout the US then random sampling and/or sentinal lab reporting would be the way to go. Unfortunately, that system was allowed to fall apart, which was part of why the COVID epidemic was as bad as it was. One way to get around this might be to use a system similar to the V-check system developed for the COVID vaccine. I still get follow-up texts from this system. Every person who buys a COVID test would be asked to sign up with the system. However, you would probably end up with a skewed sample and many people would consider it intrusive.
Waste water sampling might be another alternative but again in many places those systems have also been underfunded and understaffed or just don't exist.
If the CDC is going to recommend that mask-wearing be based on "your personal preference, informed by your personal level of risk," then it needs to level with the public about what exactly those risks are -- in particular, the significant danger of long COVID. I worry that we're inviting a massive wave of disability that neither our healthcare system nor our social welfare programs are really equipped to handle.
I also worry that, in practice, things won't be left up to people's personal preferences. Some employers will prohibit employees from wearing masks. I'm not sure there shouldn't be legislation protecting people who continue to wear masks in the workplace from being terminated for that reason.
I actually think the CDC guidelines are a good compromise. With so many people now testing at home, we can't necessarily trust the case numbers. Hospital admissions may be a lagging indicator but for public health purposes they let us know when we are heading into trouble. As a healthcare provider with an insatiable desire for knowledge, I would often go to NIH and CDC sites to see what viruses were out there so I could have a sense of what to expect. With the breakdown in the sentinel lab system this doesn't work as well but it helps. Managed care insurance plans use similar data to help predict when they need to deploy more resources on-line or into the community.
If there were no other solution for the breakdown in the value of case numbers, perhaps this would be a reasonable move. But there is a solution--random sampling. This has been proposed by several epidemiologists and is used to surveil other diseases. We don't need to fly blind on this.
I disagree wholeheartedly that hospital admissions will let us know when we are "heading into" trouble. By the time hospital admissions begin to tick up, it is too late to stop the spread. This is a virus that can generate as many at 10 cases for every positive case, and it does that within days of initial infection--often before symptoms have appeared. Meanwhile it can take 5-14 days for the disease to become serious enough to lead to hospitalization. With an infectious window of 3-5 days shortly after infection, by the time a single case gets to the hospital, they could have caused anything from hundreds to tens of thousands of downstream cases. We have not seen this kind of unrestrained spread so far because we have been working early enough to restrain the spread, on at least some level.
In the course of the pandemic, politicians have consistently underestimated the meaning of exponential growth. It happens faster than we can comprehend. Using a lagging indicator that takes a week or more to realize changes in the community means many deaths that could have been avoided--and a great deal of personal risk to individuals.
If we had a robust public health system throughout the US then random sampling and/or sentinal lab reporting would be the way to go. Unfortunately, that system was allowed to fall apart, which was part of why the COVID epidemic was as bad as it was. One way to get around this might be to use a system similar to the V-check system developed for the COVID vaccine. I still get follow-up texts from this system. Every person who buys a COVID test would be asked to sign up with the system. However, you would probably end up with a skewed sample and many people would consider it intrusive.
Waste water sampling might be another alternative but again in many places those systems have also been underfunded and understaffed or just don't exist.