In her weekly COVID-19 address to the LA County Board of Supervisors on Tuesday, LA County Public Health Director Barbara Ferrer spent a large part of her time clarifying the differences between state and local masking policies, what those policies are based on, and the factors that will determine how soon we can relax our local mask rules. She also had a lengthy conversation with several of the Supervisors about whether or not we should be relaxing rules as soon as next week, as the state of California is planning to do, or maintain our own more specific, but also more restrictive, policies for a while longer.
Current Situation
As she did in her most recent press update last Friday, Ferrer reported Tuesday that “The good news is that we continue to experience a steady decline in new cases.”
But it’s also important to note, she said, that our daily count of new cases is still almost as high as it was at the peak of the 2020-2021 winter surge. So while we are definitely heading into a post-surge period, “post-surge does not mean the pandemic is over, or that transmission is low, or that there will not be additional unpredictable waves of surges in the future that will require integrated public health measures.”
Rather, Ferrer said, “post-surge” “indicates that we’re stabilizing now, with consistent declines from the surge’s peak, and realigning our current public health response to meet the needs of the current situation.”
When Will We Relax Mask Rules?
If all goes well and the numbers do continue to drop, Ferrer said, mask rules will definitely relax and “some changes will occur soon.” But not just yet, she said, because the current mask requirements are still one of the big things helping our transmission rates drop, and it’s still too soon to remove that protection.
“We share in the desire to take masks off,” Ferrer said. But “the issue is one of timing. Masks provide an essential layer of protection when transmission is high, and they help us reduce exposures and drive down case numbers.” In fact, she said, new cases per day are still more than four times higher than they were in December, when the County’s current mask rules were enacted. So, in other words, she said, the numbers are “still really high.”
To be in a better position to relax current mask rules, Ferrer said, we need to reach a “moderate” rate of transmission, which is defined by the CDC as a weekly average of fewer than 50 new cases per 100,000 persons per day for seven consecutive days. Currently, however, we’re still at a seven-day average of 117 cases per 100,000 people per day, which is still well above the threshold for a lower transmission tier.
Looking at it another way, Ferrer reported last Friday that the county could also be considered in the “Moderate” transmission tier when there were fewer than 2,500 hospitalizations for two weeks in a row…but we were still at 2,702 hospitalizations as of yesterday, with our two-week average still much higher than that. (Hospitalizations are an important metric, she said, because our health care system has been so greatly stressed by the recent surge that we can’t really consider ourselves past the surge until our health care system has fully recovered, which it won’t until we see those lower hospitalization numbers.)
And, finally, Ferrer said yesterday that still another metric that could allow us to eliminate masks indoors in most settings would be when vaccinations have been available for children under the age of 4 for at least eight weeks (which is how long it takes for a child to be fully protected after being fully vaccinated). Ferrer said health officials hope those vaccines will be available by the end of this month…but, again, we’re just not quite in that position yet.
What Will Relax When We Relax?
“When LA County moves into the post surge period,” Ferrer said, “masking will no longer be required outdoors and at outdoor mega events, or in outdoor spaces at child care and K-12 schools.” But, “in alignment with CDC requirements, masking will continue to be required for indoor establishments, including indoor offices and work sites, indoor events and high-risk settings,” at least until we fall below a “moderate” rate of transmission.
Ferrer said that if numbers continue to drop, we should get to that level sometime in the next few weeks. But even when we do get there, she said, masks will also still be required where state and federal requirements are still in effect – such as on public transportation, indoors at child care facilities, at TK-12 schools, in health care settings, and in correctional facilities and homeless shelters. Those rules have not yet been lifted by the state, Ferrer said, and “local restrictions can’t be less restrictive than state or federal rules.”
Discussion and Dissent
One of the most interesting parts of Tuesday’s meeting was the post-presentation discussion between Ferrer and several of the County Supervisors, among whom there seems to be a growing rift between those who agree with Ferrer’s cautious path, and those who have had enough of the current restrictions and want to follow other cities and states into much faster relaxation of masking rules.
Supervisor Kathryn Barger, who has made several public statements recently in favor of eliminating mask rules, told Ferrer yesterday that she thinks aligning with the state’s mask relaxation next week would be the “right thing to do.” Waiting to drop to moderate or lower transmission rates she said, would mean waiting until COVID is almost completely eliminated, which she doesn’t think would happen any time soon. Barger said she would prefer to align with other cities and states across the country that are eliminating mask mandates now, which would provide clarity and consistency for residents, help to rebuild public trust in our officials, and cultivate good faith and more trust for possible future surges. When our local policies conflict with state and other city rules, Barger said, it creates inconsistency and “inconsistency is creating confusion,” especially when people come to Los Angeles from other places and don’t understand our local rules. Also, Barger said, she believes that relaxing mask rules will actually help convince people to become vaccinated, which is a better goal.
But Ferrer stood her ground, disagreeing that we will never reach moderate or lower levels of transmission. “There’s no way this is a forever” rule,” she said. “This has an end point.”
“The issue,” Ferrer said, “is the declines continue if the protections are in place. And when we remove a lot of those, as in the past, we tend to see our numbers go back up.” Ferrer said her “most important concern” is to get transmission as low as we can before relaxing the masking rules, to make sure no other variants move in too quickly. Ferrer said this is what happened after the Delta surge, and “we never really returned to a low rate after Delta before we got Omicron. So I would like to get to a better place, and I think in doing so we protect all of ourselves from unnecessary deaths.”
Ferrer said she does think there’s a case to be made for dropping mask rules now in places where vaccinations are high, but those rates aren’t the same everywhere in the state. “Vaccination rates are important,” she said, explaining that “San Francisco is at 82% fully vaccinated, but LA is only at 69%.”
Also, Ferrer said, to rely more heavily on vaccinations than mask rules to slow the spread of COVID, we would have to implement new vaccination requirements in many settings. Not just places like mega events and bars, as we do now, but also places such as gyms, offices, restaurants and more. Ferrer said she would be happy to consider that kind of policy, though, if the Supervisors want to pursue it.
Meanwhile, Ferrer also pointed out that unlike the state of California, which is simply following a pre-set expiration date, LA County is “aligning with the CDC” and using data-based metrics for our specific location. She said we shouldn’t simply go by an “arbitrary [statewide] date that’s not tied to conditions in the community.” In other words, Ferrer said, no specific conditions were met at the state level to trigger its mask rule expiration date – instead it was just a date picked several months ago when the latest rules went into effect. But she said the risks still too high here to drop mask rules right now, and one set of rules just isn’t practical for the whole state.
Ferrer also said there are two ways to think about mask rules. One approach is to say people do have choices about the precautions they can take, and how to take them, and that it’s a matter of individual responsibility, which seems to be the path the state is taking now. But LA County has always taken a different approach, she said, acknowledging that not all people have the same resources to protect themselves (whether because of income, access to various tools, or work requirements that involve lots of public contact), “and it’s still up to us, when there’s this level of transmission, to build in some guard rails.” And she further noted that taking this approach has allowed the County to stay open through the “worst surge we’ve ever experienced.” No businesses have closed during the Omicron surge, she said, and the only schools that closed did so because of staff shortages.
But Supervisor Janice Hahn also advocated for a faster mask relaxation, noting that the public clearly wants to ditch their masks, and pressed Ferrer for a firmer date for LA County to drop its mask requirements.
Ferrer said, though, that we need to hit a rate of 730 new cases per day to reach the moderate transmission threshold. We’re not there yet, she said, but if cases do continue their current 40-50% decline each week, and if “we’re careful and cautious,” we could hit that target in just a few more weeks. “We wouldn’t have set that threshold if we didn’t think it was attainable,” Ferrer said. But she also noted that there are always uncertainties involved in any calculations, one of which, at the moment, is the new BA.2 subvariant of Omicron, which currently represents only about 8% of COVID-19 cases, but which may be up to 30-35% more infectious than Omicron and, thus, likely to grow quickly and possibly slow our overall decline.
Still, Hahn continued to press Ferrer for a more specific date, saying that if it’s only a couple more weeks, the public could probably wait. But Ferrer said, “I’m not going to lie and I’m not going to make promises I can’t make” and that “We think the end of April is sort of the end point for us,” based on current information.
In the end, though, at least one other Supervisor, Sheila Kuehl, sided with Ferrer, saying we have to be very careful to balance both hope and desire and the current data, especially for people who have to go to work every day. “We’ve been wearing masks for two years and I think we can do it for another month or two,” Kuehl said, noting that she appreciates Ferrer’s data-centered approach, and “not what Sacramento thinks should be a flat number for the whole state.”
