CDC resists pressure to change mask guidelines

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WASHINGTON — The White House has met with outside health experts to plan an exit strategy from the pandemic and a transition to a “new normal,” but the behind-the-scenes effort is running up against a very public reality: a string of Blue state governors outpaced President Biden in suddenly dropping their mask mandates.

Two of the administration’s top doctors — Dr. Anthony S. Fauci, the president’s chief medical adviser on the pandemic, and Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, both expressed optimism on Wednesday. mixed as to the direction of the pandemic. If cases continue to drop and no new variants emerge, the country “could be heading towards what we would consider more normal,” Dr. Fauci said in an interview.

But Dr Fauci warned that the situation “is always unpredictable” and said any transition out of the current crisis would be gradual. And Dr. Walensky insisted that while his agency is working on new guidelines for states, it’s too early for all Americans to remove their masks in indoor public places.

“Our hospitalizations are still high, our death rates are still high,” she said during a White House Covid Response Team press briefing. “So while we’re working towards that and encouraged by current trends, we’re not quite there yet.”

Governors’ frenzy to drop mask mandates comes as White House Covid Response Coordinator Jeffrey D. Zients and the government’s top doctors seek advice from a wide range of public health experts, including some former Biden advisers who very publicly urged the president to change course. Zients briefly referenced Wednesday’s sessions, saying the White House was also reaching out to governors and local public health officials to talk about “steps we should take to move the country forward.”

The talks, according to many participants, aim to write a new playbook for the next delicate phase of the pandemic, when the threat of the coronavirus is likely to recede but the possibility of a new variant and another deadly surge remains very real. They address a range of issues beyond masking and mitigation, from how to get new antivirals to people who test positive for the virus to whether to upgrade ventilation systems in schools.

But the slow pace of deliberation, both within the CDC and Mr. Zients’ team, puts the White House in a difficult spot. As officials scrutinize the science and chart a cautious course, they run the risk of making the Biden administration appear irrelevant as governors forge ahead on their own.

“The administration needs to read the play and see that almost every elected leader is moving forward without them,” said Dr. Leana Wen, a former Baltimore health commissioner who has often criticized the administration, adding, “Nobody “Waiting for the CDC to say everyone should go mask-free right now. What they’re looking for are clear steps on when restrictions can be lifted and when they may need to return.”

The governors have said so themselves. Last week, after a bipartisan group of governors met with Mr. Biden, Gov. Asa Hutchinson of Arkansas, a Republican, told reporters he had stressed to the president that the nation must “move away from pandemic” and asked him for “clear guidance on how we can return to a greater state of normality.

It is now clear that the States have decided not to wait. On Wednesday, the governors of New York, Rhode Island, Massachusetts and Illinois joined a growing list of Democrats who have dropped either a general statewide mask mandate or one that applies to schools.

Asked about the moves, Jen Psaki, the White House press secretary, said the president was committed to keeping his campaign promise to listen to scientists and track the data.

“It’s not moving at the speed of politics,” she added. “It moves at the speed of data.”

The internal debate comes as the latest surge of Covid-19, fueled by the highly infectious variant of Omicron, wanes across much of the country. The seven-day average of new cases was around 253,000 on Wednesday, down from an average of 800,000 in mid-January, according to a New York Times database. Hospitalizations are also down, although deaths, a lagging indicator, continue to rise.

If the decline in cases and hospitalizations continues, as many experts predict, Mr. Biden himself will soon have difficult decisions to make: should he declare the end of the national emergency that his predecessor, President Donald J. Trump, declared in March 2020? ? Should Mr Biden lift the mask mandate he imposed for air, train and bus travel?

Mr Biden must be careful to avoid a “mission accomplished” moment. In June of last year, with cases falling, his advisers began predicting a “summer of joy” and Mr Biden himself said on July 4 that the United States was “closer than ever to declare our independence in the face of a deadly virus”. Then the Delta variant surged across the country. In late fall, the emergence of the even more contagious variant of Omicron also caught the administration off guard.

Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said any new strategy must take this into account.

“He must recognize that we are entering a new phase of transmission of the virus in our communities, always bearing in mind that we were in the exact same place a year ago today, where cases were decreasing from the peak. January, the vaccines were pouring in,” he said. noted. “And look what it brought us.”

The CDC’s masking decisions are particularly onerous: it’s difficult, experts say, to issue a single prescription for a country as large and varied as the United States.

“It’s a difficult situation, because of course people are really anxious to get some sense of normality back,” said Dr. Celine Gounder, an infectious disease specialist who recently joined Kaiser Health News as an editor. chief. “It’s highly variable across the country — the extent of transmission, the rate of vaccination — but the CDC produces guidance for the entire country, so it makes sense that they’re cautious.”

Masking has been one of the most controversial issues of the pandemic. Many Republican governors dropped their mask mandates a long time ago. Some, like Governor Ron DeSantis of Florida, have even banned mask mandates and threatened to penalize school officials who defy them. The actions drew heavy criticism from Mr Biden, who ordered his education secretary to bring federal civil rights actions to dissuade states from banning face coverings in classrooms .

But White House officials have not been critical of their fellow Democrats as they end the masking rules. Ms Psaki said there “is a clear difference between getting in the way, which Ron DeSantis did” and “allowing local school districts to make choices, which a number of these states are doing.”

Public health experts agree that school mask mandates shouldn’t last forever, but are divided on whether it’s time to abandon them. The CDC’s current masking recommendations advise state and local authorities to adopt indoor masking policies in areas of the country with high transmission.

A color-coded map on the agency’s website shows the entire country in red; 99% of all counties are in a high transmission area – a point Dr. Walensky emphasized on Wednesday.

The audience is understandably confused. Several weeks ago, with Omicron infections soaring, the CDC clarified its position on various types of masks, acknowledging that the cloth masks frequently worn by Americans do not offer as much protection as surgical masks. or respiratory. A few days later, Mr. Biden announced that his administration would distribute 400 million high-quality N95 masks to the public free of charge.

Now, several experts said, the agency must quickly come up with measures for when masking and other mitigations should be relaxed — and when they should be reinstated. Dr Wen spoke of an “offramp” and an “on ramp” for mitigation measures, and said two factors are critical: whether hospitals and intensive care units have sufficient capacity, and whether vaccines and boosters protect against serious diseases.

“Exiting restrictions must be their top priority, because that’s what individuals, businesses, national and local authorities think about every day,” she said.

Drs. Wen, Gounder and Osterholm are on a long list of experts the White House recently consulted. None of the participants would describe the discussions, except to say that the participating administration officials – including Dr. Vivek H. Murthy, the surgeon general; Dr. Fauci; and Dr. David A. Kessler, the scientific adviser for the Covid response – did more listening than talking.

The meetings with outside experts appear to have been prompted by a trio of articles published in January in the Journal of the American Medical Association, in which six former Biden transition advisers urged the administration to take a longer view and to start writing a pandemic playbook aimed at “the new normal”.

The effort was led by Dr. Ezekiel Emanuel, an oncologist and medical ethicist who advised former President Barack Obama. In the first article, Dr. Emanuel, Dr. Gounder and Dr. Osterholm, an epidemiologist at the University of Minnesota, wrote that the United States must avoid being stuck in “a perpetual state of emergency”.

To be better prepared for inevitable outbreaks — including from new coronavirus variants — they suggested the administration set specific goals and benchmarks, including the number of hospitalizations and deaths from respiratory viruses, including including influenza and Covid-19, should prompt emergency mitigation and other measures.

Mr. Biden has previously signaled that he is looking beyond the pandemic. In remarks at a press conference in mid-January, he said the nation “is moving towards a time when Covid-19 will not disrupt our daily lives, when Covid-19 will not be a crisis, but something to protect against.” But the president also said then that “we are not there yet”.

Adel Hassan contributed reporting from Boston, and Amelia Nierenberg from New York.

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