‘We are not there yet’: As states drop mask rules, the CDC stands firm

The White House has been meeting with outside health experts to plan a pandemic exit strategy and a transition to a “new normal,” but the behind-the-scenes effort is crashing into a very public reality: A string of blue-state governors have gotten ahead of President Joe Biden by suddenly abandoning their mask mandates.

Two of the administration’s top doctors – Dr Anthony Fauci, the president’s chief medical adviser for the pandemic, and Dr Rochelle Walensky, the director of the Centers for Disease Control and Prevention, both expressed qualified optimism on Wednesday about the direction of the pandemic. If cases continue to fall and no new variants arise, the country “could be heading toward what we would consider more normality,” Fauci said in an interview.

But Fauci cautioned that the situation “is still unpredictable,” and said any transition out of the current crisis would be gradual. And Walensky said pointedly that while her agency is working on new guidance for the states, it is too soon for all Americans to take off their masks in indoor public places.

“Our hospitalizations are still high, our death rates are still high,” she said during a news briefing by the White House Covid response team. “So, as we work toward that and as we are encouraged by the current trends, we are not there yet.”

The gubernatorial frenzy to drop mask mandates comes as the White House Covid response coordinator, Jeffrey Zients, and the government’s top doctors are soliciting advice from a wide array of public health experts, including some former Biden advisers who have very publicly urged the president to shift course. Zients referenced the sessions briefly on Wednesday, saying the White House is also reaching out to governors and local public health officials to talk about “steps we should be taking to keep the country moving forward.”

The talks, according to numerous participants, are aimed at drafting a fresh playbook for the delicate next phase of the pandemic, when the coronavirus threat is likely to recede but the possibility of a new variant and another deadly surge remains very real. They are addressing 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 deliberations, within both the CDC and Zients’ team, are putting the White House in a tough spot. As officials examine the science and chart a careful course, they run the risk of making the Biden administration look irrelevant as governors forge ahead on their own.

“The administration needs to read the room and see that nearly all elected leaders are moving on without them,” said Dr Leana Wen, a former Baltimore health commissioner who has often been critical of the administration, adding, “No one is expecting the CDC to say that everyone should go maskless right now. What they are looking for are clear metrics on when restrictions can be lifted and when they may need to return.”

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

It is now clear 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 fulfilling his campaign promise to listen to scientists and follow the data.

“That doesn’t move at the speed of politics,” she added. “It moves at the speed of data.”

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

If the drop in cases and hospitalizations continues, as many experts expect, Biden himself will soon have some tough decisions to make: Should he declare an end to the national emergency that his predecessor, President Donald Trump, declared in March 2020? Should Biden lift the mask mandate that he imposed for travel on airplanes, trains and buses?

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

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

“It has to acknowledge that we are entering a new phase of virus transmission in our communities, being forever mindful that we were in exactly the same place one year ago today, where cases were decreasing from a January peak, vaccines were flowing,” he said. “And look what that got us.”

The CDC’s masking decisions are especially fraught: It is difficult, experts say, to issue a one-size-fits-all prescription for a country as sprawling and varied as the United States.

“It’s a challenging situation, because of course people are really anxious to get back to some sense of normalcy,” said Dr Celine Gounder, an infectious disease specialist who recently joined Kaiser Health News as an editor at large. “It’s highly variable across the country – how much transmission there is, what vaccination uptake has been – but the CDC produces guidance for the entire country, so it makes sense for them to be cautious.”

Masking has been one of the most contentious issues of the pandemic. Many Republican governors cast aside their mask mandates long ago. Some, like Gov. Ron DeSantis of Florida, even banned mask mandates and threatened to penalize school officials who defied them. The actions drew fierce criticism from Biden, who directed his education secretary to bring federal civil rights actions to deter states from barring masking in classrooms.

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

Public health experts agree that school mask mandates should not last forever, but are divided about whether it is time to drop them. The CDC’s current masking recommendations advise state and local officials to enact indoor masking policies in areas of the country where transmission is high.

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

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

Now, several experts said, the agency must quickly come up with metrics for when masking and other mitigation measures should be relaxed – and when they should be reinstated. 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 are protecting well against severe disease.

“The offramp for restrictions needs to be their top priority, because this is what individuals, businesses, state and local officials are thinking about every day,” she said.

Wen, Gounder and Osterholm are on a long list of experts with whom the White House has recently consulted. None of the participants would describe the discussions, except to say that the administration officials participating – including Dr Vivek Murthy, the surgeon general; Fauci; and Dr David Kessler, the science 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 begin drafting 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, Emanuel, Gounder and Osterholm wrote that the United States must avoid becoming stuck in “a perpetual state of emergency.”

To be better prepared for inevitable outbreaks – including from new coronavirus variants – they suggested that the administration lay out goals and specific bench marks, including what number of hospitalizations and deaths from respiratory viruses, including influenza and Covid-19, should prompt emergency mitigation and other measures.

Biden has already been signaling that he is looking past the pandemic. In remarks at a news conference in mid-January, he said that the nation is “moving toward a time when Covid-19 won’t disrupt our daily life, when Covid-19 won’t be a crisis, but something to protect against.” But the president also said then that “we’re not there yet.”

This article originally appeared in The New York Times.