LOS ANGELES — On Wednesday, California — the country’s most COVID-cautious state — finally lifted its mandate for indoor masks.
But Los Angeles, the state’s largest city, has refused to follow suit. According to LA County Director of Public Health, Barbara Ferrer, Angelenos will: probably have to wait another month before they can officially remove their face coverings in public places.
LA isn’t the only county planning to slow down than California as a whole; Mendocino and Santa Clara also take their time. And as more Democratic governors move toward exposure, cities like Chicago are also at risk of being out of sync with their states†
Still, the tension between California’s recently relaxed rules and Los Angeles’ stricter rules neatly reflects the bigger strife now emerging in some of America’s bluest regions. Recognizing that Omicron numbers continue to fall ahead of a likely spring calm, many experts and officials who pushed for tighter security measures when the virus was rampant are now pushing for the opposite: breaking with restrictions in the name of preserving public trust — and collaboration — should COVID ever increase again.
“I believe our health regulations are only effective if people believe in them, if they think they’re fair and if they follow them,” LA County Supervisor Janice Hahn said Tuesday. “The longer we drag our feet on lifting the mandate for indoor masks, the more we are out of step with the state and the more trust we lose from our public.”
So why the delay? Critics say this is because LA isn’t adapting quickly enough to the new reality — a skill that will become increasingly necessary as the US moves from crisis mode to a sort of cautious truce with the viruswhich may require safety measures to switch on and off quickly in response to changing conditions.
LA officials are proud of their data-driven approach to COVID, and they have sought to strike an appropriate balance between public health and normalcy.
“We are fully open in Los Angeles County and I am happy that we are fully open,” Ferrer told the New York Times earlier this week† “But we did it by layering sensible protections.”
After early nationwide closures, businesses here have been open since the summer of 2020. It took a long time for schools to reopen for personal education, but they remained fully open during the recent Delta and Omicron peaks due to universal testing and masking – in contrast to the more than 20,000 schools closed in less cautious areas.
In terms of health outcomes, the average COVID death rate in LA County was no more than 0.73 per 100,000 residents per day during Delta or Omicron, the only waves to hit after vaccines became widely available. In Florida — to pick a place that has refused to demand vaccines or masks — the corresponding spike was more than twice as high (1.75 deaths per 100,000 population).
Indoor masking did, according to a new study from the Centers for Disease Control and Prevention have something to do with this† So it’s understandable that LA wants to rely on statistics, not politics, to determine when to lift its mandate.
The question is whether LA’s stats still make sense.
According to health officials, LA’s indoor mask mandate will remain in effect until the county registers a “moderate” level of coronavirus transmission for seven consecutive days, as defined by the CDA.
For LA, that means fewer than 730 cases per day in a province of 10 million.
Unfortunately, LA currently has an average of nearly six times as many daily COVID cases (about 4,100). Even at today’s rapid rate of decline — about 3.5 percent a day — it will still take 25 to 30 days for the county to cross the CDC’s “moderate transfer” threshold, according to Ferrer†
But that may be an outdated approach. The CDC has defined the four color-coded levels of coronavirus transmission in November 2020 — long before the advent of the extremely transmissible but less severe Omicron variant. At that time LA County was testing about 50,000 people a day† Today the province is testing about 155,000 people a day†
Because the absolute number of detectable cases is largely dependent on the number of tests performed – particularly in the Omicron era – LA is effectively punishing itself for increasing its testing capacity. It’s harder to get to 730 cases a day when you’re testing three times as many people — and that’s assuming you ever get there. The province’s seven-day average has not fallen below 730 cases since July 10, 2021.
Another strategy would be to link masking to positivity rates. By November 2020, when LA County conducted 50,000 tests per day, about 1.5 percent of them would need to come back positive to equate to 730 daily cases. Today, a positivity rate of 1.5 percent equals 2,325 cases. But instead, LA is still targeting 730 cases, which now represents a positivity rate of less than 0.5 percent. In other words, “average” transmission means a lot fewer transmission than before – even though many more Angelenos have immunity than then.
By adhering to pre-Omicron CDC recommendations that index indoor masking to absolute case numbers — as opposed to more relevant spread or risk measures — LA County effectively raises the bar for unmasking while reducing the risk of getting sick from COVID down.
LA County officials seem aware of the contradiction. Previously, they said they would need two weeks of moderate handover before lifting the indoor mask mandate; this week they shortened it to one. At the same time, they removed what was expected to be another trigger to relax the rules – the availability of COVID vaccines for children under 5 years old — due to delays in the federal review process. The Los Angeles Unified School District will likely from next week no more masks needed outdoors†
But even as most of California, not to mention the rest of the country, makes indoor masks optional — and even like the CDC itself reportedly prepares to revise its own pre-Omicron mask guidelineslinking indoor recommendations to “the level of serious illness and hospitalizations in a given community” rather than the raw number of cases – LA has been slow to adapt.
Ultimately, a few more weeks of mandatory indoor masking will likely have little effect on the virus’ trajectory, which is on the decline, even as Angelenos continue to gather unmasked in bars and restaurants (and sporting events), just like they always have.
Still, it could backfire if another serious variant ever sparks another wave. The next phase of the US COVID response will be about switching between security measures and normalcy, if necessary. To convince people to put masks back on, you must first show that you know when to take them off.