Mask-freeing day: Tuesday, face coverings can disappear and some normalization can return
After the stroke of midnight early Tuesday, the spell will break. Masks can fall. Churches and gyms and movie theaters can fill up. We’ll finally be able to tell a smile from a scowl and sales of lip balm — and, perhaps, breath mints — will surely rise.
As California stands on the precipice of normalcy after more than a year of pandemic drama and trauma, some worry. Are we really ready? Is the state that valiantly vowed to follow the science really following the science?
“When the June 15 date was announced back in April, I thought, ‘What crystal ball does the state have?’” said Andrew Noymer, an epidemiologist and demographer at UC Irvine. “I felt they
were maybe a bit cocky.”
Clouds hovered over much of California on Jan. 7 — one of the pandemic’s darkest days — when 22,836 people were hospitalized with COVID-19 and 4,905 were so sick they required intensive care. On that day alone, 690 people died.
Fast forward to June 8, when skies were blue. Just 1,304 Californians were hospitalized with COVID-19 and only 270 were so sick they required intensive care. No one died.
The not-so-secret weapon: vaccines. Only a half-million Californians had been vaccinated in early January. More than 22 million people had been vaccinated by early June.
Natural immunity built through rampant infection — while not expected to be as robust as vaccine-induced immunity — played a role as well.
“They pulled it off,” Noymer said. “The numbers look good. COVID is not a big deal right now in California.”
And there’s nary an expert who’d disagree.
“I’m somewhat surprised that we are where we are now, given where we were three months ago, six months ago,” said Dr. John Swartzberg, clinical professor emeritus in the Division of Infectious Diseases & Vaccinology at UC Berkeley. “It has really exceeded my expectations and is testimony to two major things: These vaccines work far better than we thought they would and we have a government that really has guided us through this last phase in a very positive fashion, making vaccines widely available.”
As of June 11, 66% of Californians age 12 and older have had at least one shot, according to state data. That’s more than half of the state’s population.
“For most of the state with big population centers, it’s about as good as it’s going to get,” said George Rutherford, professor of epidemiology and biostatistics at UC San Francisco. “It needs to be better, but we’re getting off the steep end of the curve.”
Politics or science?
Some have asserted that the June 15 date was plucked from a hat by an embattled governor facing a recall election, but politics played no role in the decision, said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, in a Public Policy Institute of California webinar on Friday.
“We were thoughtful,” Ghaly said.
In April, when eligibility was expanding and vaccine supplies were really picking up, Ghaly and other officials gathered on Zoom to do some basic math, he said.
They allowed for a couple of weeks until all ageeligible Californians would get a chance to get vaccinated; looked at the maximum amount of time that must elapse between shots, which was four weeks for Moderna; added two weeks to that, as the immune system needs that long to get into prime COVID-19-fighting shape; and found themselves looking at about an eight-week block of time.
“We were in the middle of April,” Ghaly said. “We basically fast forward to June 15. That gave enough time for people to be fully vaccinated. That was a thoughtful decision.”
The state would have adjusted the date if those projections were wrong, but they weren’t. And there’s no arguing with success.
“I think we’re ready,” said Dr. Julie Parsonnet, professor of medicine, epidemiology and population health at Stanford. “California is doing amazingly well.
“We have treatments that work — they’re not perfect, but they work — and if people get vaccinated, they shouldn’t need treatments. Everyone who can get vaccinated should get vaccinated. In my mind, there’s no excuse for any more deaths from COVID.”
More freedom, more cases?
At the stroke of midnight on Tuesday, it’s more like the pumpkin turns into a carriage rather than the other way around.
In most places, masks will no longer be required for those who are vaccinated. The unvaccinated are supposed to continue masking up in certain situations to slow the spread, but it largely will be an honor system.
Caps on how many people can gather inside stores or restaurants or theme parks or churches will be gone. And people can get as close as they like to all those other people because physical distancing requirements will be gone as well.
Many workers at grocery stores and other businesses will continue to mask up, however — state guidelines on that are evolving — and masks still will be required for all on public transit, indoors at schools, in health care settings and in shelters and correctional facilities, vaccinated or not.
For those heading to a Metallica concert at an indoor arena, they will need to get their mask or paperwork in order. Proof of vaccination or a negative COVID-19 test will be required for large indoor gatherings — of 5,000 people or more — and the same will be encouraged, but not required, for large outdoor gatherings of 10,000 people or more.
Ten thousand people or more? After what we’ve been through, that makes many shudder, despite evidence that the virus is in stark retreat. Nevertheless, more than 50,000 fans are expected when Dodger Stadium returns to full capacity on Tuesday.
A recent PPIC Statewide Survey found that while many fewer Californians fear catching the virus than they did a year ago, worry remains relatively high among people of color and lower income Californians — two groups more likely to work in essential jobs.
Latinos (42%), Asian Americans (34%) and African Americans (32%) were much more likely than Whites (14%) to be concerned, the poll found. And precisely where Californians are on the income ladder factored strongly into the equation: Households making less than $40,000 per year were more concerned (40%) than those making $40,000 to $80,000 (29%), who were more concerned than those making $80,000 or more (15%).
Their worry may prove well-founded. In the short term, as masks peel off and people gather with no restrictions, the unvaccinated will find themselves at increased risk for getting infected, experts say. Nearly all new COVID-19 cases — some 97% — are in unvaccinated people, Swartzberg said.
That will translate to an increase in cases.
“Not a profound increase, but a slight one that’s going to likely blunt any decline, and might cause a little blip, in cases,” Swartzberg said.
Stanford’s Parsonnet isn’t too worried. Current caseloads
are low enough that, if and when new cases arise, California has the manpower to isolate them, limit the spread, care for the sick and get more people vaccinated. Continued vigilance is vital, she said. Noymer is blunt. “It’s reached the point where it’s on you if you’re not vaccinated,” Noymer said. “It’s on you.”
Ghaly was perhaps more diplomatic.
“COVID will find you if you’re unvaccinated,” he said. “It’s sneaky like that.”
But there’s a wild card at work. While the vaccines seem effective against the virus variants spreading right now, it’s unclear how effective they’ll be against new variants in the future.
Noymer looks forward to a languid, basically uneventful summer, but worries about what comes next.
“It’s just not going to be that bad for the next 12 weeks. Then it’s anyone’s guess exactly what’s going to happen in the fall and winter,” he said.
The virus spreads more easily indoors and in cold weather because of decreased humidity.
“I don’t anticipate we’re going to see anything like last December and January. But I would be not at all surprised to see a swell of cases late fall, peaking midwinter,” Swartzberg said.
States in the South with low vaccination levels — and most of the rest of the world, which still has extremely limited access to vaccines — are likely to have a much tougher winter than will California. Here, vaccines for the 5-11 age group are expected to be available this fall, which could do a lot to blunt fall and winter spread.
“Nobody can predict the future,” Stanford’s Parsonnet said. “I don’t think this virus is ever going to go away completely. We need to pay attention to it the same way we pay attention to other diseases, like the measles. We don’t have immunity to measles anymore. There are cases that occur and the health departments identify them, surround them, vaccinate people and limit the spread.”
She expects much the same with COVID-19.
“We have this enormous opportunity to protect ourselves, and one another, with a very safe and very efficacious vaccine,” Parsonnet said. “The more people vaccinated in the U.S., the
more they’ll contribute to stopping the spread.”
What now?
New York has a verification system for COVID-19 vaccination. The European Union is working on one as well, which could eventually be used by U.S. citizens.
But in California? One will unlikely even be whispered about until after the recall election is over, experts said.
“Politics left and right of center don’t like this idea, so you have a chance of making everyone unhappy,” UCSF’s Rutherford said. “I suspect we’ll see commercial entities step in to do this.”
Adjusting to even a reasonable facsimile of normal isn’t going to be easy for everyone. Taking off the mask in a supermarket might feel a bit like undressing in public. And while there’s no scientific reason for fully vaccinated people to continue wearing masks in most situations, it’ll likely take some time for a lot of people to feel fully comfortable, experts say. People should, and will, go at their own pace.
Families with unvaccinated younger children might continue masking up indoors in solidarity with their kids. It could be considered polite to mask up in places where workers mask up, to reduce the volume of strangers breathing on those workers.
Rutherford wouldn’t worry much about going to a megaplex to see the new Bond movie and not wearing a mask in a big, halffull theater, but he’d feel differently in a small art movie house where people are crammed together and ventilation is suspect.
This, though, is the summer for kids to frolic maskfree in the great outdoors, Ghaly said. Californians stepped up to the plate and did what needed to be done — from masking to distancing to getting vaccinated — and they should be proud.
But this is a global disease and we are not an island.
“Parts of the world are experiencing things on the opposite end of the spectrum. Devastation,” Ghaly said. “The opportunity for variants to spread and escape the vaccines needs to be watched.”
The surest way to counter that, all the experts said, is to get everyone, everywhere, vaccinated as soon as possible.