The Centers for Disease Control and Prevention is considering updating its guidelines on the metrics states should use when considering lifting public health measures such as mask mandates, according to four people familiar with the matter.
Agency scientists and officials are debating whether to continue to publicly support using transmission data as a marker for whether to ease public health interventions such as masking, particularly in school settings, the people said. CDC staff are weighing whether the agency should use case rates as a metric or whether it should lean more heavily on hospitalization data, particularly information on hospital capacity. In recent days, the CDC has reached out to external doctors, scientists and public health organizations for input, one of the people with knowledge of the discussions said.
Any change in CDC messaging around Covid-19 metrics could impact whether state and local officials continue to lift mask mandates, including in schools.
“We should not be using case numbers at all when making decisions about restrictions. The case numbers are not reliable,” said Leana Wen, an emergency physician and public health professor at George Washington University. “The metrics for deciding when restrictions should be lifted should be solely on hospitalizations and ICU capacity. As long as vaccines and boosters continue to protect well among the vaccinated and as long as hospitals are not overwhelmed, restrictions should all be lifted.”
The CDC did not respond to a request for comment.
The debate at the CDC comes as governors across the country in states such as New York, New Jersey and Delaware, announce they are lifting mask mandates in schools. The move by states to ease public health measures has exasperated officials with the CDC and the White House Covid-19 task force who feel the pandemic is far from over and that new, more-transmissible variants could reemerge in the coming weeks and months.
While case counts and hospitalizations have plummeted in recent weeks, the country is still averaging more than 200,000 new infections and 2,500 deaths each day over the last week.
In a press conference Wednesday, CDC Director Rochelle Walensky laid out a conflicting message regarding the agency’s thinking on Covid-19’s ongoing threat and whether the data supports the easing of public health measures.
“At this time, we continue to recommend masking in areas of high and substantial transmission. That’s most of the country right now,” Walensky said. The CDC uses case rates to measure community transmission. Walensky went on to say that the CDC is also using hospitalization data as a “barometer” for how local communities are faring.
The CDC is reviewing its national surveillance data, including information from wastewater studies, case reporting, vaccinations, hospitalizations and deaths. The major problem with relying on one piece of data over another to determine whether easing public health restrictions is warranted is that the data the CDC collects is often delayed and aggregated. The agency should consider using a mix of metrics, said Ashish Jha, dean of Brown University’s School of Public Health.
“In the ideal world, we would pay attention to infections among unvaccinated people because they are the ones that lead to bad outcomes and hospitalizations and deaths overall. But our ability to track vaccinations and boosters is limited in real time,” Jha said. “Therefore, we have to use some proxies. I think at the end of the day people will care most about hospitalizations. But hospitalizations can be a lagging metric, too. Ultimately, it is probably a combination of infections and hospitalizations.”
The sudden string of decisions by Democrat-led states to begin relaxing mask mandates and other restrictions has prompted a scramble within the administration to decide how to respond, two people with knowledge of the matter said.
Though Biden health officials have been encouraged by the plummeting case rates, some are still fearful that dropping precautions too soon could backfire if another dangerous variant suddenly emerges — further damaging the nation’s morale and Biden’s political fortunes.
In a Reuters interview published Tuesday, Walensky insisted that “now is not the moment” to end mask mandates in schools and that her agency continued to advise universal masking — comments that one person with knowledge of the matter said frustrated some officials who questioned why she would take such a hard line at the same time the administration was considering changes to its position.
White House press secretary Jen Psaki later in the day took a more noncommittal stance, telling reporters the CDC would be reviewing its guidance but that “our goal remains continuing to ensure that there is guidance that helps school districts stay open.”