While millions of vaccinated people across the Bay Area can now leave their masks behind, those in Santa Clara County must continue to don theirs in most public settings. And that’s no doubt got many of them ticked off again at the county’s top health officer, Dr. Sara Cody.

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But Cody, whose hard stance has drawn both praise and scorn, isn’t budging, even after county Supervisor Cindy Chavez cracked the county’s typically united front against COVID-19 by publicly questioning an earlier public health mandate.

“I do want to better understand, philosophically, the approach to the health orders,” Chavez told Cody at a recent Board of Supervisors meeting. “And in particular, what I am concerned about, and I have raised this at a number of meetings, is just the difference between the state orders and what’s happening locally and the level of stress and confusion that I believe it’s causing.”

Chavez had questioned the county’s mandate that all front-line employees must have booster shots and those with religious or medical exemptions are to be reassigned or disciplined. She expressed “concern about the way (the county) is addressing this relative to the science.”

In an interview this week, Cody acknowledged her orders can be viewed as government overreach, even by people who take the danger of COVID-19 seriously and do all the right things to avoid it.

“I understand and we understand that there are very strong feelings and there is no policy that’s going to please everyone,” Cody said. “This has been true throughout the pandemic and it remains true.”

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But as unpopular as some of her orders are and sometimes out-of-step with the state’s, Cody says she’s not about to abandon her belief that public health backed by science should drive decisions.

“Everyone gets as much as possible an equal chance at a  healthy outcome,” she said, and that includes immunocompromised county residents who will  benefit from the mask mandates.

And she also has to take into account residents who can’t just work from home.

“The risks of COVID aren’t just the illness that someone might have, but many essential workers who get ill. They may not have paid sick leave,” she said. “And so, if we have high levels of community transmission, we have more essential workers getting ill. And if they’re ill, they miss income and that has an impact on them and their family.”

Taking the easy way out would undermine her department’s credibility, Cody added.

“One concern is losing the public trust if you suddenly do things that aren’t consistent with your core values,” she said. “So I think that, of course there’s risk on every side, and it’s a matter of balance.”

Over the last two years, the county has spearheaded many of the region’s COVID-19 rules, beginning with Cody leading the charge in ordering the first stay-home orders in the nation in March 2020. It also has aggressively cracked down on businesses that allegedly violated health rules, fining them substantially more than all other Bay Area counties combined.

But until its decision to stick with mask rule, the county had shown signs of easing up. Unlike San Francisco and Contra Costa counties, for example, Santa Clara County chose not to require restaurants and other businesses to check the vaccination status of indoor patrons.

So why is the county pivoting again by playing hardball with masks? Cody points to a real-world study released this month by the Centers for Disease Control and Prevention that found consistently wearing masks inside public places does reduce the chances of getting COVID-19, especially if they’re N95 masks.

“I feel very comfortable with the data that masking protects people and reduces their chance of getting COVID,” Cody said.

Before lifting the mask rules, Cody says the county must reach an 80% vaccination rate, stable hospitalizations and a seven-day average of 550 cases.

The county has already hit its vaccination goal, but is waiting to see the average number of COVID cases drop to 550 a week. When that happens, Cody said, hospitalizations should stabilize.

The omicron variant’s toll seems to be waning, but there are still 324 people in county hospitals suffering from the virus.

Although Cody recently estimated the mask mandate should continue for a few weeks, she said with case counts headed in the right direction it might be lifted sooner than anticipated.

As of Feb. 17, the seven-day average of COVID cases was 874, compared to a peak of almost 4,000 during the height of the omicron surge at the beginning of January.

While Cody thinks there will be “peaks and valleys” of COVID-19 cases in the future, she expects her department to play a less visible role in people’s daily lives going forward.

“I do foresee a transition away from mandates and requirements and toward guidance and recommendations, the way we more traditionally work in public health,” she said. “That is what I see in the future. For right now, I’d like to make a safe landing from (the) omicron surge so that we can kind of get on with things.”