From Texas to Mississippi, States Dismantle Covid-19 Safety Protocols at Our Peril

The gusto of Reopening 2.0 already has epidemiologists bracing for a fourth gale of coronavirus. Instead of gritting teeth for another couple of months before a solid majority of adults are vaccinated, governors and mayors are relaxing or ending restrictions on businesses and public gatherings from Massachusetts to Texas, from California to Mississippi, from Michigan to Utah, from South Carolina to Nevada, from Maryland to Washington, and from New York to Arizona.

Instead of legislatures scrambling for a few more weeks of financial relief to keep businesses and families afloat, we are seeing a mass reopening of business offices, restaurants, sports arenas and stadiums, concert halls, movie theaters, amusement parks, casinos, gyms, bowling alleys, hair salons, barber shops, tattoo parlors, and spas. Many states are trying to shoehorn teachers back into classrooms, whether or not they are vaccinated.

It is momentarily irrelevant that the Biden administration has restored science to the White House and reinstituted coronavirus briefings led by the likes of Anthony Fauci, the nation's top infectious disease expert, and Centers of Disease Control and Prevention Director Rochelle Walensky, the former infectious disease chief at Massachusetts General Hospital. Thus far, their plea for caution in coming out of COVID-19 hibernation is being met with all the attention of drivers speeding through a yellow light.

With the economy down 9.5 million jobs and social life relegated to Zoom screens, many policy makers have completely forgotten the deadly consequences of last spring's abrupt, premature ending of lockdowns. They are ignoring that the nation's seven-day rolling average of new confirmed COVID infections has leveled off well above 50,000 a day, more than five times the 10,000 a day Fauci has long advocated as the threshold for considering a major relaxing of restrictions.

Leaders are shrugging off the growing dominance of COVID-19 variants and the fact that, as of March 15 New York Times tracking, only 21 percent of people in the United States had received even one vaccine dose. Only 12 percent of people are fully vaccinated.

"Reckless" and a "national embarrassment"--experts say Texas and Mississippi ignore reality

The most jaw-dropping examples are Texas and Mississippi, which ended just about every restriction, including mask requirements. Governor Greg Abbott declared Texas to be "open 100 percent." Mississippi Governor Tate Reeves said, "We are not going to continue to use the heavy hand of government when it is no longer justified by the reality we see around us."

Masks would still be required at federal facilities and in transportation by order of the Biden administration. Businesses in both states can still require employees and customers to wear masks (which many big box stores are). But as we saw in the rash reopenings of last summer, this return to optional masking dumps a wild west of inconsistency on frontline workers, stressing them out in confrontations with unruly customers who refuse to wear masks, and elevating their risk of coronavirus exposure.

The reality those governors see is not shared by independent health experts in those states. According to the March 15 New York Times coronavirus map, Mississippi's seven-day average of daily new cases has plateaued at levels seen just before its fearsome July and January surges. Texas is on a similar roller coaster. After hitting a record 342 deaths a day on a seven-day rolling average in late January, Texas is back down to 161. But that is still more than five times the starting point of last summer's surge, and three times the level of average daily fatalities in October that kept the Texas ripe for this winter's deadly wave.

Texas and Mississippi also have some of the lowest vaccination rates in the nation as of March 15, with respectively only 19 and 20 percent of residents receiving even a first dose. And as of March 15, Texas and Mississippi were above the five-percent COVID-19 positivity rate recommended by the World Health Organization for reopening. Mississippi's March 16 positivity rate of nearly 14 percent is the sixth highest in the nation, nearly three times the WHO's recommended rate for reopening.

All those numbers have Vice Chancellor LouAnn Woodward of the University of Mississippi Medical Center saying it is not yet time to end mask mandates. "Let's not give up until we get across the finish line," Woodward said. Anita Henderson, the president of the Mississippi chapter of the American Academy of Pediatrics, thanked Hattiesburg Mayor Toby Barker for maintaining a local mask mandate. "Let's not see another wave and undo all the good progress we have made," Henderson tweeted.

In the College Station area of Texas, Lon Young, co-founder of an emergency and urgent care system, warned against the notion that the end of mask mandates equals the end of COVID-19. "This isn't like a traditional war, where peace is declared and the fighting suddenly stops," Young said. In Houston, the city's chief medical officer, David Persse, said he was at a loss for words because, "This virus attacks every organ system. The brain, the heart, the kidneys, the intestines, the skin. If it's taught us anything else over this past year it's that anytime we give it the opportunity to rear its ugly head, it will absolutely take that opportunity."

Mayors in the biggest cities of both states, most of whom saw COVID-19 first hit hardest in Black or Brown communities, were united in their protest of their governors willfully plowing ahead to risk a new wave of infections. In Greenville, Mississippi, which is 82 percent Black, Mayor Errick Simmons said Reeves was being "reckless" at a "crucial moment in the fight." In Jackson, Mississippi, also 82 percent Black, Mayor Chokwe Antar Lumumba said he will maintain a local mask order. Using a sports analogy, he said, "No one celebrates victory in the third quarter."

Mayor Sylvester Turner of majority Hispanic and Black Houston called Abbott's 100 percent reopening a "national embarrassment." Lina Hidalgo, head of the governing body of Harris County, which includes Houston, went so far as to suggest that Abbott's move is a "cynical attempt to distract Texans from the failures of state oversight of our power grid," during the state's recent epic cold snap that left millions of people without power or safe drinking water.

Recklessness elsewhere under the radar

The outrageousness in Texas and Mississippi is the leading edge of a major outbreak of dispensing with social distancing. Arizona Governor Doug Ducey lifted capacity restrictions for most businesses despite the Health System Alliance of Arizona, which represents more than 80 acute hospitals in the state, saying "Now is not the time to relax our mitigation efforts." Speaking to the Arizona Republic, Farshad Fani Marvasti, a public health expert from the University of Arizona College of Medicine-Phoenix, likened the situation to "one of those 'mission accomplished' moments when we're not quite there yet."

Oklahoma Governor Kevin Stitt lifted all his remaining state COVID-19 restrictions March 12, despite Oklahoma State Medical Association President George Monks saying, "Letting up on our efforts to battle COVID now is like a football player spiking the ball at the five-yard line. We are nearing the goal, but we are not there yet."

Utah Governor Spencer Cox recently allowed concert and sports venues in areas of low or moderatecoronavirus transmission to go back to full capacity, side-by-side seating. He did so assuming everyone is masked. But the state legislature muscled him into ending statewide mask mandates on April 10. The chief of pediatric infectious disease at the University of Utah's medical center, Andrew Pavia, tweeted that this arbitrary ending of mask mandates in a state that is still above the recommended WHO positivity rate and has the nation's lowest rate for fully vaccinated people, is "very dangerous to public health."

Infectious disease physician Brandon Webb of Utah-based Intermountain Healthcare warned to the Salt Lake Tribune, "We're still in a race between vaccination and variants. It's important to remember that the virus is just a machine ... whose sole purpose is to survive by infecting others. And it will continue to do that as long as there are susceptible individuals in the population. It doesn't sleep, doesn't care about politics. It doesn't care that we're all so tired of these precautions."

A charitable view is that one could be thankful for the governors who hedged their bets in reopening their economies with momentary continuances of mask mandates, even if they are scheduled to soon expire. Such states include Wyoming, Arkansas, and Alabama. Kay Ivey, the governor of Alabama, who is ending her mask order April 9, said, "There's no question that wearing masks has been one of our greatest tools in combatting the spread of the virus."

But by mid-April, we will be back to at least 20 states without mask orders, including the second-, third- and eighth-most populous, Texas, Florida and Georgia. Several other state mask mandates are set to expire later this month if not extended. That sets up the United States to have one-third of the nation--more than 100 million people--living in places where mask use is optional, with less than a quarter of the populace even partially vaccinated.

West Virginia Governor Jim Justice, one of few governors in a politically conservative state to stand behind an indefinite mask mandate calls the jettisoning of mask orders "ridiculous." He recently toldCNN, "I don't know really what the big rush to get rid of the mask is because these masks have saved a lot, a lot of lives. . . If we don't watch out, we can make some mistakes."

Peoples' lives on the line, again

The rush by governors and legislatures to get rid of the mask after we've lost a world-leading 530,000 lives actually runs counter to the still-high public support for masking and social distancing. An Associated Press/NORC poll last week found that 82 percent of respondents wear a mask when encountering people outside their homes, 77 percent practiced social distancing, 72 percent avoided nonessential travel, and 66 percent avoided other people as much as possible.

As hard as that has been, two-thirds of respondents in both the AP and ABC News polls approve of President Biden's sober handling of the pandemic and his reenlistment of science.

As for the specific act of lifting mask mandates, 56 percent of respondents said they were being lifted too quickly in an ABC News/Ipsos poll last week.

This is after a year when the majority of us adhered to a full year of restrictions to keep the virus from spreading. We missed family holiday dinners, funerals, weddings, graduations, reunions, and bucket-list vacations. The economic pain has been crushing. The restaurant sector has seen the closure of 110,000 establishments and has lost two million jobs according to the National Restaurant Association. The 800,000 jobs lost in the arts, entertainment and recreation industry represents a third of the sector, according to a University of New Hampshire analysis. Many state and local government budgets have run dry, losing another 1.3 million jobs.

As hard as that has been, two-thirds of respondents in both the AP and ABC News polls approve of President Biden's sober handling of the pandemic and his reenlistment of science. That suggests that the majority of people are more prepared than calculating state politicians to make one more push to live with restrictions until scientists tell us we've reached "herd immunity." That is the level where the vaccinated and those who were infected add up to enough of the population that the virus runs out of bodies to infect. Fauci has said the range is between 70 percent and 90 percent of the populace.

One way of understanding what is at risk if the nation does not make that push comes from a New York Times analysis last month of data from the American Journal of Preventive Medicine. If we keep current social distancing measures in place as people get vaccinated, we might keep loss of life to another 100,000 people by July. If we ease up on restrictions with only 15 percent of people being vaccinated (again, the US was only 10 percent fully vaccinated as of March 11), we could reach herd immunity by June but at the cost of 70,000 additional lives.

A full reopening everywhere could result in herd immunity by May, at the collateral cost of 320,000 additional deaths. And that is before factoring in the unknown effect of variants, which could double our current toll past the 1 million mark.

Another way to understand the risk is via the ongoing tracking by the University of Washington's Institute for Health Metrics and Evaluation (IHME). It currently projects nearly 600,000 deaths by July 1 under current restrictions. With the riptide of variants and the "unexpected" lifting of mask mandates in Texas and Mississippi, the institute said in a March 6 advisory that we could see a fourth surge "even stronger than in our worst scenario."

As even more states announced relaxing restrictions, the IHME issued a more dire March 10 advisory, charting a "huge jump in mobility" almost back to pre-COVID levels in 22 states and a rise in coronavirus transmission in 19 states since late February. That risks the nation seeing a worst-case scenario of 656,000 deaths, at the razor's edge of the 675,000 deaths of the 1918 flu pandemic. Masks alone could save more than 70,000 lives from the worst-case calculation.

The huge jump in mobility is deeply concerning as plenty of data suggests that even with masks, coronavirus can spread with prolonged indoor exposures. The CDC emphatically says on its website, "A mask is NOT a substitute for social distancing. Masks should still be worn in addition to staying at least six feet apart, especially when indoors around people who don't live in your household."

Biden administration not pleased

The importance of combining masks with social distancing is likely why the Biden administration has given no blessing to the relaxing of social distancing anywhere, whether in aforementioned conservative states that seem to treat public health as a mosquito to swat away or in more liberal states and cities where governors and mayors are being twisted in knots by economic agony and massive racial inequalities in access to vaccines.

Massachusetts, New York, Connecticut, California, and Pennsylvania, as examples, are far from boasting that they are 100 percent open, but are still alarming many public health experts by relaxing all kinds of capacity restrictions for social gatherings, movie theaters, theme parks, and sports and entertainment venues.

In Massachusetts, William Hanage of Harvard University's School of Public Health told WGBH radio that Governor Charlie Baker's relaxing of restrictions "is going to provide more contacts, which means that those cases are going to go up again. . .Once we start giving the virus more opportunities to transmit, it's going to take them."

In New York City and New York State, controversy is bubbling over with both Mayor Bill de Blasio and Governor Andrew Cuomo accused of sidelining science and chasing out public health officials as they crafted a more political and economic response to the pandemic. Cuomo, fighting for his political life with sexual harassment accusations, is also accused of undercounting COVID-19 nursing home deaths.

Most state actions also seem to run counter to last week's CDC guidance for fully vaccinated people. While fully vaccinated people are now free to socialize indoors with other fully vaccinated people with no masks, the CDC still recommends against gathering with unvaccinated people from more than one household, avoiding "medium or large-sized" gatherings, and delaying domestic and international travel.

Fauci, citing how Europe is experiencing a fearsome new surge fueled by new variants and relaxing protections too soon, is once more emphasizing that the nation should get its case count to less than 10,000 per day before the states fully throw open their doors for business and advise us to throw away our masks.

A clearly frustrated Fauci called the actions of states like Texas and Mississippi "inexplicable." He said the sight of last week's bike rally in Daytona Beach, Florida that attracted perhaps 300,000 enthusiasts "gives me chills." He said, "When you have that much of viral activity in a plateau, it almost invariably means that you are at risk for another spike."

Walensky, who fears that the nation could "completely lose the hard-earned ground we have gained," cited this past weekend's spike in spring air travel to its highest levels since the pandemic began as a reason for her concern. "I'm pleading with you, for the sake of our nation's health. . .where this goes is dependent on whether we all do what must be done to protect ourselves and others."

Where this goes is dependent on whether anyone will listen now that science has been restored to the White House. Fauci and Walensky are flashing a yellow light to us. Governors are dangerously close to running a red.