Last week, exactly one month after Californians elated over the state’s grand reopening, Los Angeles County officials announced that masks would once again be mandatory in indoor public places.
The move, which came in response to the explosive spread of the Delta variant of the coronavirus, was an emotional setback for Angelenos, who has lived with strict pandemic restrictions for more than a year.
Case rates have increased at an alarming rate and millions of Los Angeles County residents have yet to be vaccinated.
I spoke with Barbara Ferrer, county public health director, about what lies ahead and why her office has decided to revert to mandatory interior masking. Here is our conversation, slightly edited and condensed.
First of all, Dr Ferrer, can you explain why it was necessary to put the warrant in place rather than continuing with the guiding of the masks? You told my colleague a few weeks ago that you had no intention of “going back to containment or more disruptive mandates.” What changed?
I guess I would start by saying that we don’t see wearing masks as a disruptive mandate at all. It may be inconvenient for some people, but it does not disrupt normal business processes.
We were hoping that more people would hide inside with the recommendation. With the Delta variant, the situation has changed. I don’t think we would see an increase in cases without the Delta variant.
From the start this department has been very clear, we recommend masking indoors due to what we have seen in other countries with this variant.
Now that we know more, it’s time to impose the masks inside. This is consistent with how we approached mitigating the devastating effects of this virus with the available evidence.
We have had over 2,500 new cases today. The positivity of the test is 5.2 percent. All of these numbers reflect the behaviors and actions people took two weeks ago.
We were just urging people to wear masks indoors to avoid these big flare-ups. But it will take us at least a few more weeks to start seeing the benefits.
What are you looking for to be in a place where it is safe to lift the warrant if not the masking guidelines? How long do you think it will take?
This is an excellent question. We made the decision when community transmission went from a moderate level to a substantial level of transmission. We are on the verge of shifting to widespread transmission.
We would like to go back to a more moderate community transmission threshold, in which case we will be comfortable.
This will indicate that a lot of people have signed on to the masking mandate. But getting more people immunized is still the most effective way to reduce transmission. So it will take both.
Do you think it will be weeks? A month? Month?
It’s hard to say. It is by far the most contagious variant that we have ever seen; you end up with more breakthrough cases because it’s a more infectious variant.
I want to congratulate everyone who got vaccinated here. That’s 69% of people 12 and over.
But that still leaves us with around 4 million people, of which around 1.3 million are because they are under 12 years old. The number of sensitive people is huge in LA County.
How much costs the interior masking mandate intended to prevent the virus from spreading among unvaccinated Angelenos versus preventing those who have been vaccinated from getting sick?
I think it’s both. You don’t want a lot of community transmission because it leads to more mutations. As we have seen with the Delta variant, while the vaccines are super potent, they are reduced. But by far the most serious loss of life and health consequences are experienced by unvaccinated people.
A lot of them are really scared. These are not fools who are just stubborn. Before dismissing people as being completely irresponsible, many actually cannot get vaccinated for health reasons. We all need to make a commitment to help those with concerns in order to move forward.
I think it will help once the FDA fully approves this vaccine. This will help more private companies to demand vaccines, especially if they serve people at high risk.
Are you worried about undermining confidence in the vaccine or confidence in public health officials if people have been taught that they are much safer and can go back to some sort of normal once vaccinated?
I appreciate this question. I would like life to be easier. Everyone would like us to say one thing and stick to it for five months, but the information we have is constantly changing. We all need to recognize the reality we live in.
It’s a new virus. Whenever we have a new explosion attributed to the new variant, we sort of start over in the sense that we have to assess how it interacts with human beings.
A lot of people cling to the optics: take off your mask, to show that we are really safe again. This has never been true. Absolutely, people who are fully immunized have a lot more protection, but we’re going to continue to have variations. This is our reality.
The best we can do is get good information that is really transparent about what the data is telling us when things start to change.
I will also say for the record that LA County has always believed that people should continue to wear masks indoors.
Most of us who have been vaccinated, we have not been vaccinated to take off our masks. We got vaccinated to stay healthy and get back to doing the things we love.
For example, is the department considering allowing companies to let customers remove their masks if those companies implement a vaccine monitoring program? This is largely why the state has deployed his digital vaccine cards – to allow companies to do that, right?
I am very open to knowing if there are alternatives.
Science must guide some of these decisions. If you are indoors in a room with fully vaccinated people, your risk of getting sick or passing the infection on to others is very, very low – much lower than if you are in a room and you are vaccinated, but not everyone.
In your home, in your own social settings, you run much less risk because you know people. But the public places that we did not understand. Ultimately, however, we want to wear these masks now, reduce community transmission, and take a mask mandate off the table.
If this continues for longer than we would like, we talk to the companies and we are open to doing what makes sense.
Is there a time when you might need to close, say, reopening concert halls?
I hope not. We definitely can’t take anything off the table. But it would take extraordinary circumstances.
More likely, we would work with sites to get people to get tested or get vaccinated.
I don’t see us going back to containment, I hope. We have vaccines now. The last time we had no vaccines.
Can you talk a bit about how you are trying to get more people vaccinated?
This week we have 329 mobile teams. We continue to increase this mobile capacity. If you are a business, if you are a community supplier, if you say, “We have 10 people who might want it,” we’ll introduce ourselves.
We have people going door to door. We have a huge initiative with places of worship. We work with solo healthcare providers to get them through the vaccine approval process. It is much easier to take your child or young teen to your health care provider for the vaccine.
We are working very hard with companies that employ hourly workers to get them to release employees to come in for the vaccine. We’ve encouraged it with programs to make up for lost wages if that’s the kind of job you have. We have a community ambassador program for people to talk to their own friends and family, an ambassador program for students, an ambassador program for parents.
We try to make sure that people have access to good information. I think at this point for a lot of people it’s about relationships with the people they get information from. One of the worst things you can do is throw out people who haven’t come for the vaccine.
Social media has not been a friend in many ways. We talk to people and hear so much misinformation. These are myths that have come to life.
I appreciate the frustrations of some people who are fully vaccinated. But I think we have to move forward with kindness, with appreciation, with understanding. I think it’s a matter of strategy at this point.