Unpack CDC’s New Guidance
On Friday the CDC came out with new guidelines, appropriately signaling the urgent need to surge resources to our highest-risk patients and populations; to tailor our mitigation measures to the actual population level of COVID-19 risk; and to lift mandates that are doing more harm than good.
In short, the CDC acknowledged reality.
What do the new guidelines say, exactly?
Instead of merely using COVID case counts to guide mandated mitigation measures, the CDC now recommends looking at three metrics to better assess the risk of viral transmission:
New COVID hospitalizations over the prior week
The share of staffed hospital beds occupied by COVID patients, and
New COVID cases per 100,000 people over the prior week
The CDC then recommends that communities use these metrics to calculate their population’s risk as low, medium, or high. And…drumroll please…the CDC only suggests instituting mask mandates—including in schools—in areas considered high risk.
The CDC continues to strongly encourage vaccination as the safest and best way to protect ourselves—especially our highest-risk patients and populations—against death and serious outcomes from COVID. They also emphasize the importance of everything from COVID testing and treatment to wastewater surveillance to gauge community transmission.
I could quibble with the choice of metrics (or the existence of any metrics at all). I could argue that people can still get seriously ill from COVID-19, even in areas deemed to be “low risk.” I could also be worried that not enough people in this country have access to a primary care provider for nuanced advice about protection against the virus and for general preventative medical care. Indeed these must be the sources of ongoing, hard conversations.
But in issuing new guidance, the agency has appropriately recognized that we must learn to live with COVID (even though we don’t want to)—and that we must balance the harms of the virus with the harms of the mitigation measures themselves. It also means that it’s time to take stock of our unique medical vulnerabilities and the everyday risks we face.
The new guidance does not mean we are done with COVID-19. (We’re not!) It does not mean you cannot or should not wear a mask. (You can!) It does not mean the virus isn't worthy of ongoing attention. (It is!). Or that vulnerable people aren't vulnerable. (They are! FYI my newsletter last week was about how I’m advising my highest-risk patients.)
A return to “normal” also does not mean ignoring people at risk for poor outcomes from COVID—or turning a blind eye to the ongoing suffering and death from COVID. Indeed “normal” was pretty terrible for a lot of people in this country.
It’s merely time to broaden our definition of health; to redirect resources to where they matter most; and to allow for some normalcy and time for healing. It means recognizing that the threat of COVID is no longer what it was even three months ago and that our mitigations should be adjusted, too.
After all, shutdowns, school closures, and masks were meant to save lives when we didn’t yet have the vaccines, oral therapeutics, testing, and high-quality masks available for those who most need them.
And now we now have all of those things. What’s more, we know exactly who is at highest risk for poor outcomes from COVID—unvaccinated people, and a small percentage of vaccinated people (mostly adults who have at least four underlying conditions and/or are immunocompromised). These are the patients who need the most protection against COVID, and for whom medications like Evusheld and Paxlovid exist. (Again, see my newsletter from last week about this.) Meanwhile all of us—particularly healthy and COVID-immune people—should address other, more pressing threats to our health and well-being.
We can do both. We can walk and chew gum at the same time. We can resume living our lives while simultaneously protecting the vulnerable. We can sit in the here-and-now and plan for a better future. We can have hope and fear, joy and sadness, empathy and ambivalence—all at once. We can do hard things.
Friday’s announcement was well-received by many and seen as a defeat for many others.
To me, it’s neither a win nor a loss.
It’s merely a broad public policy change that means different things to different people and, in my opinion, should have nothing to do with politics, ideology, or morality.
Yet the combination of fear and pre-existing polarization seems to have conspired against us. Tensions are high which make transitions even more fraught.
I get it. The bonds of our communities and families have been challenged. We’ve been isolated from one another. We’ve been walled off from the rituals and routines of everyday life for too long. We have a long way to go to heal the wounds of the past two years and beyond.
If you read only one article this week about this complex time of transition, consider making it this one, written by two of my friends and fellow primary care doctors, pediatrician Aparna Bole MD and internist Dave Margolius MD. With compassion, empathy, and reason, they explain exactly why this time is so difficult to navigate and why we are so polarized. I cheered out loud when I read it.
I also laughed and cried when I watched this brilliant Saturday Night Live skit that, to me, perfectly captures the ridiculously heated culture wars around masking and the downstream effects on relationships.
By removing mandates for face coverings, we’ve effectively unmasked the major structural problems in this country—from ongoing social injustice, racial inequities, poor access to adequate health care, and widespread division (even among friends).
It’s time to reflect and recharge our own batteries. It’s time to practice empathy and kindness toward others who may have different medical vulnerabilities or levels of risk tolerance than ourselves. It’s time to roll up our sleeves and solve for society’s larger ailments. We must do better than the “old” normal.
I will see you next week. Until then, be well.