A controversial petition and open letter from UCSF health professionals calling for an end to some Covid restrictions has split the hospital system staff into two camps, with some senior doctors and epidemiologists saying this week that the suggestion to move on from pandemic mask mandates is premature.
Health experts generally agree that San Francisco—with its highly vaccinated population—is in a much different place than it was in the early days of the pandemic, and the current Omicron wave will likely subside in the next few weeks. But what comes next could decide the fate of mask mandates for in-school instruction, workplaces and businesses, and large venues open to the public.
The letter—sent to Gov. Gavin Newsom and state and county health officers and school officials—calls for California leaders to acknowledge the transition of the disease to an endemic phase and the rollback of mask requirements for students and teachers. UCSF physicians Dr. Jeanne Noble and Dr. Monica Gandhi co-wrote a toolkit—created by a multinational group of doctors calling themselves the “Urgency of Normal” coalition—for community members to advocate for rolling back restrictions to return to normalcy.
The letter emphasized the burden being placed on children in language acquisition and socialization because of isolation and masking, and it demanded that health officials “immediately allow preschool and daycare teachers and students to unmask at all times if they so choose.”
But some UCSF public health experts interviewed by The Standard said it’s too soon to roll back restrictions and the public should remain vigilant as the current wave continues and potential new variants emerge.
According to a prediction model from the state, overall hospitalizations and ICU patient counts in California are expected to return to pre-Omicron baseline levels by the end of February. The state’s Covid masking mandate is currently set to run through Feb. 15.
UCSF infectious disease expert Dr. George Rutherford relayed a particularly tragic story from the Spanish Flu pandemic from more than a century ago in San Francisco. When case counts started to drop during the first months, people in the city threw their masks aside and held a Market Street celebration for what they believed was the end of the pandemic. Less than six months later, the city’s death count had doubled and a new masking mandate was ordered.
Rutherford called it a cautionary tale about the cost of lifting restrictions too early without more evidence on the path Covid may take in the future.
“Just because we want a situation to turn out a certain way doesn’t mean that’s how it’s going to happen. We have to be prudent as we move forward,” Rutherford said. “We have done so well that one of the worst mistakes we can make is jumping off the restrictions too quickly.”
Haley Peters, a lead teacher at Peninsula Forest & Beach School, an outdoor preschool in Redwood City, estimated that roughly 75% of parents at her school would either immediately remove or strongly consider removing their children from class if mask rules were rescinded.
“We’re constantly walking the tightrope of their safety and the importance of their language development,” Peters said. “Having the blanket policy of keeping on the masks has eased a lot of the questions that we have to answer from parents.”
That’s not to say the pandemic and mask rules haven’t affected her students. Peter’s younger students, in particular, don’t even remember a time prior to the pandemic. She said masking makes it difficult to get her student’s attention, teach them foundational language skills and read their emotional state.
In some cases, Peters steps away from class and removes her mask briefly to enunciate and show how her mouth moves during lessons.
The toolkit advocating the rollback of restrictions includes data around vaccine effectiveness and claims that Covid poses a minor risk to children and vaccinated teachers. It also includes mixed research around whether student masking prevented transmission of the virus.
One CDC study cited by the toolkit found a 21% lower incidence in schools that required mask use among students, but the difference was not statistically significant.
Still, the study went on to tout the benefit of “universal and correct use of masks” as preventing transmission and “suggest[s] universal and correct mask use is an important Covid-19 prevention strategy in schools as part of a multicomponent approach.”
The toolkit advocates for “moving to mask-optional policies—and increasing school-based support and interventions for children.” For those at high risk, it recommends vaccinations and boosters, quarantining when necessary and the use of N95 respirators, while pointing out the multiple effective treatments for Covid variants on the market.
However, Rutherford pointed out that there’s a current shortage of these medications and it will take time to ramp up production.
“We should not be basing a major public health strategy on rare drugs that are in short supply,” Rutherford said.
In a statement Tuesday, California Public Health Department said “policies must continue to adapt as the situation with the virus changes” and said to expect updates to the state’s Covid policies once the Omicron surge subsides.
Locally, San Francisco health officer Dr. Grant Colfax said last week that Omicron infections peaked on Jan. 8 and hospitalizations and deaths act as lagging indicators.
"Our goal is no longer to prevent every case of Covid,” he said. “Instead, our goal is to prevent the worst outcomes of the disease, such as hospitalizations and deaths, and to do this while keeping essential services open, like schools and hospitals.”
Marin County, which was ahead of the curve in using hospitalizations attributable to Covid as its main metric for public health decisions, has started to roll back some of its restrictions at schools. The county lifted the attendance cap for large indoor events at schools and relaxed its recommendations for masking in outdoor gatherings.
“What’s positive is many of the things in the letter are things that we will eventually do, it's just a matter of when,” said Dr. Peter Chin-Hong, an infectious disease expert at UCSF. “We’re still trying to defend Mount Everest and we’re not even at the warming hut yet.”
Both Chin-Hong and Rutherford agreed that we could be at a turning point, but we’re not there yet and public officials need to communicate guideposts to help provide context to the general public about the pandemic’s outlook.
“It’s clear that people are restless, and what the state and city can do is give a roadmap so people can have a feeling that we’re moving to a destination,” Chin-Hong said. “What’s true is we’re not back in March of 2020—infection and hospitalization curves are not the same. But there’s still a lot of people who are really sick with Covid. That’s also true, I know because I’m taking care of them.”