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San Diego County Recommends Masks Indoors Regardless Of Vaccination Status

 July 28, 2021 at 10:24 AM PDT

Speaker 1: 00:00 San Diego county officials are now following the lead for the CDC and recommending that all residents vaccinated or not wear masks indoors in public spaces. The new guidance is a reversal of the county's previous message over the last few weeks, which encouraged residents to get vaccinated, but said that facial coverings were optional while the updated guidance stopped short of the kind of full requirement that neighboring LA county has implemented health officials are hoping that increased masking will slow. The alarming rate of speed. The virus has shown in recent weeks. Joining me with more is Dr. Christian. Ramers a specialist in infectious diseases who oversees clinical programs at family health centers of San Diego. Dr. Ramers welcome. Speaker 2: 00:45 Thank you, Jay. Good to be with you. What's your understanding Speaker 1: 00:47 Of why the CDC is making this change? Speaker 2: 00:50 So my understanding from the presentation yesterday that Dr Willinsky made is that there is new evidence that's emerging about the ability of fully vaccinated people, even if they don't get sick to transmit infection. And this may seem like a, like a flip-flop or like whiplash when people hear something new every day, but really they're responding to evolving information, the original numbers that we saw in the clinical trials, again, we're 95% protection from the vaccines, probably a 75% reduction in transmission and nearly a hundred percent protection from serious disease and death. And really the Delta variant has changed that whole calculus. Um, you know, that was, those trials were done last year when we didn't have any Delta around the CDC recommendation about being able to take your masks off. If you're fully vaccinated happened in April and this major Delta outbreak in India didn't really happen until the end of April or may. So we're really operating on new information here. And I think the CDC is worried that if people that even if they're fully vaccinated, don't wear masks, they can still be vectors. And, and in fact, those around them, we know that there's a lot of people who are immunocompromised or who are vulnerable or who may not be vaccinated. And so this is where the masks still have utility Speaker 1: 01:55 Understanding though, of the virus changed with the rise of the Delta. Speaker 2: 01:59 Yes. In fact, there's evidence that the amount of virus that people carry in their nose and mouth when they're sick with COVID, or even if they're asymptomatic is about a thousand times higher with Delta variants. And we're not exactly sure why it might have to do with the mutations, uh, w to do with the variant, but that's been observed. And really that is probably what's driving a lot of the increased transmission that we're seeing. So even if someone has mild illness, they're vaccinated, they're fully protected against getting really severely sick from COVID. They could pass on with these much higher levels of virus. Um, and that's where the masks come in, what to know Speaker 1: 02:30 And about the transmissibility of a Delta variant by people who are fully vaccinated specifically, we know that they, that it's still transmissible, but how transmit, Speaker 2: 02:39 You know, Dr. Willinsky cited some data that has not been published yet. So I'm not really privy to, to what it, what it showed. And I hope that comes out really soon, but I think it was alarming enough. Um, you know, from the CDC, its own data that this recommendation had to change. What Speaker 1: 02:54 Do we know about the effectiveness that masking has in slowing the spread of COVID-19? Speaker 2: 02:59 Yeah, this gets back to the fundamentals of what we know works. Uh, you know, we want to use all the tools at our disposal and not just sort of take one side or the other unmasks versus no mask. I think you're seeing public officials just, you know, rally all hands on deck here. What do we have in front of us to keep us from sliding back where we were last year and definitely for, to keep our businesses open and to keep us from having to do a lockdown again? Well, we have vaccines. We know they're very effective at keeping people healthy and keep them from getting into hospital. We have social distancing and good air ventilation. Those things help as well. And then we have masking and there was a study just put out on the MMWR, the CDC publications, showing that the combination of HEPA filters, good air ventilation plus masking gets you up to sort of 90% levels of protection, you know, kind of what we've used to think of vaccine. So really all of these tools when used together, give us the best effectiveness at preventing disease. Since Speaker 1: 03:47 We know the Delta variant is much more infectious and or much more transmissible, uh, is there a specific type of mask that people should consider? Speaker 2: 03:57 That's a really good question. You know, uh, a lot of the requirements from last year were just for a basic cloth mask, but if people are able to get the type of blown fabric, surgical masks, those probably work a little bit better. And then I know many people that are really trying to get their hands on N 95 masks. We were very worried last year at the beginning of the pandemic that the public would buy all these and really get them out of the hands of healthcare workers who really need them in high risk situations. I would say, you know, for your general, going to the grocery store type of thing, a cloth mask is better than nothing. A surgical mask is probably better than a cloth mask. And then my personal advice, and this is not really guideline driven, but if you're going to be on an airplane or somewhere that's really closed and really high risk, I think trying to get your sent your hands on an N 90 or a N N 95 is probably the right thing to do. Angeles Speaker 1: 04:43 County chose to require masks indoors before receiving the guidance from the CDC, uh, with the uptick of infections here in the last few weeks. What's your take on why San Diego county waited for CDC guidance? Speaker 2: 04:56 Yeah, I mean, I can't speak for the public officials, but I do sympathize with the difficulty of enforcing this type of thing. So we would just love for the public to do what's right to really get us again, we're all in this together. We don't want to slide back into lock downs and closing businesses and all those things. So let's really just all do what's right to decrease the transmission. Um, you know, I think the county does not want to be policing this and does not want to be a, you know, trying to find people that type of thing. They made it a recommendation at this time, following the CDC. Um, and that's really, you know, most public health officers are gonna follow what CDC says, uh, because they have the best eyes on the newest data in terms of making these decisions. Speaker 1: 05:33 The county may not want to have to police this, but, uh, how effective will this new recommendation actually be if only a portion of the population chooses to mask up? Speaker 2: 05:43 Yeah. Jane, of course, any, any intervention as good as it looks on paper, it needs to work in practice. And I would just urge people, you know, wearing a mask is a minor inconvenience, uh, but it's so effective and, and you don't want to be the person that causes these outbreaks. I mean, you know, all of us have parents and probably have friends and family that are vulnerable and just the knowledge that you could be, the one that makes somebody sick and dies. We're seeing stories and anecdotes all over the place of unvaccinated, healthcare workers causing outbreaks and nursing homes and that type of thing. Nobody wants that blood on their hands, so to speak. Um, so I would just encourage people, you know, uh, appeal to their better, their better angels, really to do the right thing. It's not such a hard thing to wear a mask. I wear a mask for eight hours a day. Sometimes it doesn't impede my oxygen levels. It's a minor inconvenience and it is still one of the best tools we have to keep these outbreaks from getting worse and to really get on the other side of this pandemic where we all want to be. Speaker 1: 06:35 Do you think it was inevitable that we were going to see a spike like this, given the county's plateauing rate of vaccination and optional masks? Speaker 2: 06:43 Yes, I did. I think anytime that we've had a reopening any time that restrictions have been loosened a little bit and people mix and, and gather and more, um, uh, closed and cramp settings, there is going to be a spike. I don't think any of us anticipated that the spike would coincide exactly what the time that the Delta variant arrived, arrived in San Diego. And so that's made it a little bit more dramatic than we thought, plus this new information about people that are fully vaccinated, um, able to transmit the disease is kind of a perfect storm. You know, again, I keep saying, I think we're in a better place than we were last year because of the vaccinations in above 60% in San Diego. And there's some hopeful signs in the UK, for example, which has very good vaccination rates that they're starting to get on the other side of this. Speaker 2: 07:23 Uh, you know, we, we, at the, uh, at one hand fear exponential spread where the curve just keeps going up and up and up and up, but we also have some degree of protection from the vaccinations that we already have. Um, so what do we do again, look at our tools on the table. I get more people vaccinated. Those people that were still on the fence, it's still the best way to protect yourself and then try to implement smart policies like, uh, like returning to masks and returning to some of the just distancing policies to keep us safe. Speaker 1: 07:48 I've been speaking with Dr. Christian, Ramers a specialist in infectious diseases who oversees clinical programs at family health centers of San Diego. Dr. Ramers. Thank you very much for joining. Always a pleasure, Jay. Thanks for having me.

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After weeks of insisting that those who are fully vaccinated against coronavirus infection could safely go without face coverings in most situations, public health officials in San Diego County have reversed course, recommending mask-wearing indoors for everyone.
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