Medical Discussion of Coronavirus

[Kamban]

So, what is the CDC recommendation on masks in physician's offices for vaccinated patients and staff.

Do all have to wear mask in order to protect the un-vaccinated patients for the slim chance of transmitting COVID or can they be maskless. I am not quite clear on this.

[Lordosis]

There is no elimination of this. But the threat of it ripping though our country and overwhelming healthcare infrastructure is abated in this country. Herd immunity does not mean it is gone. Just that it does not have enough hosts to spread unchecked exponentially. Clusters and outbreaks will happen. There is no stopping that because groups of people will always refuse to vaccinate. But measles is a pretty contagious disease and we have that under a pretty good lock now. But it will make the news when there are 100 cases linked to Disneyland.

We need to move on and stop the nonsense.

[Max Power]

There is no elimination of this....

...But measles is a pretty contagious disease and we have that under a pretty good lock now. But it will make the news when there are 100 cases linked to Disneyland.

We need to move on and stop the nonsense.

Yes, no, and yes.

Measles is apples to oranges, though... that can't mutate its form and its key proteins by its nature.
Coronaviruses, influenza, etc that we know are in flux.... COVID 19 almost certainly will be more similar to the common cold than measles.

So yeah... move on, live your life. I concur. This was an over-reaction to begin with, but there is a logical middle ground too. The info we have is still quite limited. Vaccinated or not, anyone's stupid if they're 70+, BMI 30+, significant smoker or resp dz, etc and not wearing a mask (and glasses) at airports, crowded stores and events, etc though... esp in winter flu times. That was not wise to be an unhealthy or old person in those spots without PPE before COVID, but now it's a lot more likely to be your last crowded bar, party, round trip flight, etc. This will pretty much turn us into how Japan has been for awhile: the golden oldies and a fair amount of others wear masks in winter, in crowded places, if they are under the weather, etc. It's not a bad thing if they want to live a bit longer. The world is overpopulated... I think we missed a hint here.

[Max Power]

So, what is the CDC recommendation on masks in physician's offices for vaccinated patients and staff.

Do all have to wear mask in order to protect the un-vaccinated patients for the slim chance of transmitting COVID or can they be maskless. I am not quite clear on this.

Let your conscious be your guide.

...it varies by states. Most haven't made a policy yet, and it will surely change by the time you adopt it. No hospital or MSG wants to be the next super spreader, so it will obviously be a crawl back to pre-COVID policy changes. I'm pretty sure no doc office or medical center will have unmasked staff anytime soon if they value their reputation. A logical thing for now might be slightly less cleaning and less social distance of wait room chairs? Do whatever you like... just don't be the first or the last office doing something.

[nephron]

I feel like some low level CDC staff just woke up one morning not feeling like wearing a mask to work and sent out the email saying that masks were not necessary. It seems ridiculous when just weeks before you had Fauci arguing with Rand Paul stating that masks were not just for show for the vaccinated but to protect against variants. It really did leave a lot of businesses and states in the open by no longer backing them up in enforcing their mask policy. I am amazed that there are not more calls out there by the general public to defund the CDC. We are spending 7.9 billion on an organization who's only role in the pandemic has been to hamper whatever public health response we may have had. I think that a lot of their missteps were not covered due to focus on the political administration, but people really should look at what they did and ask whether or not we would have been better with or without them. From early in the pandemic with a lack of warning despite people from outside the cdc warning of a pandemic, to faulty testing and incorrect public health guidance ("don't wear masks, they don't work if you are not in the healthcare", only test if you have a fever and just got off a plane from China, etc). There really should be stories of people being fired, like whoever chartered a flight for passengers of cruise ship infected and then sent the passengers from the chartered flight to an international airport to go home to their home cities. My wife's hospital had to send out several emails to all staff at an academic hospital stating that CDC recommendations don't apply to them which leads to the question who they actually apply to. I suspect that when people look back, they will not be able to find a significant benefit for masks mandates, business closings, etc because so much of the virus transmission was driven by individual decisions (ie if you weren't comfortable going to a bar, you weren't going to go even if it was open and if you were, you probably would have gotten infected through some other mechanism).

[Rando]

I feel like some low level CDC staff just woke up one morning not feeling like wearing a mask to work and sent out the email saying that masks were not necessary..

You raise some good questions. My take on the CDC for a long time is it's a stodgy slow-moving agency ill equipped to make rapid momentous decisions that have dramatic political, social and economic effects. The people that run it are there for political reasons, the people that actually do the work weren't ready for this. Up until the past year they've been an agency that collects data, has a lot of meetings then comes to some sort of recommendation, usually with a lot of qualifications..

On lockdowns and masks, my feeling is that masks do some good but not as much as people think. My somewhat informed WAG is that COVID is primarily spread by aerosol but to some extent droplet. Masks do a decent job of stopping droplet transmission but not that great on aerosol. Poor ventilation, people working in close proximity for longer duration and speaking loudly may well be greater factors than mask-wearing. While there was never any significant evidence of transmission by fomites it continues to be a focus for many businesses. And of course the whole beach-shaming for the past year was awful, for Pete's sake people go outside and enjoy yourselves.

[CordMcNally]

I feel like some low level CDC staff just woke up one morning not feeling like wearing a mask to work and sent out the email saying that masks were not necessary. It seems ridiculous when just weeks before you had Fauci arguing with Rand Paul stating that masks were not just for show for the vaccinated but to protect against variants. It really did leave a lot of businesses and states in the open by no longer backing them up in enforcing their mask policy. I am amazed that there are not more calls out there by the general public to defund the CDC. We are spending 7.9 billion on an organization who's only role in the pandemic has been to hamper whatever public health response we may have had. I think that a lot of their missteps were not covered due to focus on the political administration, but people really should look at what they did and ask whether or not we would have been better with or without them. From early in the pandemic with a lack of warning despite people from outside the cdc warning of a pandemic, to faulty testing and incorrect public health guidance ("don't wear masks, they don't work if you are not in the healthcare", only test if you have a fever and just got off a plane from China, etc). There really should be stories of people being fired, like whoever chartered a flight for passengers of cruise ship infected and then sent the passengers from the chartered flight to an international airport to go home to their home cities. My wife's hospital had to send out several emails to all staff at an academic hospital stating that CDC recommendations don't apply to them which leads to the question who they actually apply to. I suspect that when people look back, they will not be able to find a significant benefit for masks mandates, business closings, etc because so much of the virus transmission was driven by individual decisions (ie if you weren't comfortable going to a bar, you weren't going to go even if it was open and if you were, you probably would have gotten infected through some other mechanism).

Don't be fooled. There is definitely politics behind the CDC recommendations. They were there with the previous administration and they're still there with this one.

[Jaqen Haghar MD]

The CDC lost a huge amount of credibility and respect during all of this. They pretty much revealed themselves to be a political mouthpiece for whoever, when it came to COVID policies.

I’ve still been wearing my novelty “show mask” when out, where required, as I’ve done for the last 9 months, but here, businesses are quickly dropping all mask requirements. The gym dropped all mask requirements, the grocery store chains have now dropped them, going by the honors system for vaccination. Restaurants and bars haven’t enforced masks at all for for anyone, for probably 5 months.

It is absolutely packed here also. With all the permanent relocations, and now Covid vacationers looking to get out of the more restrictive states and get a break, we’ve been slammed for months.

I still wear my “real mask” at work, but I think I’ve only seen one mild Covid case in the past week or two. Down from 15-20 per day during our peaks. It’s been extremely busy volume-wise due to the population increase and the lack of fear of getting out and doing things.

The state was lax with restrictions during the entire pandemic, and Armageddon never came. Our biggest problem was losing staff to lockdown states in crisis. They just couldn’t resist the travel bonuses.

[HandFellow]

Let your conscious be your guide.

No hospital or MSG wants to be the next super spreader, so it will obviously be a crawl back to pre-COVID policy changes. I'm pretty sure no doc office or medical center will have unmasked staff anytime soon if they value their reputation.

Wrong. My office voted 1-9 to keep the masks. No MA, receptionist, or 75% of the doctors have worn a mask in a month. About 90% of the patients are delighted and the other 10% are confused.

[Tim]

So, what is the CDC recommendation on masks in physician's offices for vaccinated patients and staff.

Do all have to wear mask in order to protect the un-vaccinated patients for the slim chance of transmitting COVID or can they be maskless. I am not quite clear on this.

Well the explanation was rather simple (at least according to the director).

She is delivering science as science is delivered to the medical journals.Simple as that. Her definition of evidence based medicine is that of a historian, an aggregator. Rules are meant to be followed until “science” determines otherwise. CDC is back in the mode of after the fact bureaucratic guidelines. What could go wrong?

Still waiting on publications on masks for children in schools, unvaccinated in medical offices. and summer camps.

She hasn’t found any studies of maskless kids in school without social distancing.
She hasn’t found any studies of maskless and masked patients (vaccinated or not) in medical offices.
She hasn’t found any studies about kids in summer camps.

CDC is not oriented to make decisions on incomplete data. They need facts. That is not necessarily a bad thing. Our expectations for forward looking guidance is probably the cause of frustration, unrealistic.

[doctorbone]

I still can’t get the image of “impending doom” out of my mind. I skip the channel whenever I see the CDC director on tv.

[NumberWhizMD]

Although no formal studies of kids in school without masks, I will say my kids' school district was pretty lax on things. Granted, I live in a state that is generally lax when it comes to COVID. Masks only required 4th grade and up. Out of the whole school year (only 6 weeks at home to start the year), a total of 11 reported student cases and 9 reported teacher cases. This is pretty similar amongst all of the elementary schools in our school district.

Both of my kids had about 18-20 kids in their classes all year. Barriers at desks, but most not wearing masks. Teachers not always wearing masks or often just shields.

Interestingly enough, case load significantly increases as you get to the high schools, if you view the dashboards.

My guess is that spread in elementary aged kids is going to remain low. They are not the germy vectors for COVID that we all once thought they work.

For perspective, my youngest got COVID right as things started getting bad here in January. I had JUST gotten my final vaccine 2 days prior to her diagnosis, and managed to sit in UC masked with her for 1.5 hours without getting it. My hubby and other daughter also didn't get it, despite both of them quarantining at home with her and spending the weekend leading up to the diagnosis with her in enclosed places. That being said, once diagnosed, she was actually isolated from the rest of us. But still, I don't think the younger kids are the issue in terms of spreading it like we thought (and certainly are suffering from virtual learning).

[wideopenspaces]

So, what is the CDC recommendation on masks in physician's offices for vaccinated patients and staff.

Do all have to wear mask in order to protect the un-vaccinated patients for the slim chance of transmitting COVID or can they be maskless. I am not quite clear on this.

The VA is still requiring masking for all staff and patients. They'll probably be the last institution to drop it ;-)
We mask when we are indoors as our 4 yo is obviously unvaccinated and I wouldn't want to have him mask up if the rest of us aren't. And honestly it feels weirdly weird and kinda scary to me to not wear a mask. Funny the things we get used to.

[HandFellow]

Cool. What specialty??

Orthopedics. my partners are not what you would call covid believers. It feels good to be out of masks and weird at the same time. I tell you, once you start taking it off, it is hard to get back on. The HEAT!

[Tim]

https://www.fda.gov/news-events/press-announcements/fda-brief-fda-authorizes-longer-time-refrigerator-storage-thawed-pfizer-biontech-covid-19-vaccine

Pfizer can be stored at regular refrigerator temps for up to a month.

Vaccine shipments in dozens, rather than 1000.

This seems to open a much wider distribution capabilities.

Couple of questions:
•Vaccines 2-12: Risk/benefit. One thought is waiting for more results of long term side effects as opposed to pushing vaccine in a low risk category.
•Required vaccination (employer or access) ethical - Evidently the Medical (CDC and FDA) have only about 50-60% vaccinated rate. EUA only makes this problematic for any requirement or restrictions.
•Herd immunity- immunity comes from infection as well as vaccinations. Does it make sense to ignore what was the most highly publicized statistic, infections in making policy decisions?
Are we really approaching herd immunity given the targeting of the vulnerable and age groups?

• I feel like CDC/FDA can be relied on for tested results, but not predictions or recommendations. Too much noise.
•The ability of the science to truly document and understand, thus prevent future outbreaks depends on politics, not science. Too much CYA as well.