DC’s Shifting Indoor Mask Mandate: Follow the Science, Mayor Bowser

December 9, 2021 | 2:09 pm
Ketut Subiyanto/Pexels
Rebecca Boehm
Economist

Earlier this week, data released from the District of Columbia’s Department of Public Health showed a doubling in the number of daily COVID-19 cases from 11.2 per 100,000 people one month ago to 23.2 as of December 5. Hospitalizations also increased slightly, according to the same data (which are in some cases revised at a later date due to reporting changes).

These trends are concerning especially in light of recent relaxation of DC mask guidance, a crucial COVID-19 mitigation measure. Currently, DC Health advises that people wear masks indoors, but it is not a requirement. That’s because just ahead of the Thanksgiving holiday (and right before the discovery of the Omicron variant) District of Columbia Mayor Muriel Bowser and Commissioner of Public Health Dr. LaQuandra Nesbitt announced that DC would lift its indoor mask mandate effective November 22, a little over two weeks ago. The decision, Bowser and Nesbitt claimed, was based on their interpretation of data on vaccination rates and COVID-19 hospitalizations among District residents.

The decision and its communication to the public was roundly criticized by DC councilmembers, parents, residents, and public health experts, among others. Ten councilmembers signed a letter urging the mayor to reconsider the decision, while two additional councilmembers had some reservations about the decision even if they did not fully oppose it. Only one councilmember agreed that businesses should be able to make their own decisions about the mask mandate. But even President Biden’s Chief Medical Advisor Dr. Anthony Fauci criticized the decision in an NPR interview.

What is more, the Centers of Disease Control and Prevention (CDC) metrics and guidelines for indoor masking indicate that DC is now in the “High” Community Transmission category, when “everyone should wear a mask in public, indoor settings.”

Importantly, DC still requires masks to be worn indoors in certain situations such as on public transportation, during ride shares, and at private businesses that choose to require masks. They are also still required in schools, libraries, childcare facilities, nursing homes, shelters, and DC government facilities.

As a scientist with public health experience who is deeply committed to evidence-based policy, and as an employee at a DC-based science organization—about half our staff worked from a DC office when it was safe to do so—I am very concerned that the mayor’s decision is not based on the best available science and that it might result in more and unnecessary COVID-19 cases, hospitalizations, and deaths.

We need evidence-based decisions, not “flexibility” for businesses

Mayor Bowser explained on local public radio that the decision to lift the mask mandate was because “…our businesses are really looking for flexibility…their employees are telling them they want to come into offices in person, but they don’t want to have to wear a mask all day”. The mayor also said that the government has to shift their interventions “so people can look at their own risk and make decisions about masks”.

This approach flies in the face of the most basic public health science and practices intended to control infectious disease. Further, multiple studies have found that mask mandates work. A study found that a national mask mandate for employers would have reduced cases and deaths by more than 10% in the early part of the pandemic. Studies in Canada and Germany find large reductions in cases and deaths with mask mandates, too. What is more, other nearby municipalities – who actually have higher vaccination rates and lower levels of transmission – are keeping mask mandates in place ahead of the holiday and flu season because of rising case levels.

The DC government has been adamant about mask wearing so far. In fact, Mayor Bowser came out early in the pandemic on April 8, 2020 to require that people wear masks in grocery stores. So the timing of this announcement is puzzling. As the mayor noted in her recent Politics Hour interview, it could be that businesses wanting to bring employees back to the office put pressure on her to lift the requirement. The problem with that is that many offices in the District are in large multi-tenant buildings. So the decision of one company in a building to not require masks will impact everyone else in it.

And then of course, there is the increased risk of spread across the entire community (including, potentially, to very young children and others who cannot be vaccinated) because fewer people are wearing masks.

An overly optimistic view of DC’s vaccination data

The mayor and the public health commissioner cited high vaccination rates as a reason to lift the mask mandate. However, the mayor and public health commissioner should be more closely considering the actual numbers—and how they compare with neighboring communities.

According to the New York Times, 72% of all DC residents 18 and older are fully vaccinated. By comparison, nearby Montgomery County, MD, which borders DC on its northern edge, reports that 93% of residents 18 and older are fully vaccinated. (As an important side note, Montgomery County lifted its mask mandate in late October but quickly reinstated it right about the time DC lifted theirs because cases began to rise quickly.) Meanwhile in Prince George County, MD, on DC’s eastern and southern borders 78% of residents 18+ are vaccinated. And to the west, Fairfax County, VA reports that 84% of its residents 18+ are fully vaccinated. It’s easy to see that we are well behind our neighbors on vaccinating our adult population. The disparity is the same when we look at the 12+ population, too.

Racial disparities in vaccination rates are particularly concerning in DC

A closer examination of vaccination rates using DC health data indicate a significant disparity in vaccination rates across racial and ethnic groups, as well as by age groups. DC residents that identify as Asian or Pacific Islander have the highest vaccination rates across every age group, with White residents being not far behind. Meanwhile, Black residents have the lowest vaccination rate in all age groups, except the 40–64-year-old ranges, where they are nearly tied with White residents.

When the data are tabulated by ward (which divide DC for municipal purposes including local elections and city planning) the racial disparities become even more apparent. In Ward 7 (where I live) and Ward 8, which have populations that are 92% Black/African American, vaccinations rates are roughly 20 percentage points lower than other DC wards. In Ward 7, only 38% of residents are fully vaccinated, and in Ward 8 only 33%.

Despite these low vaccination rates in large parts of the DC population, Commissioner Nesbitt noted during the press conference following the announcement that “the world is not necessarily set up for the unvaccinated anymore”. Given the disparities in vaccinations across the city that we still have, especially in Wards 7 and 8, Dr. Nesbitt’s comments are nothing but careless. It rings even more callous when considering that a recent report found that between October 2020 and June 2021 49 out of 50 people in DC who died of COVID-19 were Black residents.

As a Ward 7 resident, I haven’t seen significant efforts to encourage vaccinations by the Bowser administration. There have been sporadic pop-up testing and vaccination sites at the nearby community center, but the signage and notice about these has been minimal. My view is shared by DC lawmakers who say vaccine distribution was initially rolled out in downtown locations and at mass vaccination sites that did not effectively reach people in these wards and in communities of color more generally.

Reports also indicate that Black residents have concerns about the shot, understandable given historical reasons to distrust medicine. But DC’s government shouldn’t just give up on these populations, as the public health commissioner seems to be alluding. In fact, Montgomery County, MD took an intentional approach to addressing racial disparities in vaccination rates, and the effort paid off. DC’s government should do much more right now to get Ward 7 and 8 residents (and other Black residents) vaccinated and consider reinstating the mask mandate until these communities reach higher vaccination levels.

In giving up like this, the mayor and commissioner have now put these communities at greater risk, especially given that the disparity in vaccination rates in DC has, at least in part, racist roots. My councilmember and neighbor Vincent Gray noted about the decision:

“I’m concerned about appears to be a lack of racial sensitivity and how that would reflect as the lead in the District’s outreach to the community…Particularly for African Americans who are medically underserved and experience a greater rate of co-morbidities.”

Keeping masks on indoors until early next year would protect vulnerable children too

According to DC Health data, only 10% of 5- to 11-year-olds in the District are vaccinated. Federal authorization for vaccination in this age group started in early November. My own six-year-old daughter received her first shot on November 5 at the Fort Stanton Recreation Center, where hundreds of families turned up, some of whom were turned away. The mask mandate was lifted on November 22, which was days before my daughter would even be eligible for the second shot since we had to wait the requisite 21 days until November 26.

As the data indicate, there are still many young children who have not been vaccinated in DC. Children under the age of 5 years old who are not yet eligible for vaccines won’t get their first shots until early in the new year. As the CDC Advisory Committee on Immunization Practices noted when they approved the vaccine for 5- to 11-year-olds, hospitalizations among children and adolescents increased fivefold from late June to August as the Delta wave swept across the country. As the holidays approach, and the Omicron variant spreads across the country, lifting the indoor mask mandate increases the risk of COVID-19 infections for still vulnerable children and adolescents, especially Black and Brown children.

When we follow the science, masks will come off

As Dr. Fauci noted in a recent NPR interview regarding DC’s decision,

“Masks are not going to be forever for sure. The more people that get vaccinated, the more people that get boosted, the lower the level of infection in the community will be, and then you start thinking about pulling back on masks. But you don’t want to do it prematurely.”

Dr. Fauci’s approach here is backed by science, which is how DC government should be making COVID-19 mitigation and other decisions. While the mayor’s recently issued “Mask Advisory” to encourage indoor mask wearing is a step in the right direction, all the science – and Dr. Fauci – agree that the mayor’s earlier decision to lift the mask mandate was not well supported by science.

In the future, we hope that Mayor Bowser, Dr. Nesbitt, and all others will make public health decisions with a firm rooting in science in order to ensure that all DC residents are safe and healthy, pandemic or otherwise.