Philadelphia has revived its mask mission, should other cities be?

April 14, 2022 | 12:07 PM

Are Philadelphia’s precautionary standards too sensitive? Or does the city set the rest of the model for the country?

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  Nina Feldman / WHYY
  

  

  Nina Feldman describes WHYY’s behavioral health. Although she grew up in Ann Arbor, Michigan, she lived in New Orleans before coming to Philadelphia, where she worked on the American Route, where she contributed to the NPR-affiliated WWNO. She likes to be underwater as she understands her neighborhood and sees her friends do what she is good at. She also started the New Orleans Ladies Arm Wrestling League, or no law.

Matt Slocam / AP Photo

A man wearing a face mask bicycle along Broad Street in Philadelphia on Wednesday, November 18, 2020.

Earlier this week, Philadelphia The first major city in Japan to regain the obligation of indoor masks..Many locals — and Some public health professionals — The city’s COVID-19 infection rate still remains, so I questioned the decision. Lower or similar than many neighborhoods We have not regained similar precautions yet.

However, this decision was not so definitive. It was automatically triggered when the case rate exceeded the threshold outlined in. Philly’s risk measurement systemThe city’s public health department calls it a “response level”.

Are Philadelphia’s precautionary standards too sensitive? Or does the city set the rest of the model for the country?

How Philly’s response system overlaps with CDC’s response system

The Philadelphia indoor mask obligation will come into effect on Monday, April 18th and will apply to restaurants, gyms, offices and schools. The facility can choose to request proof of vaccination instead of masking.

There are four categories of systems for measuring COVID risk in Philadelphia, from “Clear All” to “Extreme Attention”. As the case rate and hospitalization increase, more precautions are triggered.

Philly’s system is more rigorous Developed by the Centers for Disease Control and Prevention, Released in late February. The CDC system does not recommend masks until the highest risk level is reached and uses more hospitalizations than cases to measure that risk.

CDC Director Rochelle Walensky Explained the transition from case to hospitalization By saying that the current main goal is to prevent serious illness, death and burden on our health system, making it the most important for monitoring the capacity of hospitals.

However, many experts question whether it should be the only goal from a public health standpoint and say it is still important to count cases. Hospitalization can be several weeks behind the increase in the number of cases, so it is not a useful tool to prevent the increase in infection ahead of the wave.

“Instead of using weather forecasts, we just take out a bucket and check the amount of rain,” said epidemiologist Michael Levy, an associate professor at the University of Pennsylvania.

He argued that Philadelphia’s stress on the number of cases was important to prevent infection. Given that many residents are positive at home, the number of COVID cases in the city can be significantly underestimated.

And there are important reasons to prevent the spread of the infection. How COVID interacts with other illnesses, or Long-term effect.. In addition, Stanford University infectious disease specialist Abraar Karan argues that the general public’s thinking about what constitutes an “acceptable” level of illness can be distorted. He said he didn’t want to get into the habit of enduring so many illnesses.

“We’re so traumatized from early 2020 to mid-2020 that I think the criteria for what we consider to be acceptable or successful are still too low,” he said.

Flexibility and transparency

Levy acknowledged that Philadelphia’s decision to create a gradual “response level” system came from where it wanted to provide clarity. However, he said that automated systems (and such systems) exclude the ability of public health authorities to exercise their judgment.He said that color-coded risk systems are usually considered failures and cite both. Terrorist alert layer developed after the attack on September 11Pennsylvania’s color-coded pandemic resumption system.

Both systems have fallen victim to the typical pitfalls of automated schematics, Levy said. In the case of the terrorism advisory system, the designation became meaningless because the country had been vigilant for a long time. And in the case of the Pennsylvania resume code, Goal posts continued to change when the county was considered “yellow” or “green”..

“It’s easy to get yourself into the corner. I think that’s what everyone is trying to avoid,” he said.

Levy said he preferred to rely on adaptive expertise and clear communication with health authorities, as in the case of weather forecasts. He gave an example of a snowy day. This is a specification that does not have a specific set of metrics associated with it.

“It’s always a call for a little judgment based on predictions and actual accumulation,” he said. “A combination of a little expertise and a lot of common sense.”

But Jennifer Colker, a professor of health care at Drexel University, said people are tired of relying on the words of public health officials and have reason to distrust after two years of death and illness. rice field. She said having a clear and consistent system is good for building public trust.

“Public health needs to be credible, and most of the ways to achieve credibility are through transparency and credibility,” she said. “People want to know’why’, so just say,’Oh yeah, a lot of Talking Heads came into the room and decided whether to turn the mask on or off.'” Makes people angry, “Colker said.

As part of that, the city claims that its “level of response” may be clear and responsive.

James Gallow, a spokesman for the city’s health department, said: on mail. “The pandemic has proven to be so unpredictable that the system allows the city to adjust its level of protection in real time as the virus surges or falls.”

Three experts emphasized that there is no perfect point for cities and states to revive precautions during this pandemic. It’s always a little guess, a moving goal. However, the longer you wait, the less likely you are to succeed in preventing an outbreak of infection.

The tricky part of precautions is that they are measuring what isn’t happening, so it’s hard to show that they worked. And it can be difficult to make people feel that the inconvenience that health authorities are looking for in people is worth it.

“The job of public health is to protect public health in the least restrictive way possible,” said Colker. “We no longer trap people with tuberculosis, right? We used to only trap people, so it didn’t spread, but we realized we couldn’t do that alone. So we come up with other ways. . “

Both Kolker and Karaan agreed that, in theory, masks are individual-level interventions, ideally reserved as a last resort. However, in the absence of comprehensive infrastructure solutions such as enhanced ventilation systems for all buildings and methods for measuring indoor air quality, these personal-level solutions remain.