On Wednesday, the Washtenaw County Health Department posted an update on Facebook.
“Local transmission of COVID-19 is increasing,” it said. “The Washtenaw County Health Department is strongly recommending masking for everyone in indoor, public spaces.”
The response was...mixed.
“Make me,” one commenter responded.
“We will not shut down again,” another said. “Americans have been pretty docile so far, that can change.”
“This type of ‘control’ with masking is never ever going to end is it???” wrote one. “There will always be a mutation to Covid. It is a virus!!!. Something for which we can all be terrified if we choose or not. I am sick and tired of hearing about the what ifs.”
“I'm calling bullsh*t,” posted one commentor, whose profile identified them as a healthcare worker. “Where are the super sick people going then because they're not at my hospital.”
On the one hand, Washtenaw County Health Department public information officer Susan Ringler-Cerniglia wasn’t all that surprised. Facebook is gonna Facebook, especially with anything COVID-related. But on the other hand, she and the rest of the county health staff find themselves questioning what, at this point in the pandemic, they can do that actually helps.
“I don't even know how to describe the level of anger and accusations that we saw,” she said on Thursday. “It was even over and above what we've been seeing. And it was like...that feeling of, what do we have to keep doing? What is our responsibility to do? But it's just harder and harder to keep doing it right in the face of everything.”
"It feels like a sucker punch everyday"
Being back here - watching case numbers rise, putting out press releases about concerning trends - feels all too familiar now, said Ingham County health officer Linda Vail.
“It feels like a sucker punch that I get everyday,” said Vail. “I wake up every day and it's bam, again. It’s a place we do not need to be right now. But we are.”
Because this time, the growing crisis feels at least partly self-inflicted: only 58% of Michiganders ages 12 and older have received at least the initial dose of the vaccine.
Yet it is made all the more frustrating and confusing by a lack of clear information and murky messaging from federal officials.
"It's killing us"
At first, the CDC itself seemed conflicted about whether fully vaccinated people should return to masking indoors. Even after that revised guidance was announced, crucial information about the delta variant was leaked from internal slides, and the agency delayed release of the data backing up its own guidance: a study out of Provincetown, Massachusetts showing that even though the vaccines remain highly effective at preventing hospitalizations and death, fully vaccinated people could become infected, and can carry similar amounts of the virus’ genetic material as unvaccinated people.
But that still leaves critical questions unanswered: can fully vaccinated people actually transmit that virus to others? And if so, are they capable of transmitting it for the same length of time as the unvaccinated? Or do their immune systems respond faster and thus shorten the time period when they’re actually contagious? Is the virus more likely to spread in public places, like grocery stores and offices, where the new mask guidance is more likely to be observed? Or is it actually happening where people are still less likely to wear masks, like small indoor social gatherings or while dining at restaurants?
Instead, the CDC is offering a swiftly-changing, color-coded map showing transmission levels at thecounty level, based on metrics even local health officials say they need a “cheat sheet” to remember. Meanwhile, state officials have made it clear there’s no political appetite for a new mask mandate. Some local health officials say they don’t think it would help, anyway.
“Yeah, I mean, I’d be happy to share my wishes and dreams with you,” said Dr. Russell Faust, the medical director of the Oakland County Health Division. “But I also live in the real world. So the reality of the situation is, I don’t think they’d be effective.”
But that leaves every business, school, and individual for themselves - and many are turning to, or against, their local health departments.
“As you can imagine, there's a wide range of response and opinion,” said Faust. “And I don't envy the school superintendents. Because they're taking it from that wide range of opinion from parents. There are the parents that insist on a mask mandate to keep their children safe there. At the other end of that spectrum are those who are threatening to sue for any suggestion that unvaccinated students would need to wear a mask.”
The flood of incoming questions and requests for super-specific, individualized guidance is overwhelming health department staff, Ringler-Cerniglia said.
"They don't want to say it that way, because we absolutely want to be available to answer those questions. But it's also killing us,” she said. “So we can't keep up the pace of answering hundreds of questions a day, and being responsive in so many ways. So what is the balance between having those clear and updated guidelines that people can rely on, and not subjecting our staff to just ongoing beating down?”
"It's frustrating, but it beats dying of an infectious disease"
The best local health officials can do right now, they say, is keep repeating the same messages: that the vaccines are highly effective at preventing hospitalization and death. That because the delta variant is more contagious and spreading quickly, we’ll see more breakthough infections, but the vast majority will be only mild cases. And wearing a mask indoors can curb transmission.
“You have a lot of health officials now that really don't feel like they can do a whole lot other than keep recommending things, and watch how this plays out,” Vail said.
Whether those recommendations will be acted on, however, is still an open question.
“The fact is, the people that are not getting vaccinated right now are the same people who refuse to wear masks, and are quite belligerent about the whole thing,” said Oakland County Health Division medical director Dr. Russell Faust. “The reccommendation of masking up again, if you’re indoors in an area with a substantial transmission level such as ours, that makes sense. Doesn’t mean it will happen. And I can’t make that prediction.
“I know I’m frustrated. I suspect you are, too. Nobody likes wearing a mask. I hate wearing a mask. It's inconvenient. It's annoying, it's bothersome. But it beats dying from an infectious disease that we can prevent with a vaccine.”
There is one silver lining: a small but notable increase in vaccinations the past several weeks.
“Probably because of the variant, or because people have been waiting to feel safer and see what happens, we are seeing an increase in our walk-in [vaccinations,]” Ringler-Cerniglia said. “So we had a day, I think last Friday, where we had about 40 people [at our clinic] and that's double what we were kind of seeing. So that's encouraging.”
“People are seeing that [increased risk from the delta variant] and people are getting vaccinated as a result,” said Vail. “And that's sad in some ways. And it is progress at the same time.”
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