Written by By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Public Health Education Specialist at the Greenwich Department of Health
Many view changing CDC pandemic guidance as a sign of indecision or lack of knowledge about the virus itself, or about the many complex aspects of disease management and control. While we are all constantly learning new things about COVID-19 in all its mutated forms; changing guidance is more accurately viewed as public health’s rapid response to what we are learning. Community health guidance must be able to change quickly in order to remain responsive to the changing nature of COVID-19 (or any virus). As we have seen over the course of the 2019 pandemic, our guidance shifted its direction, its targeted approaches, and its prioritized actions in response to new emerging mutations.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) categorize each COVID mutation into “variants of interest”, “variants of concern”, and “variants of high consequence.”
Each variant requires a different level of approach, a different degree of monitoring, and its own uniquely applied course of protection and mitigation action. Viruses “of interest” have genetic characteristics that cause scientists to predict high transmissibility, the likelihood of their being able to avoid detection to some degree, and of being less than fully responsive to vaccines. Viruses “of concern” have proven to be more infectious than ones that are merely “of interest”. They result in more serious illness; they are more likely to evade detection through tests; they are more likely to cause breakthrough or re-infections in previously infected people and in those who were vaccinated, and they can be resistant to antiviral treatments. The resultant illnesses seen in those who become infected are more serious in nature, thus they warrant a higher level of concern. We saw the impact of this during the COVID surges that overwhelmed our nation’s hospitals and emergency rooms. The Alpha, Beta, Gamma, and Delta variants of COVID-19 were all classified as “variants of concern”. Fortunately, we have no COVID-19 variants in the category “of high consequence”. A person with a COVID infection in this category would likely have minimal to no vaccine-conferred protection conferred. Delta and Omicron are being closely watched for further genetic mutations. Both Omicron BA.1 and Omicron BA.2 have spread rapidly, however while Omicron in both variations is more transmissible than the Delta virus has been, neither variant has shown itself to be more deadly than prior COVID versions. In fact, people have tended to be more mildly ill.
The rationale for the latest CDC guidance-changes at the end of February 2022 reflected our nation’s ideological shift in focus from eliminating COVID, to preventing serious illness and death when one becomes infected. This shift indicates that we are viewing COVID as a virus that will likely remain with us, but at a more predictable and manageable level (endemic as opposed to pandemic), similarly to our seasonal flu outbreaks. It is possible that annual COVID vaccines may be in our future in order to control infection outbreaks and levels.
Public Health guidance must change as viruses mutate, and that is what viruses do; they change continuously in small and sometimes large ways. They can mutate up or down in their level of concern to us, which then impacts what people are asked to do to protect themselves and others.
Multiple variants can infect people at the same time in any community or region, so public health guidance can differ based on the characteristics of the virus in those different locations. This is what City and Town Administrators, as well as School Boards, are being asked to consider as they pass their COVID restriction guidance and regulations. Hopefully each is doing that in close consultation with their local public health directors who are the experts in this. This is what the Connecticut Commissioner of Health asked communities to do in her guidance memo. Public health and the various medical health care fields are different areas of practice; each having their own unique but complimentary bodies of knowledge.
Each nursing home and congregate care facility is a community unto itself and they generally have people with higher health risks residing there. Each school is a community, and as of now all children under five are unvaccinated. Each prison and detention center is a high-risk community. Each City and Town may need different protective actions and guidance depending upon how they are being affected.
We can see this in our widely divergent infection rates just across Connecticut. Guidance and regulations need to take into account such things as a community’s percent of fully vaccinated people, how wide-spread the infection is in that community, the community’s resources and degree of prosperity.
They need to consider which segment of their population is being hit or hardest hit, the degree to which community members adhere to recommended safety-measures (masks, social distancing, isolation and quarantine), and the age, overall health, and underlying conditions of the people living and working in each community.
A lot of this is impacted by what is called the social determinants of health in each location; each of which impacts health, mental health and well-being, and the quality of life of those living in our diverse communities (Social Determinants of Health).
This includes access to care, healthy food, and services; to education, recreation and diversional activities. It includes community safety. We don’t all enjoy the same benefits even if we live in the same town.
Who Should Be Wearing Masks Now in Connecticut? (See resources below )
The statewide school masking requirement will no longer apply from February 28, 2022 forward; school masking requirements in Connecticut will be established at the local level. This will ensure minimal disruption to in-person learning with schools managing COVID-19 as part of a routine disease prevention model.
Healthcare Settings: (Hospitals, medical offices, urgent care centers, dental offices, physical/occupational therapy offices, chiropractic offices, medical spas, blood-collection facilities, clinical laboratories. Masks are required.
Congregate living settings, (Residential care and residential group homes when healthcare or supportive care is being provided). Masks are required.
Shelters: (Inside homeless shelters or other shelters including temporary shelters): Patients/clients can remove masks when they are alone, in rooms by themselves, if socially separated, or if the wearing of a mask is unable to be tolerated due to a medical condition. Masks are required.
Private businesses & State & Local Governments: (Private retail stores, government office buildings,
correctional facilities) have the option of requiring masks to be worn inside of their establishments.
On Public Transportation: Masks are required.
Helpful Resources and Links
Connecticut Mask Guidance: (https://portal.ct.gov/coronavirus)
Statement: Connecticut Department of Public Health and Connecticut State Department of Education Release Updated School Guidance Feb 18, 2022
Latest Guidance Feb 28, 2022
CT Office of Early Childhood: OEC Memos About COVID-19
Bolenger, R.,Ray, S. (2022). From Johns Hopkins Medicine COVID Variants: What You Should Know
CDC (2020). Healthy People 2030. Healthy People 2020 (Internet). Washington DC USDHHS. Office of Disease Prevention. Retrieved from Social Determinants of Health
Miller, Z. (2022). CDC To Significantly Ease Pandemic Mask Guidelines Friday. Retrieved from CDC to significantly ease pandemic mask guidelines Friday Feb 25, 2022