Many public health professionals are feeling a stomach-churning sense of déjà vu right now. After a massive spike in COVID-19 cases beginning in mid-October and increasing through the fall and winter holidays, we’re getting close to returning to case levels we saw earlier in the fall season. As new case diagnoses dropped dramatically in late January and throughout February, we’re seeing once again public health policies rescinded or loosened, just as we did last year when cases dropped to low levels.
At that time, I warned: “If we don’t change our collective behavior, fall will likely be worse than summer. Many of us in public health have been concerned about an even greater resurgence of COVID-19 infection in the fall, especially as most areas are looking to reopen schools in some capacity. Since we’re seeing a spike in cases now, what will happen in the fall is uncertain—and frightening if we continue on this course.” And the fall and winter were frightening indeed, with case diagnoses reaching up to 300,000 per day, and deaths averaging above 3,000 per day for weeks on end.
This time around, many aspects of pandemic response are far better. We currently have three Food and Drug Administration–authorized vaccines, and we are ramping up their administration across the country. But we are not yet close to levels of vaccination needed to reach herd immunity, and removing or reducing restrictions too quickly before vaccines can be administered leaves us susceptible to yet another wave, particularly as more infectious viral variants have been identified across the country.
Relaxing restrictions right now is premature and dangerous.
To date, COVID-19 restrictions have been relaxed in states including Texas, Iowa, North Dakota, Maryland, Mississippi, Connecticut, Arizona, West Virginia, and Wyoming, reducing restrictions on businesses, eliminating mask mandates, or a combination of both factors.
This may lead to an increase in risk from not wearing masks, notes infectious disease epidemiologist Cherise Rohr-Allegrini, Ph.D., MPH, who served on San Antonio’s COVID Response Coalition and is the CEO of the San Antonio AIDS Foundation. Texas is one of the states that has rescinded its mask mandate and allowed businesses to fully reopen, which concerns Dr. Rohr-Allegrini. “The perception that the pandemic is over and precautions are unnecessary is powerful,” she says. “We saw this last May, after the governor prematurely went ‘back to normal.’ Many people, even those cautious who took COVID seriously, saw the openings as a sign the pandemic was over.”
Saskia Popescu, Ph.D., MPH, an epidemiologist and assistant professor at George Mason University, agrees. In Arizona, where Popescu lives, the governor has eschewed a state-wide mask mandate, but many cities have implemented them. Seeing other states lift their restrictions “often has that effect of normalizing the ‘We’re past COVID’ mentality. I think it’s been easier for those with state mandates as it creates a more standardized approach, whereas this has been stress on local leaders,” says Dr. Popescu.
And with a lack of a state-wide mandate, businesses are left to make their own decisions regarding aspects of pandemic prevention. This is also fraught. In Texas, representatives of a major grocery store, H-E-B, have shared confusing messages regarding required mask usage following the governor’s repeal of the state’s mask mandate. Smaller businesses may have even greater difficulty enforcing mask usage without a mandate in place. A Mexican restaurant in the state that will still require customers to wear masks has received threats from people saying they will call U.S. Immigration and Customs Enforcement. A ramen restaurant in Texas was vandalized with racist anti-Asian graffiti after the chef and owner publicly disagreed with lifting the mask mandate. “Businesses are left to fend for themselves,” says Dr. Rohr-Allegrini. She adds that she has friends in the food and beverage industry who intend to require mask wearing, but from experience, know it will be hard to enforce and opens them up to harassment.
COVID-19 vaccines are promising, but they alone may not be enough to stop the spread.
While the vaccine rollout is expected to accelerate through March and April, both scientists I spoke with agree that right now it is not enough to fill in the gaps. “I describe it as Wile E. Coyote—the vaccines—and Roadrunner—the virus— in a race, neck and neck. The roadrunner just got a jet pack, and the coyote had an anvil dropped in front of him,” says Dr. Rohr-Allegrini.