Dr. Richard Fleming: Letter to Benicia City Council on Benicia’s Mask Mandate

February 11, 2022
By Benicia’s Dr. Richard Fleming
(posted here with permission)

Dear Council members and Mr. Upson – Should Benicia lift its current indoor mask mandate?

My recommendation is: Not yet, but hopefully soon.
Richard Fleming, M.D., Benicia, CA

Our state is lifting the statewide mask mandate February 15. Most Bay Area counties will be lifting their indoor mask mandates the week of February 14, 2022, though the specific approach varies. Some counties will require that unvaccinated people continue to wear masks in indoor public spaces, and that masks are still required by all in some indoor spaces.

There is clearly a strong desire to return to normal life and social interactions after two years of this pandemic. There are objective signs the pandemic may be on the cusp of turning into an endemic situation, given increasing vaccination rates and increasing natural immunity. But it is apparent that different geographic areas are in different stages of moving towards endemicity. And it is also clear from our collective experience over the past two years that it is not unusual to see viral spread increase after public health restrictions are lifted in defined geographic areas.

Given these two realities, I feel our city should proceed in a measured way – relying on objective data which gives the most accurate available picture of the current state of the pandemic in our city – in deciding when to lift the indoor mask mandate. This mandate, it should be noted, has been supported and complied with by the vast majority of city residents and visitors to our city. It would be tempting to yield to feelings of exhaustion with the pandemic, but doing so may lead to policy changes we come to regret.

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When our city council put in place the current mask mandate on August 25, 2021, it decided to use an objective metric to decide when this mandate could be lifted. When case rates in Benicia stayed in the CDC-defined moderate transmission level for 30 consecutive days, masking would no longer be required. Subsequent discussions in the council have considered using more than one metric to make a mandate-lifting decision, but no decision was made and goal numbers were not established.

Using several metrics would provide greater assurance about when it would be safe to lift the mask mandate. Any single metric has some intrinsic flaws, so a combination of several would provide a more accurate picture of the state of the pandemic in our city.

Under our current metric – case rate – we have too many cases per week to stop the mask policy. According to Resolution 21-88, we need to reach 27 or fewer cases weekly and maintain that for 30 days. We are currently at 100 new cases per week. Though this number is very high, it is trending downwards. For much of January, we were averaging 200-400 cases per week. Progress is being made, and there is reason to hope that in the weeks ahead, we will achieve a moderate level of transmission. (It is important to keep in mind the caveat that case numbers are increasingly inaccurate and reflect an undercount due to the growing use of home antigen tests. This is why adopting several metrics would provide greater accuracy.)

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Other metrics that could be used include the following. I feel that in assessing this data, we look not just at current numbers, but at trend lines, since those can provide dynamic information on the trajectory of the virus.

  • Hospitalizations. We do not have Benicia-specific data, so Solano County data can be used as a proxy. The county is currently seeing 35 covid-19 hospitalizations per 100K residents, which is close to the highest level of the pandemic. More concerning is that our hospitalization rate is trending upwards. It has risen 48% compared to two weeks ago. Our hospitalizations are rising more rapidly than any Bay Area county other than Marin, whose hospitalization rate is only 21 per 100K. So, even though the official case-rate numbers are trending in a good direction, hospitalizations paint a more concerning picture of where our county stands.
  • Vaccination rate. Currently, 78.6% of city residents have gotten 2 shots of Moderna or Pfizer, or 1 shot of J&J. Of this number, 55% are boosted. So the proportion of city residents who are truly fully-vaccinated is 43.2%. (Boosters are proven to be crucial for optimal protection.) 35.4% of city residents received full initial vaccine doses but are not yet boosted. They do have greater immunity than unvaccinated people, or those who did not complete their initial vaccine series. There are many city residents who have some degree of natural immunity, but their level of protection is not clear. A significant proportion of people who report having recovered from covid have no detectable antibodies, and it is not clear how long antibodies persist in those with natural immunity. Bottom line, while our community’s immunity is increasing, a significant proportion of our residents remain highly susceptible to serious covid infection.

Comparing our city’s vaccination rate to nearby counties, 6 of the other 8 Bay Area counties have a higher percentage of their entire county vaccinated than does the city of Benicia. We are still lagging behind in what should be achievable vaccination levels.

  • Test positivity rate. No city data is available. Solano County’s positive test rate is 19%, compared to a statewide rate of 7%.
  • Hospital capacity, ICU bed availability, and ventilator availability. In these metrics, our county is doing fairly well, though it is also true our hospital staff and health care workers are under significant stress and are looking forward to the period when covid-19 becomes truly endemic, rather than aspirationally endemic.

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Bottom line, I encourage you to maintain your commitment to using objective data to decide on when to lift the mask mandate. I recommend you adopt 3 metrics – cases, hospitalizations, and vaccination rates – as the data to look to. Choosing a goal for each metric, and requiring 2 of the 3 goals to be met over some period of time, would help maintain a safe environment for our city. I feel making the decision based on such measures would be widely-supported in our city. And, at whatever point you decide to lift the mandate, I recommend you also clearly advise our residents that indoor mask-wearing in public spaces is still appropriate and encouraged until the metrics improve even more, and that you also allow individual businesses to continue requiring masks of their own customers.

Sources for above data available upon request.

Thank you.

Richard Fleming, M.D.