Tag Archives: Masks

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

Thanks!  And about the data we use for our decision-making…

Richard Fleming, M.D., Benicia, CA

Benicia Mayor and Council Members:

Thank you for continuing the mask mandate at your meeting last night. I really appreciate the time and attention you have been devoting to this issue. And I’m sorry to keep writing you, because I know you are all very busy. But I hope you can take a few minutes to read this email.

I am writing to express my concern with using only one metric — and a problematic metric at that — as the basis to decide to lift the mask mandate. And I also feel that the mask mandate should not be automatically lifted without further discussion at a meeting of the city council, even if one or more metrics are met.

Problems with case rate metric. There are two problems limiting the use of the case rate as a metric for measuring community transmission of covid-19. As Councilmember Largaespada has pointed out, the case rate depends on how many people are being tested. The second flaw is that increasing numbers of people are doing at home covid tests, and data from these tests does not get captured in the official case rate numbers. The use of at-home testing will continue increasing in the weeks and months ahead for obvious reasons. The case rate should be looked at, but is not in and of itself an adequate measure of covid in our city.

Other metrics can help. Eight of the nine Bay Area counties are using 3 metrics, as has been discussed previously. City data is available on two of the three, and county data is available for hospitalization rates. Using 3 metrics in combination would provide more clarity about the extent of the virus’ presence in Benicia. If only one metric is going to be used, either the vaccination rate or the (county) hospitalization rate would be less subject to sampling bias than the case rate. But since all three data points are available, why not use them? Each metric has some validity issues, so using all 3 together provides a more accurate picture.

Vaccination rate. There was some discussion at your meeting last night over how to view the vaccination rate. The specific issues were whether to use a numerator of people who have gotten at least one shot or those who are fully-vaccinated, should the denominator be the entire population or those eligible for vaccines, and differing vaccination rates by age.

(a) The fully-vaccinated rate is most meaningful. Data shows that a single shot (Pfizer) reduces risk of infection by 52%, while the second shot reduces risk by 95%. Similar date is available for Moderna. But immunity wanes over time. At 6 months after the second vaccine dose, people’s immunity is roughly the same as if they had only gotten one shot. Far fewer than half of fully-vaccinated people have received boosters yet, so the fully-vaccinated percentage overstates the proportion of the population who are well-protected. As far as what denominator to use, while I feel the best denominator is the entire population, it is reasonable to use a denominator of those eligible for vaccination, i.e. five years of age and up. According to California’s Department of Health and Human Services, 73.3% of Benicia’s population over age 4 is fully vaccinated as of November 30. (My statement last night that 67.7% were fully vaccinated was based on numbers from early November and using the entire population as the denominator). While 73.3% is a good number, we are still lower than the fully-vaccinated rate of most Bay Area counties.

(b) Vaccination rates by age. While older people are more vaccinated than younger, it is still important to try to safeguard younger people from this virus. Though the risk of death for younger people is lower, there is growing data on the prevalence of long-lasting symptoms among young people after covid infection. So, even though most of our city’s elderly are fully-vaccinated, we should not relinquish our efforts to protect all age groups. The virus is having a serious impact beyond hospitalizations and deaths.

Hospitalization rate. This metric is less subject to the vagaries of the officially measured case-rate data, but is not specifically available for our city. Another factor with this metric is that as treatment options improve, hospitalization rates will likely decline even if actual cases were to be increasing. Nonetheless, this metric can be helpful in combination with the other two metrics. As was noted at your meeting last night, hospitalizations for south county residents may well be lower than for north county residents. Nonetheless, the county’s hospitalization rate is a proxy for Benicia’s hospitalization rate, even if the actual number for Benicia is lower than the county’s. Solano’s current hospitalization rate is 10/100K. This is much higher than any other Bay Area county, and is also higher than the state’s hospitalization rate (9/100K). Even if Benicia’s residents are being hospitalized at a lower rate than the county, it is still most likely a higher number than in many other Bay Area communities.

Looking to the future. As was clearly articulated by several speakers at last night’s meeting, we need to not only look at the past, but try to anticipate the future. Looking at our hospitalization and local case rates trending down and vaccination rates trending up is indeed reassuring. As several of you said at last night’s meeting, the susceptible population in Benicia is shrinking. This bodes well for the future. But please take note of and keep in mind the following — even though all other Bay Area counties are much better vaccinated than we are, the case rates are trending up significantly in 7 of those 8 counties. Hospitalizations are also trending up in 5 of those 8 counties. Vaccination status is protective, yes, but recent trend lines in those counties point to a problem, likely due to cooler weather, holiday activities, and some degree of waning immunity.

Based on the above, I strongly urge you to do two things:

1. Switch to using 3 metrics to make decisions about public health safety measures to confront covid-19. Three metrics will provide a more accurate picture of the pandemic’s status in Benicia.

2. Do not lift public health measures based on auto-pilot, certainly not using one metric, but even if you decide to use 3 metrics. Instead, when the metrics are met, I urge you to then discuss the issue at your next city council meeting. There are so many other factors which may be at play even if the metrics are met, and a decision which can have such an impact on so many people’s health and welfare should be carefully thought through and discussed.

Thank you,

Richard Fleming, MD
Benicia, CA

ALERT – On December 7, the Benicia City Council will make a potentially life-or-death decision

With Winter coming and the Omicron variant looming, the City Council’s Dec. 7 mask mandate vote is crucial

Stephen Golub, Benicia – A Promised Land: Politics. Policy. America as a Developing Country.

On Dec. 7, the City Council will make a potentially life-or-death decision: whether to extend Benicia’s indoor mask mandate. If it fails to do so, the mandate will end that evening.

Such a failure will be a de facto vote for Covid and against public health. Here are a few of the many reasons why:

  1. The omicron variant is here. More specifically, the first case of this new, potentially dangerous Covid variant has been detected in San Francisco, in a vaccinated individual. https://www.sfchronicle.com/health/article/First-U-S-omicron-case-found-in-San-Francisco-16666493.php  The World Health Organization warns that it “poses a ‘very high’ global risk because of the possibility that it spreads more easily and might resist vaccines and immunity in people who were infected with previous strains.” https://www.npr.org/sections/coronavirus-live-updates/2021/11/29/1059723751/omicron-variant-latest-high-risk-world-health-organization  I don’t want to sound too alarmist, since we will not know until later this month (at the earliest) whether omicron is a false alarm or a five-alarm fire. But that’s all the more reason to be cautious and maintain the mandate.
  2. Winter is coming. It brings the likelihood of a surge in Covid cases and resulting deaths due to more people being indoors and at holiday gatherings. We’ve seen last winter’s Covid wave and other waves caused or exacerbated by relaxing precautions prematurely, even after vaccines were made available. The Council must learn from experience and not make that mistake. And again, it’s best to err on the side of caution.
  3. The overwhelming consensus among scientific studies and experts is that face masks help protect against Covid, even for the vaccinated. Further information and links to the research can be found at The Benicia Independent blog, including its reposting of the excellent letter Dr. Richard Fleming of Benicia sent to the Council last month (https://beniciaindependent.com/open-letter-to-benicia-city-council-dr-richard-fleming-on-mask-mandate/) and my own letter at that time (https://beniciaindependent.com/10-reasons-to-extend-benicias-face-mask-mandate/). The pro-mask/mandate consensus has been further represented by almost all Bay Area counties’ health officials, the State health department, the CDC, the Napa-Solano Medical Society, thousands of medical and public health authorities and the numerous Benicia-based medical and public health experts who have called in to Council meetings in support of the mandate. The one partial exception to this overwhelming consensus is the Solano Country health officer. But as Dr. Fleming’s letter points out, he has not provided any data in support of his position.

Those wishing to let the Council members know of your opinion on the masks mandate may contact them at:

You can also contact City Clerk Lisa Wolfe, LWolfe@ci.benicia.ca.us, who forwards emails on such matters to the Council and staff.

If interested in participating in the December 7 meeting via Zoom or call-in, the Office of City Manager Eric Upson will have the relevant information, at 707-746-4200 or EUpson@ci.benicia.ca.us.

Stephen Golub

Open Letter to Benicia City Council: Dr. Richard Fleming on mask mandate

Professional perspective and corrections: vaccine, hospitalizations, role of government, Bay Area comparisons

Email, by Richard Fleming, M.D., November 17, 2021, with permission

Hi Benicia City Council members,

Richard Fleming, M.D.

Thank you for taking the time to discuss and consider the safest way forward for our city during the pandemic. I hope you can take a few minutes to consider the following points:

  1. Vaccination rate.  According to publicly available data from the California Department of Public Health, the fully-vaccinated rate for the city of Benicia is 67.7%.  We have never been above 70% and certainly never been above 80%, numbers which have been mentioned in past city council meetings. (If we include those who got only one shot, the percentage is 76.7%, but the more important number is those who are fully vaccinated.) I strongly urge you to use the CDPH-reported fully-vaccinated rate for Benicia in future city council meetings. Also keep in mind that many fully-vaccinated people have not yet gotten boosters, and are beginning to lose some degree of immunity. Thus, the proportion of our city which has good immunity against covid-19 is actually less that 67.7%.
    You can see the state-provided numbers here:
  2. Vaccine availability is not a good measure of our city’s immunity to covid-19.  It is not a good metric to use in making public health safety decisions. Vaccines are equally available throughout the Bay Area, yet our city’s vaccination rate is below the average vaccination rate for the other 8 Bay Area counties. It is clear that availability of the vaccine does not equate to uptake of the vaccine. It is better to make public health decisions based on the actual level of immunity, rather than the potential level of immunity.
  3. Are cases or hospitalizations a better metric to follow? As Councilmember Largaespada noted at last night’s meeting, covid cases can vary depending on how much testing is being done. He correctly pointed out that the hospitalization rate is a better gauge of the virus’ impact on our city. I am unaware of Benicia-specific hospitalization data, so Solano County’s data is a fair proxy. The August City Council decision used cases as the metric to follow. I strongly urge you to change this metric to hospitalizations, since this measure more accurately captures how the pandemic is affecting our residents. Also, it is important to not view ICU capacity as equivalent to hospitalization rates. Councilmember Largaespada interchangeably referred to ICU capacity and hospitalization rates, but those are two very distinct and different measures. Since treatment options for covid-19 have improved dramatically, many covid-19 patients who are quite sick are now being safely managed on standard medical units or step-down units. The only ones needing ICU beds these days are the sickest of the sick. If ICU capacity in our county is going to be used as a metric, we could have stopped all public health precautions several months ago.
  4. Should covid public health policies let those who choose not to be vaccinated live with the consequences of their decision? At your meeting last night, it was said we at some point need to just move on, and accept the fact the virus will be with us for a long time. Since vaccines are now widely available, it is up to individuals to decide whether to get them or not. I have two responses:
    (a) Yes, covid-19 will likely become endemic at some point, like influenza. But we are not there yet. In fact, we are far from that point. In very bad influenza years, the country loses an average of 142 people per day. Covid-19 is still killing over 1,000 people per day. Covid-19 is surging in many areas of the country and the world, and the coming winter months, along with holiday parties, will very likely increase the risk of viral spread. Most public health experts do anticipate covid-19 will become endemic and something we need to manage in our lives. But we are not there yet.
    (b) Government has always had a role and responsibility to help protect people from themselves. That is why, for example, we have seat belt laws. The availability of seat belts does not necessarily mean they will be used, so we have laws which force people to use them. Even more importantly, government has a role to insure people not make individual decision which harm others. That is why why have drunk driving laws. A person may feel they can hold their liquor and drive safely, but the government has decided to not leave that judgment up to each individual. With covid, those who opt to not be vaccinated are both putting themselves at risk and putting others at risk. It is fully appropriate for government to adopt policies to protect both the individual and the community from those who are putting themselves and others at risk.
  5. What other Bay Area counties are doing. At last night’s meeting, I said that the other eight Bay Area counties are all retaining mask mandates. As was correctly pointed out, Marin has lifted their mask mandate, but it is only lifted for fully-vaccinated people. Partially vaccinated and unvaccinated people are still under a mask mandate. Marin has the highest vaccination rate, the lowest hospitalization rate, and the lowest death rate in the Bay Area. Contra Costa has not yet made a decision to lift their mask mandate. They along with several other counties are lifting mask mandates for selected businesses, but only when 100% of employees and customers are fully vaccinated. The other Bay Area counties have fared better during the pandemic than Solano County, and are approaching easing up on precautions very cautiously. I strongly encourage you to follow a similar approach.

Thank you for your work helping safeguard our community.

Richard Fleming, MD


For details on Council’s discussion and outcome, see: “Benicia City Council debates changing mask mandate, decides to keep in place, will review again on Dec. 7

Benicia City Council debates changing mask mandate, decides to keep in place, will review again on Dec. 7

The Council’s August 24 Mask Mandate remains in place for now

By Roger Straw, November 18, 2021
Benicia Mayor Steve Young

Benicia Mayor Young reported on last night’s City Council meeting that “Council decided not to change the mask requirements but to continue with the same metrics.”

The mandate, he continued, “will be reviewed again at the Dec 7 meeting.  If our 7-day case rates stay below high or substantial for another two weeks, the mandate will be dropped.”

The Mayor agreed with the Benicia Independent and many throughout the community that the City should be wary of dropping the mandate before the holidays and onset of winter.  “I was urging to wait through the holidays,” he wrote.

Dr. Richard Fleming agreed: “While the council agreed to continue the current mask mandate until their December 7 meeting, there appeared to be a desire by some to lift the mandate soon if the current case counts stay where they are for two more weeks.

“I feel strongly,” he continued, “that such a step would be premature and would risk opening the door to more viral spread.  I wrote the Council this morning (see text here), to explain why I think they should reassess the basis on which they decide whether to retain or remove the mask mandate, based on scientific evidence.”

Dr. Fleming added that “Many city residents called in to offer their opinions, and the vast majority were in favor of retaining the mandate until the pandemic has subsided significantly.  A number of callers spoke of the likelihood of a winter surge in cases due to colder weather and holiday gatherings.”

Council rejected a motion by Councilmember Lionel Largaespada to ease the metrics governing the mandate, which would have basically done away with the citywide mask mandate at this time.  Largaespada’s motion died for lack of a second.

Mayor Young was prepared to bring a motion to allow local businesses to voluntarily permit customers to enter maskless if 100% of employees and customers show proof of vaccination.  Young wrote, “The idea generated over 100 form letters of virulent opposition, and were evidently persuasive to council who did not support it.”  Sensing no support, Young chose not to offer the motion, and joined the majority in support of the City’s previously agreed upon mandate metrics – requiring 30 consecutive days below the CDC’s SUBSTANTIAL transmission level (7-day case rate).

For Benicia’s current and recent 7-day case rates, see https://beniciaindependent.com/coronavirus/#beniciacases.

No final vote was required on maintaining the status quo.  As Mayor Young wrote, “Since we weren’t changing existing policy it didn’t require a motion.”

Richard Fleming, M.D.

>> For an important analysis of Council’s discussion, see “Open Letter to Benicia City Council: Dr. Richard Fleming on mask mandate“.