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Should you still wear a mask? We asked UCSF’s Dr. Bob Wachter

Now that the last San Francisco Bay Area county has lifted its indoor mask mandate, people in the Bay Area are no longer legally required to cover your face while seeing a movie, shopping for groceries or dining at a restaurant. The move comes in response to a statewide rule change in mid-February that left any continued mandates up to individual county governments. That means individuals (and individual businesses) have to make their own rules. So we checked in over email with Dr. Bob Wachter, the chair of UCSF’s department of medicine, about how he decides when to skip the mask and when to be extra-cautious. Wachter has amassed more than 250,000 Twitter followers by sharing his insights on masks, vaccines and more during the pandemic. Some of his most popular threads have assessed the risk of doing certain activities. SFGATE: How risk averse are you? For example, do you eat raw cookie dough (not recommended by the Centers for Disease Control and Prevention)?Dr. Bob Wachter: I’m moderately careful — I don’t get particular joy out of skiing or driving fast, don’t hang glide or skydive. I used to scuba dive but don’t anymore. But cookie dough: sure, worth the small risk! My training and 40 years of work as a physician has made me particularly attuned to the risks and benefits of various activities, and I’m probably biased by seeing what it looks like when things go wrong.SFGATE: When and where are you still wearing a mask and why?Wachter: I am now comfortable eating indoors in restaurants. I also am fine getting together in small to mid-sized groups (up to 10 or so) of people who I’m pretty confident are vaccinated. (For example, I’ve resumed, maskless, my eight-person poker game.) I haven’t worn a mask outdoors since early in the pandemic. But in larger indoor groups or in places where it seems unnecessary to accept any risk of catching COVID, I’ll still wear a mask. So I wear one when I’m shopping, and would wear one if I went to a movie or indoor sporting event. I’m still required to wear one in the hospital. Flying: I keep it on for as much of the flight as I can, and try to remove it (briefly) to eat when others around me have their masks on.SFGATE: What factors should people consider when determining whether or not to wear a mask in certain situations?Wachter: How much COVID is there in your region, what is your own personal risk from COVID (have you had three shots or, if you’ve had a documented infection, at least one to two shots; and also are you older, immunosuppressed, have medical co-morbidities or live with people who meet any of these categories). It’s also worth understanding how risk-averse you are.SFGATE: Do you trust officials to make the right call given what has happened throughout the pandemic?Wachter: In the Bay Area and California, I have lots of trust in the public officials — who, without exception, have been doing their very best to make good decisions under rapidly changing conditions beset by plenty of uncertainty. We’re very fortunate here — obviously, this is not true in many other parts of the country, where decisions have been colored by politics and, often, misinformation. That said, it’s impossible for officials to fully appreciate the myriad individual circumstances and so — while they can establish general guidelines — it’s important for people to make their own choices. Some of the nicest feedback I get from my Twitter feeds is that many people have told me that they trust my decision-making process, and so make their decisions based on what I’m doing, which is a heavy responsibility, and one I take quite seriously.SFGATE: In which situations — please give some specific examples — do you think people should wear a mask, even though it may not be required?Wachter: Pretty much what I said above. I am not critical of people who choose not to mask in large crowds or while shopping — particularly if they’re low risk and if community transmission rates are low. But to me, it’s reasonable to mask in those kinds of situations. And it’s important to recognize that while community rates are quite low compared to where they were last month, they are still high enough that exposure to COVID should not be considered a rare event. At UCSF Medical Center today, for example, our asymptomatic case-positivity rate (positive test in patients with no symptoms of COVID) is 1.5%, which would imply that one in 67 people in SF who feels perfectly well would test positive for COVID. That’s not nothing.SFGATE: In which situations — please give some specific examples — do you think it’s safe for people to go ahead and not wear a mask?Wachter: There simply is no bright line that separates “safe” and “not safe” — it’s a matter of it being safe enough to be worth a small risk. Certainly, all outdoor activities are safe, as are small groups of people who are fully vaccinated and boosted. Gatherings can be made safer by adding testing of everyone immediately before the gathering. And they’ll get safer with wider availability of effective oral therapies (the main one is Paxlovid).SFGATE: What’s the risk of vaccinated and boosted people not masking at all while dining out in an indoor restaurant?Wachter: I did this math recently in the Washington Post (drawn from a prior Twitter thread). Cases have come down even more since I did this, and one would have less contact with people in a restaurant than at a party). So I’d guess that the risks would probably be three-quarters lower than I estimated in this article. The odds I presented in the Washington Post were these:-So, my chances of getting COVID from attending this party: about 1 in 50-Odds of needing to be hospitalized if I got COVID given my age and vaccination status: about 1 in 200-Odds that I’d die if I got COVID: about 1 in 1,400-Odds that I’d get long COVID in some form if I developed COVID: about 1 in 20-Finally, odds of infecting my elderly mom if I visited her while infected: about 1 in 3-Chance I’d be hospitalized for COVID : 1 in 10,000-Risk of dying of COVID-19 : 1 in 70,000-Odds of developing long COVID : 1 in 1,000-Danger of infecting my mom : 1 in 150So I’d probably divide each of these by four to come up with today’s odds in San Francisco.SFGATE: I’m healthy, fully vaccinated and boosted, and I’ve recently had COVID. Am I safe to not wear a mask in all situations where it’s not required?Wachter: You have COVID immunity superpowers. At least for several months, you are as protected as can be, and can feel very comfortable not wearing a mask pretty much everywhere. For someone like me, who has had three shots but never had COVID (and whose booster was nearly 6 months ago), I am still tremendously protected against getting very sick and dying, but my protection against symptomatic infection has dropped considerably. Given the small but non-zero risk of long COVID and of a pretty bad infection that might lay me up for a week or so, I’d still prefer to avoid getting COVID if I can.

Now that the last San Francisco Bay Area county has lifted its indoor mask mandate, people in the Bay Area are no longer legally required to cover your face while seeing a movie, shopping for groceries or dining at a restaurant. The move comes in response to a statewide rule change in mid-February that left any continued mandates up to individual county governments.

That means individuals (and individual businesses) have to make their own rules. So we checked in over email with Dr. Bob Wachter, the chair of UCSF’s department of medicine, about how he decides when to skip the mask and when to be extra-cautious. Wachter has amassed more than 250,000 Twitter followers by sharing his insights on masks, vaccines and more during the pandemic. Some of his most popular threads have assessed the risk of doing certain activities.

SFGATE: How risk averse are you? For example, do you eat raw cookie dough (not recommended by the Centers for Disease Control and Prevention)?

Dr. Bob Wachter: I’m moderately careful — I don’t get particular joy out of skiing or driving fast, don’t hang glide or skydive. I used to scuba dive but don’t anymore. But cookie dough: sure, worth the small risk! My training and 40 years of work as a physician has made me particularly attuned to the risks and benefits of various activities, and I’m probably biased by seeing what it looks like when things go wrong.

SFGATE: When and where are you still wearing a mask and why?

Wachter: I am now comfortable eating indoors in restaurants. I also am fine getting together in small to mid-sized groups (up to 10 or so) of people who I’m pretty confident are vaccinated. (For example, I’ve resumed, maskless, my eight-person poker game.) I haven’t worn a mask outdoors since early in the pandemic. But in larger indoor groups or in places where it seems unnecessary to accept any risk of catching COVID, I’ll still wear a mask. So I wear one when I’m shopping, and would wear one if I went to a movie or indoor sporting event. I’m still required to wear one in the hospital. Flying: I keep it on for as much of the flight as I can, and try to remove it (briefly) to eat when others around me have their masks on.

SFGATE: What factors should people consider when determining whether or not to wear a mask in certain situations?

Wachter: How much COVID is there in your region, what is your own personal risk from COVID (have you had three shots or, if you’ve had a documented infection, at least one to two shots; and also are you older, immunosuppressed, have medical co-morbidities or live with people who meet any of these categories). It’s also worth understanding how risk-averse you are.

SFGATE: Do you trust officials to make the right call given what has happened throughout the pandemic?

Wachter: In the Bay Area and California, I have lots of trust in the public officials — who, without exception, have been doing their very best to make good decisions under rapidly changing conditions beset by plenty of uncertainty. We’re very fortunate here — obviously, this is not true in many other parts of the country, where decisions have been colored by politics and, often, misinformation. That said, it’s impossible for officials to fully appreciate the myriad individual circumstances and so — while they can establish general guidelines — it’s important for people to make their own choices. Some of the nicest feedback I get from my Twitter feeds is that many people have told me that they trust my decision-making process, and so make their decisions based on what I’m doing, which is a heavy responsibility, and one I take quite seriously.

SFGATE: In which situations — please give some specific examples — do you think people should wear a mask, even though it may not be required?

Wachter: Pretty much what I said above. I am not critical of people who choose not to mask in large crowds or while shopping — particularly if they’re low risk and if community transmission rates are low. But to me, it’s reasonable to mask in those kinds of situations. And it’s important to recognize that while community rates are quite low compared to where they were last month, they are still high enough that exposure to COVID should not be considered a rare event. At UCSF Medical Center today, for example, our asymptomatic case-positivity rate (positive test in patients with no symptoms of COVID) is 1.5%, which would imply that one in 67 people in SF who feels perfectly well would test positive for COVID. That’s not nothing.

SFGATE: In which situations — please give some specific examples — do you think it’s safe for people to go ahead and not wear a mask?

Wachter: There simply is no bright line that separates “safe” and “not safe” — it’s a matter of it being safe enough to be worth a small risk. Certainly, all outdoor activities are safe, as are small groups of people who are fully vaccinated and boosted. Gatherings can be made safer by adding testing of everyone immediately before the gathering. And they’ll get safer with wider availability of effective oral therapies (the main one is Paxlovid).

SFGATE: What’s the risk of vaccinated and boosted people not masking at all while dining out in an indoor restaurant?

Wachter: I did this math recently in the Washington Post (drawn from a prior Twitter thread). Cases have come down even more since I did this, and one would have less contact with people in a restaurant than at a party). So I’d guess that the risks would probably be three-quarters lower than I estimated in this article. The odds I presented in the Washington Post were these:

-So, my chances of getting COVID from attending this party: about 1 in 50
-Odds of needing to be hospitalized if I got COVID given my age and vaccination status: about 1 in 200
-Odds that I’d die if I got COVID: about 1 in 1,400
-Odds that I’d get long COVID in some form if I developed COVID: about 1 in 20
-Finally, odds of infecting my elderly mom if I visited her while infected: about 1 in 3
-Chance I’d be hospitalized for COVID [from attending party, based on the 1 in 50 chance of catching COVID-19 at the party]: 1 in 10,000
-Risk of dying of COVID-19 [from attending party]: 1 in 70,000
-Odds of developing long COVID [from attending party]: 1 in 1,000
-Danger of infecting my mom [from attending party]: 1 in 150

So I’d probably divide each of these by four to come up with today’s odds in San Francisco.

SFGATE: I’m healthy, fully vaccinated and boosted, and I’ve recently had COVID. Am I safe to not wear a mask in all situations where it’s not required?

Wachter: You have COVID immunity superpowers. At least for several months, you are as protected as can be, and can feel very comfortable not wearing a mask pretty much everywhere. For someone like me, who has had three shots but never had COVID (and whose booster was nearly 6 months ago), I am still tremendously protected against getting very sick and dying, but my protection against symptomatic infection has dropped considerably. Given the small but non-zero risk of long COVID and of a pretty bad infection that might lay me up for a week or so, I’d still prefer to avoid getting COVID if I can.



Should you still wear a mask? We asked UCSF’s Dr. Bob Wachter Source link Should you still wear a mask? We asked UCSF’s Dr. Bob Wachter

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