I write regarding the responses from the OHA to KATU's report on a recent protest against the lifting of the state mask mandate in healthcare settings.(1) The OHA statements are inadequate and non-responsive.
Mask mandates work well to reduce the quantity of airborne viral particles, in part because the presence of a mandate signals the serious need for protections (2, 3). Although case numbers are undercounted because of lack of access, accuracy, and reporting of testing, wastewater levels remain persistently high in Multnomah County and hospitalization rates remain persistently high in Oregon (4, 5).
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| Graph of Multnomah County Wastewater from Biobot, levels March 15, 2023: 607copies/mL (higher than any time before 21/22 surge, persistently high since summer 22). Graph of Oregon hospitalizations for COVID-19 from OHA Public Tableau, as of March 15 2023 (persistently high: since May 2022 has not gone below 200) |
Further vaccination is currently unavailable; I and many Oregonians received a bivalent booster over six months ago, and are considered "up to date," although vaccine efficacy appears to wane in less than three months (6, 7). Most COVID deaths at this point are among those who are vaccinated (8). Those who are immunocompromised may not receive the same benefit from vaccination (9). Moreover, because of the unchecked spread and evolution of the virus, vaccination cannot keep up with evolving variants (10). To slow the continued evolution of the virus to ever-more immune-evasive variants, we must slow the spread of infection.
In addition, death and longcovid are not the only negative individual outcomes from infection. Current evidence suggests infected adults and children are at greater risk of new onset diabetes (11, 12, 13), adults are at increased risk of cardiac problems (14, 15) and the long-term impact on children’s cardio-vascular health is uncertain (16). In addition, people can experience kidney injury (17, 18), liver damage (19), erectile dysfunction (20, 21), hearing loss (22-25), immune dysfunction (26-29), brain and memory dysfunction (30), ocular damage (31, 32) and dermatological complications (33, 34). In fact there are few organs that SARS-CoV-2 can’t harm, largely because COVID-19 is a vascular disease (35-37) with immune-mediated severity impacting multiple organs (38, 39). SARS-CoV-2 is an airborne virus that is transmitted via the respiratory system (40), but the disease it causes is not localized to the respiratory tract (41) with its multi-organ, multi-system impacts stemming from its vascular nature, the associated immune perturbation, and other systemic effects.
The observable increase in community illness and chronic ill health (42, 43) should motivate those responsible for public health to take all possible measures to insure our well-being. That is not what lifting the mask mandate in healthcare conveys.
Perhaps, if the dangers to public health will not motivate state leaders, those responsible for health care systems will consider not only their ostensible goal of doing no harm, but also their legal liabilities (44).
For all these reasons and more, I urge you to maintain mask mandates in the healthcare settings for which you are responsible.
Thank you.
(1) Group in Portland protests lifting of mask mandate in medical settings https://katu.com/news/local/group-in-portland-protests-lifting-of-mask-mandate-in-medical-settings
(2) Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff https://www.nejm.org/doi/full/10.1056/NEJMoa2211029
(3) Death Panel Podcast: Why Mask Mandates Work w/ Ellie Murray https://soundcloud.com/deathpanel/why-mask-mandates-work-w-ellie-murray-030923
(4) Biobot Covid-19 Wastewater Monitoring in the U.S. https://biobot.io/data/
(5) OHA Public Tableau: Oregon's Hospitalization Trends by Severity https://public.tableau.com/app/profile/oregon.health.authority.covid.19/viz/OregonCOVID-19HospitalCapacity/HospitalizationbySeverity
(6) Waning Immunity Against XBB.1.5 Following Bivalent mRNA Boosters https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900747/
(7) Bivalent booster effectiveness against severe COVID-19: Outcomes in Finland, September 2022 – January 2023 https://www.medrxiv.org/content/10.1101/2023.03.02.23286561v1.full.pdf
(8) Why Do Vaccinated People Represent Most COVID-19 Deaths Right Now? https://www.kff.org/policy-watch/why-do-vaccinated-people-represent-most-covid-19-deaths-right-now/
(9) mRNA COVID Vaccine Effectiveness Lower in Immunocompromised People https://www.technologynetworks.com/vaccines/news/mrna-covid-vaccine-effectiveness-lower-in-immunocompromised-people-367003
(10) Bivalent COVID Boosters Offer No Extra Protection, Studies Suggest https://www.usnews.com/news/health-news/articles/2023-01-11/bivalent-covid-boosters-offer-no-extra-protection-studies-suggest
(11) Diabetes risk rises after COVID, massive study finds https://www.nature.com/articles/d41586-022-00912-y
(12) Diabetes after SARS-CoV-2 infection https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00324-2/fulltext
(13) Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm
(14) Long-term cardiovascular outcomes of COVID-19 https://www.nature.com/articles/s41591-022-01689-3
(15) The impact of COVID-19 and COVID vaccination on cardiovascular outcomes https://academic.oup.com/eurheartjsupp/article/25/Supplement_A/A42/7036729
(16) SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001064
(17) Pathophysiology of COVID-19-associated acute kidney injury https://www.nature.com/articles/s41581-021-00452-0
(18) Covid-19: Infection increases the risk of kidney disease even in mild cases https://www.bmj.com/content/374/bmj.n2189
(19) Impact of COVID-19 on liver https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/
(20) Tip of the iceberg: erectile dysfunction and COVID-19 https://www.nature.com/articles/s41443-022-00540-0
(21) COVID-19 Infection Is Associated With New Onset Erectile Dysfunction: Insights From a National Registry https://www.smoa.jsexmed.org/article/S2050-1161(21)00158-6/fulltext
(22) Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom https://pubmed.ncbi.nlm.nih.gov/34558562/
(23) Incidence of Hearing Loss in COVID-19 Patients: A COVID Hospital-based Study in the Eastern Part of India https://ijcrr.com/uploads/3357_pdf.pdf
(24) COVID-19 and Sudden Sensorineural Hearing Loss: A Systematic Review https://www.frontiersin.org/articles/10.3389/fneur.2022.883749/full
(25) Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/hearing-loss-tinnitus-and-dizziness-in-covid19-a-systematic-review-and-metaanalysis/0AAEFD3E7D35CCF68415E38BDC493E63
(26) Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection https://www.nature.com/articles/s41590-021-01113-x
(27) Autoimmunity is a hallmark of post-COVID syndrome https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-022-03328-4
(28) Immuno-proteomic profiling reveals aberrant immune cell regulation in the airways of individuals with ongoing post-COVID-19 respiratory disease https://www.sciencedirect.com/science/article/pii/S1074761322000462
(29) COVID-19 and Immune Dysregulation, a Summary and Resource https://whn.global/scientific/covid19-immune-dysregulation/
(30) COVID Effects on the Brain, a Summary and Resource https://whn.global/scientific/covid-effects-on-the-brain-a-summary-and-resource/
(31) COVID-19 and Eye A Review of Ophthalmic Manifestations of COVID-19 https://journals.lww.com/ijo/Fulltext/2021/03000/COVID_19_and_Eye__A_Review_of_Ophthalmic.8.aspx
(32) SARS-CoV-2 infects and replicates in photoreceptor and retinal ganglion cells of human retinal organoids https://www.cell.com/stem-cell-reports/fulltext/S2213-6711(22)00104-7?
(33) Common skin signs of COVID-19 in adults: An update https://www.ccjm.org/content/89/3/161
(34) Dermatologic manifestations and complications of COVID-19 https://www.sciencedirect.com/science/article/pii/S0735675720304861?via%3Dihub
(35) COVID-19 – A vascular disease https://www.sciencedirect.com/science/article/pii/S1050173820301286?via%3Dihub
(36) COVID-19: A Serious Vascular Disease with Primary Symptoms of a Respiratory Ailment https://academic.oup.com/jalm/article/6/5/1099/6317833
(37) Is coronavirus a disease of the blood vessels? https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/is-coronavirus-a-disease-of-the-blood-vessels
(38) COVID-19 infection: an overview on cytokine storm and related interventions https://virologyj.biomedcentral.com/articles/10.1186/s12985-022-01814-1
(39) SARS-CoV-2 infection results in immune responses in the respiratory tract and peripheral blood that suggest mechanisms of disease severity https://www.nature.com/articles/s41467-022-30088-y
(40)Ten scientific reasons in support of airborne transmission of SARS-CoV-2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fulltext
(41) Similarities and Differences between Flu and COVID-19 https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm
(42) Long Covid is keeping millions out of work – and worsening labor shortage in the US https://www.theguardian.com/commentisfree/2022/sep/15/long-covid-is-keeping-millions-out-of-work-and-worsening-our-labor-shortage
(43) Long COVID Appears to Have Led to a Surge of the Disabled in the Workplace https://libertystreeteconomics.newyorkfed.org/2022/10/long-covid-appears-to-have-led-to-a-surge-of-the-disabled-in-the-workplace/
(44) Hospitals That Ditch Masks Risk Exposure
https://blog.petrieflom.law.harvard.edu/2023/02/20/hospital-liability-covid-infection/
