Health Care

Health commissioner recommends masking indoors, but state rules remain unchanged

Mark Levine at podium, with Phil Scott
Mark Levine, commissioner of the Vermont Department of Health, speaks at Gov. Phil Scott’s twice-weekly Covid-19 press conference on Dec. 22, 2020. File photo by Mike Dougherty/VTDigger

Updated at 11:58 p.m.

Health Commissioner Mark Levine recommended all Vermonters consider wearing masks indoors, regardless of vaccination status, at a press conference Tuesday.

But he stopped short of the full recommendations from the federal Centers for Disease Control and Prevention that all people wear masks in all indoor settings in counties with high or substantial transmission — which currently includes all 14 counties in Vermont. 

Instead, he said, Vermonters should use their best judgment on whether a situation presents a risk.

For example, he said he felt safe forgoing a mask at the press conference because the room was large, people there were mostly vaccinated, and they were able to socially distance.

Gov. Phil Scott said he had been discussing masks at previous press conferences, using phrases like “you have to assess your situation” and “I think it’s a good idea.”

“I’m saying we should promote them during times when it’s necessary,” Scott said. “If you’re assessing your situation, taking some personal responsibility, going to a concert where there’s hundreds inside, you might want to wear them.”

Still, Levine’s comments represented a shift from previous weeks, when the commissioner said vaccinated Vermonters could wear masks if it made them feel more comfortable.

Levine said his stronger wording was inspired by recent outbreaks at long-term care and correctional facilities, and the fact that schools are reopening. “It’s just bringing all that front and center, and making sure that we can do as much as possible,” he said.

Levine also responded to a letter he received last week from 91 rank-and-file Vermont Health Department employees, begging Levine and other leaders to take a firmer stand as Covid-19 cases surged in the state. The letter urged them to consider stronger Covid guidance and to “publicly and strongly” recommend universal masking indoors.

However, Levine said, there are “no differences of opinion within the Department of Health.”

The experts in the department’s epidemiology department have been working “pretty darn hard” to come up with appropriate recommendations, and there’s no “contentiousness” about that, he said.

But there are a “lot more factors that go into major decisions,” including economic concerns, mental health or the ability of Vermonters to do things, Levine said.

“My letter back to them just tried to convey the sense that we don’t operate in a vacuum,” he said. “We are not the ones who are in total control of everything that happens during the pandemic. It’s a very collaborative and deliberative process.”

Asked if Vermont would have less Covid transmission with indoor masking, Levine said masks aren’t 100% effective, but are a strong mitigation strategy. 

Back-to-school preparations

Schools are opening across the state, starting an important Covid countdown timer: 10 days before state recommendations say that students can unmask if a school meets certain vaccination requirements. 

Education Secretary Dan French said at Tuesday’s press conference that all but one school district, Canaan, have adopted state guidance for masking during the beginning of the school year. Schools following the state guidance could then allow vaccinated students to unmask if more than 80% of eligible students are vaccinated.

But state guidance is not without contention. Letters from Democratic leaders in the Legislature last week criticized the state’s sparse guidance and questioned whether the state should take a stronger approach.

On Tuesday, four medical organizations — the Vermont chapter of the American Academy of Pediatrics, the Vermont Medical Society, the Vermont Academy of Family Physicians and the University of Vermont Children’s Hospital — issued a joint statement urging continued universal indoor masking in schools, regardless of vaccination level.

“With Covid-19 cases on the rise in Vermont, we are already seeing the effects on schools and classrooms only a few short days into the school year,” the statement reads. “Minimizing disruption to the school year is important for schools, families and students.”

Scott said if he wanted to require schools to follow state guidelines, he would have to reimpose the entire emergency order, something he’s reluctant to do.

“We can’t be in a perpetual state of emergency. It’s just not conducive to good government,” he said.

He pointed out that almost all districts had followed state recommendations.

Current state guidance also offers limited provisions for schools that switch to remote learning because of outbreaks or fear of transmission. French said days during which 50% or more of the student body is remote may not be counted in the required number of school days for the year. The days would have to be made up.

East Montpelier Elementary School, for instance, switched to remote learning this week after learning that two people tested positive for Covid. “That necessarily does not qualify as an attendance day” French said. 

“Unless there’s some provision made through a waiver or what have you, they would have to make that day up,” he said. “We’ll get into that as we better understand the patterns.”

Last year, the State Board of Education issued a broad waiver of in-person instruction. French said that’s “probably” something he will do again, but those waiver provisions aren’t available until February.

He said districts that are considering closing portions of schools, or shutting them down entirely, should follow the recommendations of contact tracers.

Forty-seven of 51 supervisory unions in the state have signed up for widespread student surveillance testing, said Mike Smith, secretary of the Agency of Human Services. He said he was confident it would be available for all 47 unions by the end of September.

School-based clinics continue to provide vaccinations for Vermonters, targeting children ages 12 to 17. Three-quarters of children in that age group are vaccinated, the highest of any state, according to state data. Children under 12 are still ineligible for the vaccine.

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Will Vermont cases fall?

For the third week in a row, Mike Pieciak, commissioner of the Department of Financial Regulation, expressed confidence that Covid cases would soon start to plateau in Vermont. His department is in charge of modeling future Covid patterns. 

He cited three metrics as encouraging signs: The case growth rate, the estimated infection rate and the reproduction rate, the latter two based on a model from a coalition of Ivy League researchers. 

However, each data point has its own uncertainties. 

The case growth rate is a measure of how fast cases are going up in Vermont — not only how many new cases there are, but how many new cases there are compared to the day or week before. 

For several weeks, the case growth rate was falling. First Vermont had 83% case growth over the previous week, then 41%, then 5%. 

But this week’s data popped the case growth back up to 22%. The state reported 968 cases in the past week, compared to 794 the week before — that is, Vermont had 174 more cases this week than last.

That’s compared to 758 and 794 cases in the weeks prior, which was only a 36-case jump.

Pieciak said there was a 54% increase in testing due to college students returning, and a lower test-positive rate, suggesting that more frequent testing could be revealing Covid cases that are increasing the state’s total.

The reproduction rate is a metric that shows how many new infections each individual is causing. Vermont’s reproduction, or Rt, rate is below 1, based on Covid estimates from academic researchers. That would indicate that each infected person is spreading the virus to fewer than one person on average.

The researchers’ model also calculates the “estimated” infections per capita, rather than the confirmed cases, based on the assumption that there are undetected cases in the community. That estimate also appears to be declining. 

However, both metrics have a significant caveat: The margin of error for recent data is explosively high. The model for Rt, for example, says that Rt should be around 0.82, but could actually be anywhere from 0 to 2.

The model website for the project says, “Present-day estimates of Rt are highly uncertain, and can change dramatically over time. We feel most confident about results for dates which are at least 14 days in the past.”

That lends more uncertainty to whether Rt is really below 1 or whether estimated infections are actually falling.

The state reported 104 new Covid cases Tuesday. Twenty-eight people are currently hospitalized with the virus, including eight in the ICU.

One new death was added to the data on Tuesday, bringing the total to 276. Pieciak said deaths in August still tended to be older individuals. Eight Vermonters who died in August were over the age of 70.

Another 2,761 Vermonters were vaccinated this week, bringing the total to 86.1% of eligible Vermonters who have started vaccination. About 68% of the total population is fully vaccinated.

Vermont no longer holds the national record for the greatest percentage of eligible adults starting vaccination. That title now belongs to Hawaii. 

Vaccination mandate agreement reached

Vermont has reached an agreement with corrections officers to finalize its vaccination mandate, Scott said. 

The state plans to require about 1,000 corrections staff to self-attest to their vaccine status, he said. If they are unvaccinated, they would be required to wear masks and get tested on a weekly basis.

Scott said the administration was considering vaccination requirements for “the whole enterprise.”

“The sooner that we can get more people vaccinated, the better off we're going to be in the future, throughout the country but certainly for Vermont as well,” he said.

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Erin Petenko

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