This commentary is by Anne N. Sosin, a public health researcher and Policy Fellow at the Nelson A. Rockefeller Center at Dartmouth College and the co-lead on research on Covid-19 and rural health equity in northern New England. This opinion piece was written with the encouragement of Deborah Lisi-Baker and is dedicated to her memory.
A week after schools across the country lifted masking in a “return to normal,” a friend diagnosed with cancer shortly before the pandemic tested positive for Covid-19. Her vaccinated 5-year-old felt embarrassed to mask alone in his kindergarten classroom.
My friend did not choose cancer, her child did not choose to go to school, and she does not choose to teach in front of a roomful of unmasked students. Yet, we choose as a state whether our policies and actions will protect her and others at high risk or needlessly endanger them in the essential places where they work, learn, and play.
My friend is one of the 1 in 37 — or more than 7 million Americans — who are immunocompromised and cannot benefit fully from the protection of vaccines. Severe Covid-19 outcomes among the vaccinated have overwhelmingly concentrated in this group. The ability of Omicron and the BA.2 subvariant to evade the protection of vaccines and prior infection puts the immunocompromised and others with significant underlying illnesses at especially great risk as mask policies fall in the spaces where they learn, work, and meet other needs.
The immunocompromised are our teachers, health care providers, and children. They include the 8-month-old infant undergoing cancer treatment while her teacher parent spends every day in close, indoor proximity to their unmasked students. The immunocompromised include a Newport resident whose community mobilized to find a kidney donor this year. They are Democrats and Republicans, rural and urban, farmers, teachers, grocery store cashiers, and legislators.
Our lives and livelihoods depend on the immunocompromised as much as theirs on us, and they deserve more than callous oversight in our pandemic exit strategies.
Also at risk are children too young to be vaccinated. At the peak of the Omicron surge, children from birth to age 4 in the U.S. were hospitalized at five times the rate as at the staggering peak of the Delta surge. One in five of all Covid-19 deaths in children in the U.S. occurred during the Omicron surge, and Covid-19 is currently the third-leading cause of death in children.
While Vermont has maintained lower hospitalizations and avoided a death in a child to date, vaccination of the people around them is insufficient to protect them against Omicron and BA.2.
And while much of our attention has focused on the short-term risk of Covid-19, thousands of previously healthy Vermonters continue to be affected by and at risk of developing long Covid. Studies suggest that as many 1 in 10 vaccinated people may go on to develop long Covid.
Covid has not collapsed along with the political will of American or Vermont’s leadership to control it. The same day that the state dropped school mask recommendations, U.S. Rep. Peter Welch tested positive for Covid-19. Since then, scores of other leaders across the country have tested positive. Wastewater monitoring sites across the country, including those in Vermont, report growing levels of SARS-CoV-2 and other countries are seeing surges driven by the even more transmissible BA.2 subvariant.
Schools across the state and New England have already reported outbreaks, the BA.2 variant is now dominant in Vermont, and six of Vermont’s 14 counties now have medium or high transmission under the CDC’s much higher thresholds. Adding to concern, a flurry of new studies has demonstrated the “wall of immunity” many hoped the Omicron surge would provide against future variants may not alone offer reliable protection against reinfection with BA.2 or a new surge.
As a BA.2 surge looms, we must move beyond the empty rhetoric of calls to “protect the vulnerable.” We should continue to require masking in the highest risk settings and — in the absence of mandates — participate in communal masking.
Masking together makes our schools, workplaces, and essential spaces safer for the most vulnerable among us. Masking also enables all to participate in life fully and safely and without feeling visibly stigmatized or pressured. And as a Virginia court has just ruled and the U.S. Secretary of Education wrote in a March 24 letter to schools, this is not a matter of solidarity but rather an imperative of the Americans with Disabilities Act.
If political leaders, schools, and businesses are unwilling or unable to mitigate the places where high-risk people and their families need to be, they must ensure meaningful accommodations, including access to remote schooling and work and other protections.
Thankfully, my friend was able — with rapid mobilization from a team of specialists — to access treatment and continues to recover. Yet, Covid therapies were already scarce and hard to access — only 850,000 doses of the monoclonal antibody Evusheld have been distributed— and funding for testing and treatment has run dry.
Many worry that continued masking now will mean permanent masking. Yet, the arrival of vaccines for children and expanded access to treatment should leave all Vermonters protected. Others are particularly concerned about the impacts of masking on children; however, expert after expert has refuted claims that masks harm child development. And while some have equated masking with lockdowns, closures, or other restrictions, it simply allows everyone to be in the same spaces, with the same protection.
The new CDC guidance normalizes a very high level of death and characterizes masking as an individual choice rather than as a community prevention strategy. It sets a threshold for masking far higher than that needed to keep schools safe or to make one-way masking safe for the most vulnerable.
Congressional inaction has meant that many at highest risk may not have access to testing and treatment if and when they need them.
Yet our policy choices reflect our values. Vermont policymakers and residents can and should make choices that reflect a commitment to protecting, rather than abandoning, the most vulnerable members of our families, schools, workplaces, and communities.
