Regarding his opinion on the mask order for K-5th grade, Dr. Bob Lorinser shares information and data supporting the decision to rescind the order.
I hope this information helps the public understand why I believe it is time to rescind the order. I respect contrasting views on this matter, but my conclusion was made after pouring over the data and considering public health matters.
The public should know my decisions and why and how I make them. I have used this data to support the lift of the isolated mask order for Marquette County. If, after reading this, you have more questions, please reach out to me.
It is important to note, as stated in the update on Jan. 26, 2022, the Marquette County Health Department (MCHD), along with the Michigan Department of Health and Human Services (MDHHS) and the Center for Disease Control (CDC), still strongly recommends:
PreK‐12 settings continue masking, as well as all public and crowded spaces. Applying preventive measures that include physical distancing, mask-wearing, hand hygiene, and other mitigation strategies reduces the spread and impact of COVID‐19.
Personal responsibility: Testing, quarantine, and isolation.
Vaccinations
We need to ask the first question: What are our goals for a K-6th grade mandate? Once we define that, we need to ask ourselves additional questions:
Is it an equitable policy to continue the mask mandate for the lowest risk category after the availability of the vaccine? No.
Does mandating masking in schools work to eliminate risk in the community? No, not at this point, unless students universally mitigate outside of schools.
Potential harms from a mandate? Any decision can have benefits and disadvantages. In September, my original support for the order–limited to K-6th–was because no pediatric COVID-19 vaccine was available. This is no longer the case, and MCHD should consider rescinding the masking order, and if we didn't, we would lose public trust.
Since September, MDHHS goals guiding COVID-19 policy changed, and I thought they were fantastic! So I applied those goals to our K-6th mask order:
Prevent Death and Severe Outcomes
The infection fatality rate of about 1/100,000 in this age group.
The mask mandate would prevent a small percentage, in my opinion, because mask-wearing is still recommended. It is vital that the announcement still recommends masking in schools. However, it is no longer mandated.
Protect Health Care Capacity
There has been only one pediatric hospitalization for COVID-19 I am aware of over two years in our county.
Keep Vital Infrastructure Functioning
Mitigation efforts of isolation and quarantining of students impact adults creating difficulties; some think it is more problematic than the illness itself.
COVID-19 Deaths by Age group 5-17
Cumulative COVID-19 deaths from Jan. 1, 2020, through Jan. 15, 2022 (2 years) for 5-17-year-olds in the USA = 461, or 231 per year
Estimated 5-17-year-old population in USA = 53,462,467
The calculated annual death rate from COVID = 4.3/1 million population.
Infection Fatality Rate: 231 as the numerator divided by the estimated cases of COVID-19 in the 5-17 year category as the denominator (seroprevalence from Sept 2021 and definitely higher), 41% of 53.5 million = 21.9. The calculated death rate per COVID-19 infected 5-17 year olds is an estimated 10.5/1 million.
Omicron
The arrival of Omicron and COVID vaccinations adjusted the metrics one should use to gauge our public health mitigation efforts away from cases to MDHHS stated goals of:
Preventing Death and Severe Outcomes
Protect Health Care Capacity
Keep Vital Infrastructure Functioning
We aren't out of the woods yet in this tsunami of Omicron, but I am encouraged by the recent 7-day average I sent on Monday, Jan. 24.
Cases are currently triple (300%) of Nov/Dec 2020 wave. Still, our hospitalizations are 75% compared to that time, counting all COVID-positive patients in the hospital, including the so-called innocent bystanders (possibly averaging around 30-50% of all of those hospitalized, making even the 75% high).
On Jan. 26, 2022, at UPHS Marquette, there were 25 total COVID patients with an unknown percentage of them falling into three potential categories: admitted secondary to COVID, incidental COVID, COVID contributed to their hospitalization (e.g., COVID diarrhea leading to dehydration). It is estimated a substantial portion of them were not admitted from COVID.
The relationship between cases and hospitalizations and death is markedly different from before, especially for the vaccinated. The most significant risk is to unvaccinated older adults, especially those with immunosuppressive illnesses and medical problems. The group not protected by the vaccine, because they are illegible, are those under age five. They are also the group least at risk for the consequences of COVID-19, except for those less than one year of age.
How should we look at the numbers? First, we should look at the real goals as listed above.
Preventing Death and Severe Outcomes
The best protection is vaccination.
Protect Health Care Capacity
Based on the numbers capacity is not imminently threatened.
Keep Vital Infrastructure Functioning
Mitigation efforts of isolation and quarantining of those with illness and exposure create difficulties; some think it is more problematic than the illness itself.
Prevention of COVID-19 illness, regardless of the severity, shouldn't be the primary goal. We are entering our third year of the pandemic. Individual risk assessments and personal responsibility should be the drivers at this time.
Get vaccinated.
Mask for additional protection.
Modify your behavior based on your risk assessment.
As for masking in schools
MDHHS published graph Dec. 14
My commentary:
The benefit of the school mask mandate after the vaccine's arrival was defeated by an increase in community transmission, the appearance of the Omicron variant, and the lack of appropriate use and type of mask. Coupled with a lack of use of various mitigating behaviors outside of schools, these are many possible explanations that now, unfortunately, render the mandate ineffective within the community. Within the classroom, transmission is decreased.
In my discussions with MDHHS leadership regarding the efficacy of masking in school classrooms, we believe when community transmission reaches a certain threshold, masking only in school settings does not reduce the overall risk of infection because exposure continues to occur in other settings (i.e., settings in which mitigation strategies are not followed). However, masking is still effective in limiting transmission within the classroom when students and staff are masking. For those avoiding exposure elsewhere, masking in this setting will still benefit. Masking works.
"Masking is still effective in limiting transmission within the classroom.... For those avoiding exposure elsewhere, masking in this setting will still benefit. Masking works." – Dr. Bob Lorinser
Comparing COVID, RSV, and influenza hospitalization rates
Another consideration for children has been the presence of respiratory syncytial virus (RSV) and influenza. COVID is more contagious and more severe. Thankfully, we have a vaccine for the flu. We also have a vaccine for COVID19, but this isn't comforting for parents with kids under five who are still waiting.
Here were my recommendations from MAPS School Board Aug 2021
1st Recommendation: Our local schools should determine the level of risk to escalate or deescalate mitigation strategies such as masking in schools after discussing the facts and in consultation with students, parents, school staff and teachers, public health experts, and others.
2nd recommendation: Marquette Board of Education to consider requiring universal masking of 3K-6th grade since a COVID vaccine is not currently available for those under age 12 and highly recommend masks for other grades. The duration of the required or recommended masking depends on multiple factors. I recommended we review this monthly or when significant changes occur.
I recommended that the masking decision be reviewed monthly or when significant changes occur.
One of the most critical issues is understanding risk when contemplating COVID mitigation.
The risk/benefit trade-offs need to be understood clearly to help individual decision-making. The public's risk/benefit assessment may differ from MCHD, and the public willingness to accept public health initiatives varies with the risk.
I want to share just one of many COVID risk calculators that may help (COVID-19 Risk Calculator). I can't independently verify the accuracy of this calculator like others, but I spent some time trying, as reported below. You can modify the data input to see how it changes your risk and others. The following are my results.
County prevalence
We found data from Marquette County, MI, for your zip code. As of Jan. 23, 2022, this county had 2,654 new reported cases in the last 14 days and 12,815 total reported cases of COVID-19. Many people who contract COVID-19 are not tested and therefore not reported, and we estimate that your county has an under-reporting factor of 1.3x.
Taking into account the under-reporting factor and average time from symptom onset to recovery, we estimate that:
There are 3,436 total sick people distributed throughout the county, including those not officially reported.
1 in every 19 people in your county is currently infected with COVID-19.
In a group of 50 people, there is a 93% chance that at least one person has COVID-19.
In a group of 10 people, there is a 41% chance that at least one person has COVID-19.
Risk of contracting COVID-19
Among people in your county who have behaviors and levels of interaction with others similar to yours, the estimated probability of catching COVID-19 through community transmission in a week is 0.064%. For comparison, 0.41% of Americans catch the flu every week during flu season.
In general, handwashing per CDC guidance reduces people's risk of being exposed to COVID-19 by 55%. Wearing personal protective equipment per CDC guidelines reduces people's risk of COVID-19 exposure by 68%.
Risk of adverse outcomes from COVID-19
Among people who are the same age, sex, and health status as you and get sick from COVID-19, the risk of hospitalization is 6.8%, the risk of requiring an ICU is 5.9%, and the risk of death is 1.4%. Put another way; we estimate that one person in a group of 15 people will be hospitalized if infected, one person in a group of 17 people will require an ICU. One person in a group of 72 people will not survive.
My weekly risk of contracting COVID is 0.064% or 0.0064
If I get COVID, my hospitalization risk is 6.8% or 0.068
My risk of dying if I get COVID is 1.4% or 0.014
I modified this report to make it more practical for me. Because I can't be hospitalized or die of COVID without getting COVID, my weekly risk:
Hospitalized 0.0064 X 0.068=0.0004 or 4/10,000
Dying 0.0064 X 0.014= 0.00009 or 9/100,000
At 66, my risk of dying is around 1.7% per year, or 0.03% per week, or 30/100,000 per week. So, my assessment = no change is needed in my protection.
My COVID risk of dying is 1/3 (problem really around 1/15) of my general risk of not waking up over the next week in general, second to age. The additional risk of dying if I contract COVID over the next one year if the rates of COVID stay at this level (which it will not since already decreasing) is the equivalent to being age 67.
If you do this for a child, the risk of dying is:
(E.g., a vaccinated 6-year-old male without medical problems and average risk social behaviors)
9/100 Million per week or 4.7/M per year of death with masking
26/100 Million per week or 13/M per year without masking
Likewise, should I decide for their child? Is the benefit of wearing a mask worth the "risk"? The benefits of masking for COVID are the same as influenza for children.
Finally,
Did I support the MCHD order in Sept? Yes.
Do I support MCHD rescinding its mask order in Jan? Yes.
Do my grandchildren wear a mask to their elementary schools? Yes, the parents were given the information. Questions were answered, and they decided to mask appropriately.
My recommendations are based on the ever-changing science of the pandemic. Sometimes medical and science data can be complicated, but the public should have access to information that helps everyone understand the facts that shape decisions.
As the Medical Director for Marquette County Health Department during COVID-19, I'm reminded of the importance of principled leadership. We make tough decisions — decisions that might not always be the most popular, but they ought to be the most informed.
I strive to be a responsible leader who makes decisions with facts and data, not with misinformation or reaction to hyperbole.
Sincerely,
Dr. Bob
