To understand the abrupt about-face in masking recommendations from the U.S. Centers for Disease Control and Prevention, the state of California and Humboldt County Public Health, you have to take a hard look into what happened in Barnstable County, Massachusetts.
Entering the Fourth of July weekend, it looked like Barnstable County largely had COVID-19 under control. Nearly three in four eligible county residents were fully vaccinated, with 82 percent having received at least one shot. On July 3, the Massachusetts Department of Public Health reported Barnstable County, which has a population of about 213,000, had a 14-day average of zero new COVID-19 cases per 100,000 residents per day. In short, things looked promising.
But in the ensuing two weeks, according to the CDC, "multiple summer events and large public gatherings were held" and cases quickly followed. In all, the CDC report traces 469 cases back to Massachusetts residents who attended those events and gatherings, though local officials say the total case count is well north of 800. Of the cases the CDC tracked, 74 percent were traced back to fully vaccinated people. Of those breakthrough cases, almost 80 percent were symptomatic, with patients most commonly reporting coughs, headaches, sore throats, muscle pain and fever. Five hospitalizations were tied to the case cluster, including four fully vaccinated individuals, two of whom had underlying medical conditions.
Genomic sequencing from the case cluster found two things of note. First, nearly 90 percent of the cases were the highly contagious Delta variant, which health officials have described as the 2020 version of COVID-19 on steroids and now accounts for 85 percent of all new cases in the United States. Then, alarmingly, the sequencing indicated fully-vaccinated breakthrough patients carried a similar viral load — or the amount of virus present in a sample, an indicator of how much virus an infected individual is shedding and therefore of how contagious they are — as their unvaccinated counterparts. The report also notes that asymptomatic spread among the fully vaccinated might be underrepresented.
Even in a preliminary form, the data was considered a game changer, according to internal CDC documents leaked to the Washington Post, and reportedly spurred officials to take immediate action even before the data's official July 30 release. Specifically, the CDC issued a recommendation that everyone — regardless of vaccination status — resume masking in indoor public spaces in areas of "high" or "substantial virus spread," which includes Humboldt County (read more on page 21). That recommendation was quickly followed by ones from the California Department of Public Health and the county of Humboldt.
CDC Director Rochelle Walensky told Fox News that the data from Massachusetts was supplemented with that of other studies from around the world and that "the trends seem clear." But Walensky stressed that vaccination continues to protect against serious disease and death, pointing to data indicating that of 164 million fully vaccinated Americans, only 6,239 (0.0038 percent) have subsequently been hospitalized with the virus.
"If you are vaccinated, you are protected from severe illness," she said.
In Humboldt County, two of 236 COVID-19 hospitalizations and none of the 54 associated deaths have been confirmed in fully vaccinated individuals, and the county reported that about 25 percent of samples that underwent genomic sequencing in June came back as the Delta variant. But data on both breakthrough cases and local prevalence of the Delta variant remain severely limited.
At a July 21 press conference, Health Officer Ian Hoffman explained that reporting real-time data on breakthrough cases is simply infeasible due to staffing limitations, noting that such information has to be attained through contact investigations and then verified, while staff is struggling to keep up with other data collection and reporting functions.
"We collect tremendous amounts of data on COVID every day," he said. "It's already a tremendous amount of work."
Similarly, he said that while the Public Health Laboratory has begun in-house genomic sequencing, it's a lengthy process. But Hoffman said as local trends come into focus, Public Health will report them out to the community.
What is very clear is local case numbers are spiking sharply and now rival those of any period to date in the pandemic.
In the week before the Journal went to press, the county confirmed 280 new COVID-19 cases with a test-positivity rate of 10.4 percent, which far outpaces the national average of 7.8 percent, 11 new hospitalizations and one death of a resident in their 30s.
On Aug. 3, the city of Eureka also reported that samples taken from its wastewater collection facility as a part of a nationwide COVID-19 tracking program show virus concentration levels higher than 99 percent of other samples from across the nation.
"This new local data, including both rising case counts and now the wastewater testing results, are cause for concern," Hoffman said in a press release. "Everyone must continue to do their part to protect themselves and each other."
Hoffman has previously said that spiking case counts alone are unlikely to trigger additional local mitigation measures like business closures or mandatory masking, which he said would only be implemented as a last resort if hospital capacity becomes threatened. According to a statewide database, 20 local residents were hospitalized with COVID-19 as the Journal went to press Aug. 3, including seven under intensive care.
Locally, health officials and physicians continue to urge vaccination as the best way for individuals to protect themselves and prevent COVID-19's spread. In an Aug. 3 press release, Hoffman urged residents to take safety precautions in their everyday lives and to limit gatherings outside their households given the rise of the Delta variant.
"Everyone is frustrated that this is moving backwards given all the progress made," he said. "Think about what level of risk you can tolerate, what makes sense for yourself, your family, when deciding what activities to continue in public."
In Facebook post July 30 — the same day the county reported a single-day record 69 new COVID-19 cases — First District Supervisor Rex Bohn urged his followers to take the virus and mitigation measures seriously, saying he'd just spoken with Roberta Luskin-Hawk, the CEO of St. Joseph Health.
"She is scared," Bohn wrote, adding she feels the next four to six weeks will be pivotal. "The fear I heard in her voice was real. They have 16 hospitalized right now [and] with our highest case count today since this started, we are in troubled waters. ... There are staffing shortages at the hospital which is going to affect other care and needs. I am vaccinated. I am scared. I am going to do better with my masking, be more aware of others and pray for all of us."
Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or firstname.lastname@example.org. Follow him on Twitter @thadeusgreenson.