August 7, 2021

Dear Neighbor,

As you’re probably heard by now, Montgomery County has re-instituted the indoor mask mandate as of this morning. Students will be headed back to in-person school (in masks) in a few short weeks. Case rates have gone up significantly over the last few weeks, while hospitalizations and deaths have seen a mild increase.The Governor has also announced limited vaccine requirements for certain state employees, and has publicly pleaded with holdouts to “get the damn vaccine.”

If you’re like me, this news is a bit soul crushing. I was envisioning a more normal fall, and planning a (many times rescheduled) spring wedding.  I’m angry and disappointed that we are here again, but I am also extremely hopeful. Thanks to the vaccine, we are in a much better position than we were in last fall.

Here’s a summary of where we are today moving into the fall.

Increasing Case Rates and Current Hospitalization Numbers

Over the last month the Delta variant has gone from 2% of Maryland cases to nearly 100% across Maryland and Montgomery County. Because the Delta variant is exponentially more transmissible, we have seen corresponding increases in our number of positive COVID cases. 

The new metric you will see used more often in Montgomery County is the number of new cases per 100,000 over a seven day period. This is the metric established by the CDC for evaluating how much spread exists within a region. In the last two months, we have gone from 6 new cases a week (per 100,000 residents) to 58 new cases a week (per 100,000 residents) in Montgomery County. That’s nearly a tenfold increase.

While this is a stunning increase, for some perspective, back in January we were seeing 349 cases a week (per 100,000 residents) in Montgomery County–  that’s a case rate six times today’s case numbers. Montgomery County trends can be viewed on the COVID Data Dashboard.

Montgomery County’s 2 week average daily case rate of 8.23 (per 100,000 residents) is below the state average of 9.21. Our less well vaccinated neighbors Prince George’s (11.64), Frederick (10.9) and Anne Arundel (9.91) have higher case rates than us, while better vaccinated Howard is only at 5.04. Rural Dorchester county leads the state with a COVID case rate of 24.61 per 100,000- and a vaccination rate of only 45%.    

The good news is that our hospitalization utilization and death numbers remain low. Across Maryland we currently have 337 people hospitalized with COVID. Back in January we peaked with 1,952 people hospitalized. Just over 2% of Montgomery County hospital beds are currently being utilized by COVID patients. This is more evidence that the vaccine is working to prevent severe illness and hospitalization. 

Last week in Maryland we averaged three COVID deaths a day. Our high during the pre-vaccination peak was 70 deaths a day. At least 9,622 Marylanders have lost their lives to COVID, including 1,583 Montgomery County residents. Maryland state data can be found HERE.

Montgomery County Mask Mandate

The Governor has left the issue of mask mandates up to local jurisdictions. In Maryland, Prince George’s County, Baltimore City, and Montgomery County have followed Washington, DC in mandating masks indoors. Anne Arundel County will require masks in government buildings. 

Montgomery County’s mask mandate was approved by the County Council with specific triggers linked to the community transmission levels established by the CDC. The mandate went into effect when the County reached seven consecutive days with a rate of over 50 new infections per week per 100,000 residents (we are currently at 58 and have been over 50 for 8 days). This classifies Montgomery County as a “substantial transmission” area. According to CDC guidelines, this means indoor masks should be required, even among the vaccinated.

Thanks to a thoughtful amendment by Councilmember Andrew Friedson the mask mandate has a predictable end. The mandate will cease automatically after we return to a status of “moderate transmission” (under 50) and sustain it for seven days. This is doable. Remember, we were below 50 new cases per week per 100,000 throughout June and July. If we continue to increase vaccinations and use appropriate caution, we can bring the rate of community spread down to the CDC’s moderate transmission standard which will trigger an automatic end to the mask mandate. Read the full text of the Montgomery County Order here.

Breakthrough Infections

People who have been fully vaccinated are still testing positive for COVID. In fact, in the last few weeks since the Delta variant has taken over, about 25% of positive COVID tests in Maryland are among vaccinated people. At the beginning of June only 10% of positive cases were among vaccinated individuals. 

To date, Maryland has seen 3,836 positive COVID cases among fully vaccinated individuals. This represents less than 0.12% of vaccinated Marylanders. It is worth noting that the higher a region’s vaccination rate, the more likely it is that is to show a high rate of positive tests from vaccinated individuals. In this regard, we are victims of our own success.

Many of these post-vaccination cases are asymptomatic. It is extremely rare for these cases to result in hospitalization, and even less likely for a vaccinated individual to die as a result of COVID. While 454 of the 3,836 positive cases (12%) are associated with hospitalization, this percentage does include asymptomatic COVID patients hospitalized for other reasons. In other words, the mandatory COVID tests upon hospital admission are identifying a number of asymptomatic vaccinated COVID positive individuals going to the hospital with unrelated injuries or illnesses. 

Nevertheless, while rare, it is possible for vaccinated individuals to become sick and even die with COVID. Early post-vaccination infection and hospitalization data is available on the state website HERE. 

Booster Shots & Vaccines for COVID Survivors

I’ve heard a lot recently on the question of booster shots. Dr. Fauci has indicated we may receive guidance on this for seniors and immunocompromised individuals this fall. So far, Maryland’s infection, hospitalization and death data are not showing any evidence of an urgent need for booster shots for our population. However, we are monitoring this closely.  

It is however strongly recommended that if you are a COVID survivor who has not been vaccinated, you seek a vaccine immediately. The re-infection rate with COVID variants is extremely high. Immunity from a previous case of COVID is not enough to protect you from the Delta variant. You need a vaccine.

Full FDA Approval & Vaccines for Children

The FDA is expected to issue full approval for the Pfizer vaccine in September. Many institutions, including certain hospital systems have been waiting on full approval, instead of the current Emergency Use Authorization, before requiring vaccinations for their populations–  so many that Dr. Fauci has warned us to expect “a flood” of new vaccine mandates. There is also hope that full authorization will encourage unvaccinated individuals to get vaccinated. Hopefully this will build momentum for the vaccination push. 

In addition, we should soon be able to increase vaccination numbers by providing protection to children between 5 and 11. While no date is certain, this vaccine should be available mid-fall, if all goes well with the recently expanded trials. Until then, families with school age children must remain extremely cautious. Their children have no protection from the Delta variant. These families are depending on all of us to help reduce community spread. Despite the fact that elementary school children cannot access the vaccine, there is still no requirement for public school staff, bus drivers, or teachers to be vaccinated. 

The Future of Vaccine & Testing Mandates

With a full FDA authorization on the horizon, we can expect to see some changes in the vaccine landscape. Of course, the need for mandates will be inversely correlated with a population’s willingness to be vaccinated. 

The Maryland Hospital Association has been a leader in requiring their staff to be vaccinated. Leading Age, the nation’s network of nonprofit long term care facilities, also bravely issued support for vaccine mandates for nursing home staff. However, there is currently no universal mandate for nursing home workers or home health care providers. Governor Hogan has imposed a “mandate-light” (a vaccine mandate or required weekly testing) on the state employed congregate care workforce. The Administration  has hinted that if the nursing care industry doesn’t self-impose a vaccine requirement on their workforce, the Health Department might do it for them. We don’t want to head into another winter with significant spread in congregate care facilities. 

Montgomery County Government is in negotiations with their workforce for mandates for County employees, including public safety employees. It’s up to the Board of Education to take responsibility for negotiating vaccine mandates with school system employees- after months of opposition to this idea, national teachers union leaders seem to be softening on this idea in response to concerns about teacher safety. Polite reminder: children under 12 are our most vulnerable population because they currently have no access to vaccines for themselves. 

Only 40% of Metro transit employees report being vaccinated. Weekly testing at a minimum may be required if that number doesn’t increase to 70%.

A coalition of 13 local theaters, including Round House Theatre and the Shakespeare Theatre  have announced they will require proof of vaccination for patrons. The same holds true for Broadway’s theaters.  While you’re in New York, you can now only visit restaurants, bars, and gyms only after showing proof of vaccination. 

United Airlines became the first US Airline to require vaccination for employees. Frontier Airlines soon followed. Disney is requiring all salaried and non-union hourly employees to be vaccinated. Walmart is requiring vaccinations for corporate staff and regional managers, but has stopped short (so far) of requiring vaccines for retail employees.

How Maryland Compares to US Hotspots

The New York Times has a handy state-by-state tool to help us understand what’s going on across the country. As concerning as I find our increase is cases, I think it’s important to appreciate how well Maryland is doing in comparison to other states. Our current daily rate of 9 new cases per 100,000 compares to Florida’s 84 new cases, and Louisiana’s 97 new cases. While they have 52 and 40 COVID hospitalizations per 100,000 residents, we have only 9. Louisiana’s COVID death rate is ten times ours, at 0.6 per 100,000. Maryland is at 0.06. Florida’s death rate is more than five times higher than Maryland's, at 0.34 per 100,000 (remind me to cancel my attendance at that upcoming conference in Tampa!) In Maryland we are healthier because of vaccines. 

That’s a lot of COVID news to unpack! In summary, masks are back, hopefully temporarily, as we engage in a major push for more vaccinations. Case rates are increasing as our area faces the Delta variant. But we are holding strong and maintaining the health of our region thanks to high vaccination rates. We are keeping businesses open and continuing with much of life as we used to know it. It’s still a race against the clock to get even more people vaccinated. It’s all hands on deck as we protect our children under 12, and await the pending answer on booster shots. We need our business community and civic leaders to continue to step up and make tough choices in defense of public health. Nobody said leadership was easy. I’m looking forward to a day in the not too distant future when I can have a bonfire for my family’s masks. And maybe, just maybe, have that wedding I keep postponing.

Best wishes for a wonderful end to your summer,

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