PHILLY SPECIAL — Masks are back. Philadelphia became the first major U.S. city Monday to announce plans to reimpose an indoor mask mandate. Then came the debate: Some people claimed the city was acting too soon, as CDC guidance doesn't yet recommend indoor masking for Philadelphia. Others said the announcement was an indicator of what's to come across the U.S., if cases of BA.2, the Omicron subvariant, continue to creep up. So Nightly called one of the people behind Philadelphia's pandemic policy, health commissioner Cheryl Bettigole, to better understand the move and its potential relevance for the rest of the country. This conversation has been edited. Philadelphia established a data-driven level system in February that determines when pandemic restrictions, like masks, come and go. Why do you feel this is the best policy at this stage in the pandemic? We had heard a lot, especially from the business community in Philadelphia, about wanting some kind of predictable, transparent metrics so we would tell them what we were doing. We talked to restaurant owners, hotel owners, the sports stadium community. We talked to a lot of public health experts. We also took a deep dive into Philadelphia's data. Each time we were hit with a wave, I remember standing in front of the news cameras, and trying to get people to understand that the rate of rise is something really important that we look at — that if cases are doubling, even if the numbers are small, that's very concerning. We took the span of the pandemic at each of the waves, the initial wave at Delta, at Omicron. The version that seemed to be the most predictive was a 50 percent rise in cases over a 10-day period. And again, not as a single metric, but as one of the signs. So the metrics that we put together included overall case counts, this rate of rise metric, and of course hospitalizations. We initially included positivity, but then the screening programs all started to come to an end, and we realized positivity was going to just change dramatically in a way that wouldn't necessarily be related to what was happening with disease. So we dropped positivity. We didn't include death data for the same reason that everybody else hasn't included it, which is that it's a late metric. Why bring back indoor masking before hospitalizations go up? What we're trying to do is anticipate when we think hospitalizations, and ultimately deaths, are likely to rise. We had a massive wave with Omicron. Philly went on to have 750 deaths. I've spent a lot of time looking at data from other places. In the U.K., which has similar vaccination rates to what we do, their Omicron surge in January looked a lot like ours. Their BA.2 wave is bad. They've stopped doing as much testing but their hospitalization wave peaked above their January hospitalization surge, and deaths are going up. Then I was looking around the country at different places that seem to be ahead of us. New York State, New Jersey, Delaware have seen a rise in hospitalizations. They're small, but they're bigger today than they were yesterday. So it feels like something may be starting. If hospitalizations are going to go up in Philly, they should start to go up soon. If it turns out that we've reached a point in the pandemic where hospitalizations are no longer associated with case rise, then great. That would be wonderful news, and then we will need to go back and revisit our metrics. We're at an all-time-high of pandemic fatigue. What do you expect mask compliance to look like in Philly? I've gotten a mixed reaction. I've gotten a certain amount of hate mail, like misogyny and all sorts of expletives. The business community was quite perturbed, even though it's the same people we talked to before, who were happy to see our metrics in February. But I've also gotten some very positive messages from individuals, a lot of public health folks. Maybe the one that means the most to me — one of our local Black clergy members, who leads a large church, was very grateful for this. Philly's Black community has suffered immensely in this pandemic. We're the poorest big city in America. If you wanted an exercise in why health equity matters, this pandemic is it. In general, our mask wearing has been much higher than in other places. People didn't entirely stop wearing masks in Philadelphia, where we've been hovering around the 40 to 50 percent mark. I'm sure there will be people who absolutely refuse to wear masks. That's always going to be true. At most parts of the pandemic, when we had a mask mandate, we've been around the 80 percent range. I don't know if we'll get quite 80 percent on this, but if we want to drive down numbers, we don't have to be perfect. People criticized the move because it's at odds with CDC guidance, which does not advise masking for Philadelphia and considers the city to have a "low Covid-19 community level." CDC has absolutely said that local health jurisdictions should be able to respond to local conditions, which is what we're doing. We are, again, the poorest big city in America, with huge health disparities on an underlying basis. That's part of what we're responding to here in Philadelphia, and CDC has been supportive of that. They are trying to make a system that will work for the entire country, in an incredibly polarized environment. So what they put out has to be read in that way. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author at mward@politico.com, or on Twitter at @MyahWard.
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