I think of children and high risk people (and, by extension, their household and close contacts) differently.
My understanding is that unvaccinated children are at comparable or lower risk to vaccinated adults with regard to COVID hospitalization and death. I haven’t looked at any specific studies on this. But it’s been reported from the beginning of the pandemic that children are at orders of magnitude lower risk for serious complications or death from COVID compared to adults, and I haven’t seen anyone contradicting that narrative with anything other than anecdotes. Yes, children can get very sick and can die, but according to everything I have heard that’s very rare and usually the result of an underlying condition that puts them in the high risk category I’ll discuss below. So currently, I’m not considering children to be at higher risk or needing protection even though they’re unvaccinated. But if I should be, I’d be interested in the argument for that.
High risk people were a thing long before COVID. What I mean is, there have always been people who were immunocompromised for various reasons, and/or old, frail, etc. And until we figure out how to solve those underlying problems (which we definitely should try to do!), there will continue to be such people. For most of the people with a high risk condition, I don’t think COVID is significantly larger or different kind of risk from other communicable pathogens like colds, flu, pneumonia, tuberculosis, hepatitis, etc. If your immune system isn’t working well, you have to worry about everything. Or not, and accept a much higher risk of serious disease or death from such pathogens - which is what I think most of them do, as they have always done.
Of course most of the people at high risk have household members and other people who want to see them. Again, that’s always been true and will continue to be for the foreseeable future.
So the way I’m thinking about high risk people is: Suppose it is the case that we all ought to wear masks indoors in public right now to protect high risk people - either directly or indirectly via their household members and contacts. I don’t see where that ever ends. It implies we should have been wearing masks to protect such people before COVID, we just didn’t think about it correctly. I don’t think COVID is ever going away completely, but even if it did there would still be a plethora of other things we spread that are really unlikely to kill a healthy person but much more deadly to a high risk person. So it implies we should continue to do so indefinitely.
If there is some objectively reasonable stopping condition for mask wearing with regard to protecting high risk people, I’m unaware of it. I’d be interested in hearing what it is.
I am also open to the idea that we should have been wearing masks to protect high risk people all along, and we should continue to do so indefinitely. I don’t know details, but I understand the practice of mask wearing was already kinda common in some parts of Asia long before COVID. I find it facially plausible that masks forever is the right thing to do.
But if masks forever is the right answer, I want to fully understand the reasoning behind that before jumping on board with it. For now I’m deferring to the pre-existing western tradition of not wearing masks to protect high-risk people except in settings (like medical) where such people reasonably need and are expected or known to be, and leaving intra-household and close contact protection a matter for the affected individuals to handle as they see fit.
Then we get to hospital-protective masking considerations:
Big picture, it needs to be said that widespread and ongoing hospital/medical capacity problems are a result of a century of government interference in health care. Not COVID, not Delta, not anti-vaxxers, and not anti-maskers. Initially yes, COVID was new and unexpected and it was reasonable to have some capacity problems in dealing with it. But left alone, people are remarkable at scaling up supply to meet demand. Even if it’s demand for dumb stuff that most people wouldn’t demand if they were smarter. Demand is demand. We’ve had over a year now. The government just doesn’t leave people alone, especially in regard to health care, and deserves way more of the blame than they get for hospital overload when it occurs.
With that said, I do recognize that we are where we are, with the health system we have, and it working as best it can is better than it not working as well because it’s overloaded.
I pay attention to hospital capacity in my area. Until recently, it didn’t seem like the hospitals in my area were overloaded or at much risk for becoming that way since early this spring. I think things have changed recently and now it is a substantial and relevant risk again.
One problem with making a clear assessment is there are multiple possible constraints:
- Beds
- ICU Beds
- Ventilators and other specialized equipment
- Appropriately trained staff for any of the above
- Supplies like oxygen, masks/PPE, or medications
Another problem is the matter of hospital capacity has been super politicized. Most people making comments about it aren’t just trying to give accurate information; they have an agenda they’re pushing. People will most often quote the status of one constraint at one hospital to make whatever case they’re trying to make. Ex:
Right-Winger: There is no hospital overload. We spoke to a nurse at Hospital A and she confirmed their COVID ward is nearly empty (meaning - they have plenty of open beds in the non-ICU COVID area. But you later hear another nurse in that same hospital saying the ICU was 97% full & if 2 people arrived in dire need of ICU at the same time they’d have to airlift one of them to another hospital).
Left-Winger: The situation is dire! Administrators at Hospital B say they have less than 3 days of oxygen left at current production and consumption levels, and are asking people to conserve water so some of the oxygen used in treating water can be diverted to hospitals. (except, you then find out Hospitals A, C, and E have plenty of oxygen and will probably ship some to Hospital B if Hospital B were about to actually run out).
Then there’s stuff like:
I don’t think it’s from my area but something similar plausibly could be. It’s anecdotal and I don’t know the whole situation. Of course it could actually be that the hospital in question is indeed overloaded with COVID patients. But hospitals were making up bullshit reasons to send patients home long before COVID, and this could also just be a convenient bullshit reason. Sometimes they don’t think the patient will understand the actual medical reason. Sometimes they know the patient has no insurance and can’t pay. Sometimes the patient does have insurance and the insurance contract incentivizes minimizing time in hospital. Sometimes the patient (or in this case the patient’s guardian) causes problems when they’re at the hospital. Sometimes there are established policies and protocols with specific criteria that don’t make sense in a particular situation but the staff are told to follow the protocol anyway. Bottom line, I wouldn’t take such stories as strong evidence that the hospital involved is actually overloaded with COVID patients even though it could be.
And lately there’s a big issue in my area about mandating vaccines for hospital staff. Supposedly there’s mostly enough beds, space, and equipment and supplies but not enough staff to actually use a lot of it in the hospitals in my area. And supposedly lots more of the staff they have are out protesting and threatening to walk off the job permanently because now that it’s officially approved by the FDA, the hospitals are mandating the vaccine for all staff unless they have a medical or religious exemption. One source quoted the current vaccination rate among staff at a local hospital as 41%, which just astounds me if true. WTF? Are a bunch of hospital staff really anti-vaxxers, and is walking off the job because staff don’t want to get vaccinated a significant cause of or risk of hospital overload? Or is this really about something else like pay/benefits? Or maybe it’s just a right-wing fever dream based on a few isolated instances? I don’t actually know yet.
So…a few summary points:
- The issue of hospitals being full is complex and politicized. When masking for the purpose of preventing hospital overload there’s a real risk of having our behavior jerked around for political reasons - either way.
- I don’t know/agree that full hospitals is currently a widespread/pervasive condition, but I also don’t know that it’s not. Given the ambiguity I think it’s a risk worth taking seriously.
- Since I wrote my first post about not masking unless requested/required, from the best I can tell conditions in my area have changed substantially with regard to overload risk and hospital-protective masking makes more sense for me to do now.
- Unlike protecting individuals (children, high risk people) I think the hospital capacity concern is mostly area specific - city, region, perhaps state for small states. I still don’t agree with a blanket statement like people should always mask indoors because of hospital capacity issues.
- Whatever the current state of hospital capacity, I expect it to change a lot over time. Both up and down. It wouldn’t surprise me if, for example, Delta subsides over September and with it hospital capacity issues, such that hospital-protective masking stops making sense in my area by October. But then a new variant comes around, or people just start traveling & getting together in November/December such that it’s a reasonable concern again in the winter.