With daily numbers of new COVID-19 continuing to rise since the re-introduction of Los Angeles County’s mask mandate, frustration also continues to grow among the public and within the medical community alike. The mandate, which requires all individuals to wear masks at all times while indoors, regardless of vaccination status, has drawn fierce opposition from all corners of the vaccination debate.
“Masks, when worn correctly are proven to work. But vaccines by far, remain the most powerful tool in the public health arsenal to control this pandemic,” says emergency physician Dr Michael Daignault. He references that as of last week, all of the patients admitted to LA County-run hospitals for coronavirus-related illness were unvaccinated. It’s a comparison that is further validated by the national trend, that 99.9% of COVID-related deaths have been in the unvaccinated. Dr. Daignault has been particularly disheartened by the steadily increasing number of young unvaccinated adults seeking medical care in the ER. "They’'re naturally frightened and also filled with remorse that they didn’t get vaccinated in the last two months that they’ve been eligible,” he says.
The current surge in Delta variant-driven cases exposes the failure of what was essentially an "honor system" of conduct - a system that that relies on unvaccinated citizens to wear masks in indoor public settings like grocery stores, movie theaters, and gyms, with minimal reminders from small business and without any enforcement from public health authorities or law enforcement.
“We shouldn’t be surprised by this,” says Daignault. “To expect people who have not wanted to wear masks from the beginning of the pandemic to suddenly change their behavior during a complete lifting of restrictions and absence of enforcement by small businesses would be utterly naive.”
The failure of this honor system and the resulting intermingling of large numbers of unvaccinated people contributed to a rapid rise in new cases in LA and the subsequent revived mask mandate, which Daignault calls necessary to control further exponential spread of the virus, which then could lead to a surge in patients visiting the ER. Earlier this Spring, experts in infectious disease and health policy proposed a threshold of 5 hospitalized covid patients per 100,000 for when to either loosen or enact restrictions such as mask mandates. As of Wednesday, LA County exceeded that threshold with 585 hospitalized patients.
But for Dr. Daignault, there is a potential opportunity with this surge, looking to the future when cases eventually are on the decline. “We could end up right back here again,” he says. With the mask mandate in place, he recommends that small businesses be encouraged by city government and the LA Department of Public Health to set up vaccine verification systems. “If a business like a gym or movie theatre can demonstrate such a system, then vaccinated patrons would be allowed to go maskless. This would incentivize people to get vaccinated. Young adults, who have the lowest vaccination rate, were skeptical of city and state-wide raffles and lottery systems aimed to spur vaccination.” Daignault believes they’d be more interested in getting vaccinated if they could go maskless at their gym, the movie theatre, or favorite bar or restaurant.
Doubt in vaccines has been a difficult obstacle for medical professionals to battle. Dr. Daignault argues that a mask mandate for all, while necessary during a surge, could potentially sow doubt in vaccines, at a time when it’s most critical for their widespread uptake. “In times like this, people will respond better to a positive catharsis – seeing vaccination as a way to resume the activities they love in their lives,” he says. He points to the example of France, where over 1 million people signed up for vaccinations the next day after President Macron announced that proof of vaccination would be required for all citizens to visit their beloved cafes.
Daignault admits that there’s still a lot of uncertainty over how this will all play out here in Los Angeles. “Worst case scenario is that given how easily transmissible the Delta variant is, it will rapidly burn through the unvaccinated, or incompletely vaccinated, and those who are not fully protected from natural immunity from their previous infections,” he says. This in turn would result in a surge in hospitalizations, but he’s quick to point out that it’s not because the Delta variant causes more serious illness, but because the sheer number of rapid new infections will produce a corresponding higher number of those individuals needing hospitalizations.
“The best case scenario is that the 1 million incompletely vaccinated will complete the process soon for a total of 6 million completely vaccinated. That would give us 8-9 million with either natural immunity or vaccination-immunity, assuming also a large percentage of the population who had coronavirus also already were vaccinated.” Those figures still leave 1-2 million individuals exposed to the coronavirus variant, including those under 12 years of age who are not yet even eligible. “The silver lining of this surge is that it will convince some of the hesitant to get their dose,” he hopes. “Treating sick COVID patients is easy. We’ve got the protocol down: high-flow oxygen, steroids, blood thinner. But it’s so disheartening since all this suffering could’ve been easily prevented by a free vaccine at your neighborhood pharmacy.”
You can follow Dr Michael Daignault on Instagram @dr.daignault.
Reuben Mourad is an internationally published lifestyle journalist and television host. You can follow him on Instagram @reubenmourad.