"This is a historic abandonment of the population"

Brief: How New CDC Guideline Changes to Community Transmission Levels are Already Impacting the Medically Vulnerable — 15 March 2022 Update

I was asked to prepare a brief to provide some background on the way that the recent changes to CDC masking guidelines and community transmission levels impacts the social rights of disabled, immunocompromised, and medically vulnerable people. This was not initially intended to be made public, it was intended to help people understand what is happening and how we are leaving immunocompromised and other medically vulnerable people (like me) behind. While this was initially made as background, I’ve decided to make this video public after sharing it in the Death Panel discord server and getting requests from people who wanted to send it to people in their life.

So here is the video of the brief, a transcript (slightly edited for clarity), and a few Death Panel episode recommendations if you’re looking to dive in deeper on this topic. I hope that it might be helpful to explain to some who might not know what medically vulnerable people are facing now with these recent changes.

If this is too long for you to watch, listen or read—here’s the bottom line: There's nothing that we can do or say to truly make the pandemic be over if we're going to continue to undermine the public health response by pretending that cases aren't happening or no longer matter. The medically vulnerable are already paying the price of this non-plan and we need your support.

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Brief: How CDC Guideline Changes Are Already Impacting the Medically Vulnerable — 15 March 2022 Update

Beatrice Adler-Bolton  - 00:02 

Hi, my name is Beatrice Adler-Bolton. I am a Disability Studies scholar. I am also the co-host of the podcast Death Panel with Artie Vierkant and Phil Rocco. And I am the co-author of the forthcoming book "Health Communism" out from Verso [Books] in October of 2022. So, I just have a quick statement that I wanted to read about the way the new CDC masking guidance is already making things more dangerous in the United States for the medically vulnerable.

Beatrice Adler-Bolton  - 00:28 

And just to quickly break down the new CDC risk level guidance functionally, the new changes do three really important things. First, it eases rules for masking indoors, allowing most people to go unmasked even when their counties would have been high under the old system. It de-emphasizes case counts, secondly, making the one comprehensive advanced indicator that we have of a new wave in the United States, less important to calculating risk going forward. And third, it marks a shift to a strategy where states will now be allowed to sustain elevated case levels indefinitely without putting masking recommendations back into place.

Beatrice Adler-Bolton  - 01:08 

So, to give an example of how this would work. Previously, under the old system, a seven-day average test positivity rate of 100 cases per 100,000 people would have qualified a county to be considered high risk. Now, with the new metric, counties with up to 200 cases per 100,000 people are still considered in the low category, unless their hospital capacity is being overwhelmed. So, the new CDC guidance allows 20 times the previous low threshold which was 10 cases per 100,000 people. It allows double the old high threshold. And in terms of when the masking recommendations would actually come into place, it's not until you hit the high level of risk under the new system—where cases are above 200 cases per 100,000 people and hospital capacity is over 15%. And so now with the new metric counties with up to 200 cases per 100,000 People are still considered in the low category. And in terms of what that means for scale. It's that at a national scale, right? If every, let's say every single county all 3000 or so counties in the United States, were butting right up against that 200 cases per 100,000 [people] metric. That would mean that we'd be having up to 95,000 new positive cases a day and the CDC would still not be recommending masking for the majority of the American public. Under the old system, only 47 of over 3000 US counties were rated low risk. Under the new system, that figure immediately jumped to 742. For counties that are rated high, the number was reduced from 2,648 under the previous system to just over 1000 under the new system.

Beatrice Adler-Bolton  - 03:03 

So, it's important to note here that, and many people have covered this in-depth, the CDC has abandoned masking not because of data or science that suddenly says "this is safe now" they've rolled back masking because of political and social pressure. And now these changes to CDC guidance have already made public life more dangerous for immunocompromised, disabled and medically vulnerable people, particularly vulnerable workers, as well as for parents and household members of children who are still too young to be vaccinated. And again, it's not until April at earliest that we should be hearing any answer either way from the FDA about vaccines for the under-five set.

Beatrice Adler-Bolton  - 03:42 

So, while fortunately, at the moment cases are trending downward in the United States. That's only one sign and there are a lot of other signs that point strongly to the possibility of a new incoming wave. For one while wastewater surveillance of COVID in the US is still relatively sparse, 62 sites have seen a greater than 1,000% increase in viral RNA detected over the last reported 15-day period, which is about 15% of the sites that are reporting. So that in the context of the fact that the next wave is already beginning in Europe with cases trending back up in Austria, the Netherlands, Switzerland, Germany, Greece, Finland, Portugal, France, the United Kingdom, Ireland, Italy, and Belgium. This is really starting to look like it's a—not only probability—but something that could be coming even sooner than we had hoped.

Beatrice Adler-Bolton  - 4:35 

And "BA.2" is not a new variant. It is an evolutionary branch of Omicron, which many have said was "mild", but Omicron was not mild. Omicron took over 150,000 American lives in a manner of weeks, and hundreds of those were children. I don't think that we should be waiting to see what BA.2 does, before we act. The problem is the new CDC guidance advises people that it's okay to go out and get infected, as long as you're not immunocompromised, and immunocompromised people are the only people who should be masking. And this, of course ignores all the risks of long COVID. It ignores the fact that it is immiserating to force sickness on the population, whether they're going to have severe outcomes or not, in this kind of concentrated way, where you're not expecting people to be even able to take time off of work. We're expecting a lot of people to be okay with being infected, to be okay with going to work sick because they don't have sick pay.

Beatrice Adler-Bolton  - 5:37 

Ultimately, as the Biden White House even said earlier today, this is also within the context of the impending COVID funding crisis in Congress. This is really only going to accelerate and get worse going forward. So, right now, the moment that we're in, with cases trending downward in the United States, this is the perfect time to beef up things like wastewater surveillance to increase, ventilation in classrooms, to make sure that people have access to therapeutics, to testing, to masks. And that's just not what's happening right now.

Beatrice Adler-Bolton  - 6:17 

Instead, funding for existing COVID programs is going to be cut in coming weeks. As per reporting that was released today: today is March 15, 2022. The White House is warning that it's going to have to end a program that pays to test, treat, and vaccinate uninsured people for COVID-19 because the administration is run out of money for the program. Another immediate impact will be to the therapeutics that people were promised would be made available to help keep the vulnerable safe if we were going to roll back masking. The White House has said that it will have to end federal funding for monoclonal antibodies which were previously provided free of charge. They have also said that there will be rationing in the coming weeks. The White House has said that they need to scale back planned purchases of preventative treatments like Paxlovid, for immunocompromised people. They also say that research into next generation COVID vaccines will be curbed and that some surveillance for new variants will also be stopped.

Beatrice Adler-Bolton  - 6:48 

And this is in my opinion, as a disability studies scholar, an unprecedented retraction of social rights for the vulnerable who are guaranteed access to society as both consumers and workers, technically, by the Americans with Disabilities Act and the White House is more focused on the midterms than in rectifying the ways that its CDC guidance abandons a huge portion of the population.

Beatrice Adler-Bolton  - 7:36 

So, it's important to understand that while many people tend to invoke a very narrow and restrictive definition of who qualifies as immunocompromised, often citing a figure that's like 2.5% of the population, or 7 million, 8 million people, the true number is much larger. And this is what I study. And it's kind of confusing, because if you study disability policy, then, in America, you start to learn that the US government does not use one consistent definition of disability. You can really pick and choose a very narrow or very broad definition of who is vulnerable right now, according to your use and purposes. The figure that I prefer to use, the analysis that I find closest to the population that, in my opinion, I think is probably being put at severe risk here. I think Dr. Amanda Stevenson's analysis using 2020 National Health Interview Survey data is pretty close, the figure that she came up with is that it's likely closer to 38 million people who are immunocompromised and more vulnerable in terms of not producing the same vaccine response. And that's about 11% of the population. And, and that's again, in a narrow definition of who is vulnerable right now, that does not include all of the children under five, all of the people who have long COVID, who are not being counted in official disability statistics who are now made vulnerable by their prior infections. It's not counting anyone who has a pre-existing condition that they may not be aware of, because of the way that medical care has been disrupted throughout the pandemic.

Beatrice Adler-Bolton  - 9:10 

So, the fact of the matter is, is that while functionally masking is really not that big of a deal, what we're seeing right now is an effort to de-normalize masking in the United States. And, while it may be absolutely normal in many countries, particularly in Asia, to be masking, not all the time, but when infections of respiratory diseases are high, instead of working towards normalizing that kind of practice in the United States. We're actively working to try and un-normalize it and what we need to be doing right now if we want the vulnerable to survive this transition to "living with" COVID. Then we need to normalize masking because the more infections that are happening at a community level, the more vulnerable people are going to be put at risk because the only way to keep people safe ultimately, is to keep infections down.

Beatrice Adler-Bolton  - 10:07 

This new CDC strategy instead of being oriented towards trying to keep infections down in the community, it's oriented towards trying to avoid severe outcomes. But the metrics that we're using are lagging indicators like hospitalization. So, it's going to mean that there will already be high levels of community spread, before any of these protections even theoretically start to kick in or be noticeable at the statistical scale within this new system. And the fact is that the scientific evidence remains the same. COVID has killed officially 1 million people in the United States, probably more. It has hospitalized 4.5 million people. It has caused long COVID in an unknown number of people. It has orphaned hundreds of thousands of children and caused widespread disruption to our healthcare system and to society. And the fact is, the removal of mass mandates not only denies social rights and membership in society, to the disabled, to the immune compromised to the medically vulnerable. The bottom line is that the removal of mask mandates will only fuel or accelerate more variants.

Beatrice Adler-Bolton  - 11:20 

This is a historic abandonment of the population, the undoing of masking, these attempts to un-normalize masking, they will prolong the pandemic, and it will put the most vulnerable at greater risk in the process. It's the opposite of "focused protection: it's the opposite of a "targeted" plan. It's like trying to protect your house from burning by pouring accelerant on a fire. And the fact of the matter is, is that these are people's lives, that this is people's health, and that their future ability to you know, remain "productive" members of the population is going to rely on their ability to protect themselves from COVID. And the United States Government, at this moment in time, is deciding that they would prefer to pursue the strategy of personal responsibility into the midterms, rather than protect the population from a novel respiratory pandemic.

Beatrice Adler-Bolton  - 12:11 

And again, my opinion, from studying the history of disability in the United States is that this is an absolutely unprecedented retraction of social rights for the vulnerable. And again, this—it's important to remember that we live in a country that for many hundreds of years preferred to institutionalize disabled people rather than allow them to live in society. And ultimately, the devaluation of social rights for the disabled, which again, are guaranteed—codified into law, not just by the Americans with Disabilities Act but by, by earlier legislation, like section 504 of the Rehabilitation Act. This is not even a new phenomenon. This has been put into the legal architecture of the United States gradually since the 1960s. And yet, even so, our CDC recommendations in 2022 do not reflect the reality in which it seems that the ADA is considered to be valid.

Beatrice Adler-Bolton  - 13:06 

Fundamentally what we're seeing right now, again, unthinkable, absolutely unprecedented retraction of social rights, abandonment of the population. And as we continue to see cases, circulate throughout the community, the vulnerable will continue to be at risk. There's nothing that we can do or say, to make the pandemic be over if we're going to just pretend the cases aren't happening and our current strategy seems to prefer that as the best option for going forward and seems to buy into the "reality" that this is the only way it was ever going to be.

[Image description: "Gauze bandage is protection against flu!" Soviet public health poster, 1960s, colors edited/changed. A person in a mask is being hit in the mask by a blue and yellow arrow.]

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Thanks as always for listening, watching and reading. Want to learn more and hear some exhaustingly detailed coverage of the full risk levels and new COVID guidelines? We’ve also discussed this issue at length on recent episodes of Death Panel, and will be covering it again on our main feed episode which will be released later this week!

Here are the episodes that I would recommend checking out to learn more about these recent CDC changes: