Emergency ending

1. Many thanks Will – very helpful as always.

2. Very helpful information. Thank you!

3. Thank you again for the information that you provide. I always appreciate it, and especially this past year.

   Question, does this bullet point mean it’s permanent until June 15, or will be permanent?:
   “We need to make permanent some of the changes that have facilitated continued functioning of businesses and institutions through the emergency — for example, virtual participation in public meetings, virtual notarization of documents, virtual town meetings. The Governor left the emergency formally in place until June 15 to allow these rule changes.”

   1. There are a lot of rules that are written to be effective until the emergency ended, for example, allowing public meetings to happen via zoom. Many of those rules need to be made permanent.

4. I’m sorry, but this is moving faster than I think is smart, because there are too many selfish people out there. Advising (but not requiring) unvaccinated people to continue to wear masks is laughable. How many unvaccinated people are going to voluntarily wear masks? Zero. That’s why I’m going to continue to wear a mask at the grocery store even though I’m fully vaccinated and it’s no longer required.

   1. Even though I am fully vaccinated, I am in the self preservation mode and will remain masked for the foreseeable political future, I do not implicitly trust the word of politicians and always take a wait and see attitude to verify with time their words. They only care about not immediately filling up ICU wards and crashing the healthcare system, Not me as an individual. Jan 6 2021 validated this. Hopefully they will start filling up jails with insurrectionists.

      1. You should let go of the hate. It’s not healthy. You should love all of God’s creations….vaxxed and unvaxxed.

         1. amen

            1. I heard no hate. I heard an informed lack of trust, based on the known behavior of other people, and a love for those who still need care and protection. I heard a resolve to do what is in the original commenter’s own power to reduce the risks that still exist to individuals even now when the daily case numbers in Massachusetts are no longer in the thousands, but “only” in the hundreds. It’s amazingly great that hospitals are unlikely to be overwhelmed by COVID (barring new variants). And that does not remove the life-threatening or just life-changing risk (think Long COVID) for those who are not protected by the vaccine. That includes people whose compromised immune systems may not mount the usual robust vaccine response, as well as those still too young to be vaccinated, or unable to for health reasons.

   2. Completely agree, Paul. It’s been proven at this point that wearing masks and social distancing limits the spread of COVID (not to mention regular colds and flu). Of course we all want to get back to “normal” but rushing into it will only prolong the pandemic—and it’s not over yet! Vaccines are clearly helping limit the spread but this data is not showing the fact that affluent communities have higher rates of vaccination than others, including those who were more hard-hit by the pandemic to begin with. The CDC guidelines are endangering those who have not been able to get vaccinated yet (including young children!), those who have limited immunity despite being vaccinated (such as immunosuppressed populations), and those who cannot get vaccinated for medical reasons. We are throwing vulnerable communities under the bus for convenience.

   3. I agree. I’m also fully vaccinated, and will continue to wear a mask when shopping. I certainly won’t go to any venues, so grocery shopping is just about the only place I’ll be where they’ll be others around. Opening up this soon is a business/profit based decision. I’m saddened that I’m not surprised at this decision, though.

5. My concern is that COVID will circulate through the general (adult) population now largely undetected and will then wind up spreading through childcare and schools for unvaccinated younger kids. While most kids recover without complication, MISC is a real concern for some and can have severe effects.

6. Great summary. Thank you.

   1. I agree — very nice and succinct. Thank you.

7. Thank you Will. Very helpful

8. Thanks for taking the time to share this information with us Senator Brownsberger. In turn, I will share it with my friends, relatives & others who live in Massachusetts & beyond. I was shocked to learn how high the percentages of vaccinated persons in Mass are, 94% of persons over 65 vaccinated & 71% of those between 28 & 64 yrs of age……..someone deserves a lot of credit for those high numbers. I wld say our Governor should take a bow. I wonder how much our stats compare to those of bordering states.

9. Are masks required outside today in Boston if fully vaccinated?
   Still feel confused…

   1. Today they are not required outside for anyone as long as you can maintain social distancing.

10. Dear Senator Brownsberger,

    The Governor once forcefully- angrily replied to a question at one of his regular updates that personal behavior was responsible for the spread of Covid and and resultant morbidity and mortality and it was not attributable to the structure of his restrictions phasing. Was that the Governor’s assertion? Is it scientifically valid or not to say that essential workers died and suffered to spare and give relief to businesses? Is it a tacit privilege of his emergency powers for the body politic and media not to question this, or is my premise incorrect? Why did the state choose to use the decline in cases and not absolute numbers if lives when reopening? Is the recent, months long plateau following the large peak that began in fall/ winter 2020 a result of less aggressive social-distancing phases, and what would the cost have been to get that plateau down to the very low spring/summer plateau? What did that recent extended elevated plateau spare us from economically and socially? What does it say about learned helplessness? With the current data, can we derive what essential workers’ are worth to us? Thank you.

    1. HI Fred,
       You may prove right that the opening is premature. My own take is that it probably makes sense, but none of us know for sure. Only time will tell. Happy to discuss the nuances of your questions if you’d like to call.

11. Hi Senator Brownsberger,

    Thank you for this helpful summary. Is there any guidance for indoor spaces where kids congregate outside of school–eg libraries? Kids and teens are not vaccinated yet. Kids should be able to safely visit a library, museum, etc. The new mask rules make it very difficult on these institutions and on the families who frequent them. Yes, libraries and museums can opt to maintain stricter masking policies, but that leaves their employees to enforce masking rules for patrons who have abandoned masks per the new state guidelines. The relaxing of indoor masking requirements came too fast and put families and the institutions and businesses that serve children and teens in a very difficult position.

    Leanne Hammonds. Library Trustee in Watertown

    1. Thank you, Leanne.
       This point is well taken. Some institutions may draw some pushback. But I do think that the children’s libraries will have the credibility to maintain stricter policies in line with schools.

12. Mutations are coming with uncertain consequences. Relaxing too soon I think. Being heedful might be a good strategy until the situation clarifies.

13. Thanks for this summary, Will. As a fully vaccinated 70-year old who has dutifully followed all the guidance and restrictions, I am joyfully putting my mask in my pocket and enjoying the sight of smiling faces. I’m not going to worry about unvaccinated people who decide they won’t wear masks. They will primarily hurt themselves when they contract the disease. Unfortunately, immuno-compromised people and children under 12 will still have to wear masks. I’m puzzled by the requirements for masking on subways and planes. Also, why do vaccinated teachers need to wear masks?

    1. It isn’t possible to guarantee social distancing on public transit or in airplanes, and they don’t have the same ventilation as many other indoor spaces.

       Vaccinated teachers need to wear masks because schools are largely unvaccinated populations, because kids over 12 are just recently eligible and kids under 12 aren’t eligible yet. Masks reduce transmission risk and the risks are higher in largely unvaccinated groups. Basically, the situation hasn’t changed for schools yet.

14. Thank you for the clarity.
    I’m curious if our medical community has been asked for their input by the state and city before local guidelines change. I’m also interested in the guidelines when large groups of unvacinated and under-vaccinated student invade once again in September many from areas where COVID is still winning. No, it’s not over.

    1. Yes. The Governor’s process for rule changes includes considerable consultation with a medical advisory panel.

15. I think it is important for people – especially seniors, and those with compromised immune systems, like me, to understand that you can still catch Covid-19 after you have been fully vaccinated.

    I know someone who does contact tracing for the state, and has recorded this enough to warn me. Someone else has spoken of a nurse who got vaccinated early on – she caught it from her kids.

    Yes, the outcome is usually less severe – but do I want to risk this? No. I’ll continue being the odd duck with my mask.

16. Belmont schools have discontinued pooled Covid testing citing low participation. Shouldn’t they have done outreach first? Even with low participation shouldn’t they have encompassed a few more incubation periods post full opening? Would that data have been useful especially in modeling and detecting variants for now and in the fall?

17. Hi Will:
    Thanks for sending this … it’s helpful follow-up information.
    It’s good to see that so many of us got our vaccine shots.

18. Years ago I studied British medical textbooks about the exotic maladies of India and Africa. Fascinating. When the pandemic arrived my inclination was to follow Dr. Fauci (and the CDC). Their advice was in line with the contents of those text books. Now my sense is we are reopening too soon. This virus is so debilitating and deadly that every effort should be made to eradicate it ASAP. We should reopen very carefully. Wealthy countries must help the poorer countries.

19. I’ve been told but can’t independently confirm that one reason for the difficulty in finding lift/Uber rides has been the emergency Covid order understandably preventing price gouging had the impact of preventing surge pricing as well, thus decreasing supply of drivers. Has that order been lifted?

    1. There is legislation to lift that order, but I believe it will lift by itself at the end of the emergency.

20. Would have waited longer, maybe mid-June, to do this. As long as it’s raging in other countries, we should make effort to help them. Many in this country are not vaccinated. It’s going to be around.

21. I was a germ avoider before this pandemic. I will continue being a germ avoider.
    Regardless of what the government tells you the road ahead will never be germ free. Now the world is more at risk of a biological attack we have educated our enemies how to kill our economy.
    The question is will we learn from this and be prepared for the next pandemic or will we return to complacency.

22. Are there any observations to share about masking and distancing in places like movie theaters or music concerts? Or church services? Or situations in which people will be singing? (I know people have been working on this, but I’m a little worried about the CDC statement completely lifting all restrictions there for those who have been immunized as well.)

    I will also observe that masks and social distancing did not just work (partially) to control the spread of CoViD-19. It transformed influenza from an annual scourge and cause of thousands of deaths into a non-event this year, and it helps to prevent the spread of other illnesses. There are some practices that still make sense, even if the pandemic is under control (and it would also help to limit the spread of the next pandemic, when, not if, it happens).

    1. Indeed. We could do much more to control influenza and we have all learned a lot about that. I think many people will continue to take precautions.

23. How is the state of emergency ending going to affect people who are risk of eviction?There is still ongoing months-long waits for rental assistance.
    How is this going to affect telehealth appointments?How is this going to affect behavioral health coverage & co-pay waivers?
    This removal of mask mandate feels incredibly premature.  It, along with the recent CDC decision, feels like it was mostly informed due to pressure from certain media outlets about masking status combined with general covid precaution fatigue and vocal people who want to “get back to the way things were” — often from folks who were blessed enough to have already received and completed a vaccine series and who are overly anxious to “move on.”
    Regardless of what % scientists postulate herd immunity may be able to be present at based on vaccine penetrance, it is universally accepted that herd immunity, is impossible to achieve, without vaccination of the ENTIRE population, which includes all minors under age 18.  Currently, only 1 vaccine, the Pfizer one, is approved for older youth.  Roughly 20% of the general population falls into the under 18 category.
    Reopening before all children are eligible and fully vaccinated is short sighted.

    1. The vaccines, on their best use case day, are only 95% effective.  Meaning, if you went to a mass vaccination site and were one of 100 people there who got vaccinated, of that 100, 5 of those 100 people who got vaccinated wouldn’t have received an effective vaccine, because their natural body chemistry makeup is not effected (or to an enough of a degree) for the vaccines to trigger enough of a antibody response.  That’s potentially 5 out of every 100 vaccinated people, who upon hearing this new relaxing mask requirement, decide to go maskless, who will then be surprised that they’ve contracted covid in the course of their normal daily activity that puts them in co-mingled environments with others, DESPITE their being fully vaccinated, including people who have died from covid.
       Why isn’t there a fast, rapid, fingerstick screening that can check all people who are receiving, or who received vaccination, to see whether or not the vaccine will even work for them?  To identify those 5 out of every 100 people, from the outset, so that we’re not wasting precious vaccine resource on people who we know from antibody testing it won’t work for (if only we actually tested them), and redistributing that scarce resource to those it will work for and try to achieve herd immunity, sooner?  To inform those 5 people about their status, so that they can take appropriate precautions for their lives, in spite of this mask-wearing rollback mandate?  Don’t people deserve to make the choices for their lives and know their appropriate risk level instead of playing roulette & hoping you’re not one of the 5, even though we already know, for 5 of those people, the vaccine will not work?  This is the fine print that should be more widely known.  It’s the same thing as oral contraceptives where if the woman taking them has a higher BMI, it is already known that the oral contraceptives at the standard dose will not work.  It feels like a wish and a prayer and a whole lot of hope or musical chairs where people just hope they’re not the one without a chair when the music stops, even though it’s already known there aren’t enough chairs.
       Who exactly is protecting the often low-income workers who are in customer service, face-to-face roles, where they’re interacting with the general public as part of their jobs?  The grocery store restocking & checkout employees, the barista, the department store worker, the retail sales associate, the bus driver?  Specifically, for stores where masking is optional, or where the guidance regarding store policy is unclear or ambivalent?  Where is OSHA?  Specifically, who is going to provide for the security of those employees who then have to deal with an unruly customer who is unwilling to comply?  There are numerous cases, even when the mask mandate was “mandatory” where unsafe confrontations popped up.  Now, for those same vulnerable employees, how much harder have you unnecessarily made their essential worker jobs?  I’ve ridden public transportation busses during this pandemic, when there was a mask requirement, with people who weren’t wearing masks, who were visibly coughing, where the driver did nothing (likely to not wanting to deal with a potential confrontation) and where I, along with many other bus riders, kept nervously eyeing one another and trying to distance ourselves from someone who was maskless and very visibly and audibly sick.  And that was WITH a mandatory mask requirement.

       1. The covid pandemic is a PUBLIC HEALTH crisis.  Yes, there is also a resulting MEDICAL crisis, but at the root, it is a PUBLIC HEALTH crisis.  There would not be a MEDCIAL crisis if the PUBLIC HEALTH crisis didn’t exist in the first place.And yet, the people who are predominantly the vocal faces of leadership on a national scale throughout this pandemic, are MD MEDICAL practitioners, who while they may have a public health leaning, that is not their primary focus, nor their formal academic or professional training.The general public does not understand this difference, and more needs to be done to raise awareness on this difference.
          PUBLIC HEALTH is UPSTREAM and PREVENTION-focused.  It tries to anticipate and mitigate problems BEFORE they snowball, while interventions are LESS EXPENSIVE.  A big part of why it is so effective and has such a high ROI is because the interventions are POPULATION-focused.  The burden of lift is dispersed among the greater population with the public health entity and government directing efforts.
          MEDICAL care is DOWNSTREAM and AFTER-THE-FACT TREATMENT (NOT necessarily Cure)-focused.  It tries to deal with problems AFTER they’re already established, after they’re already difficult and increasingly complicated, and interventions are MORE EXPENSIVE.  It has a low ROI because the interventions are personalized and INDIVIDUAL-focused.  The burden of lift and cost is highly concentrated primarily and solely on the individual, which sometimes, can be crushing.  (Most bankruptcies are not due to personal irresponsibility, but due to medical, healthcare-related debt).

          It’s the same reason while health insurance companies under an HMO (Health Maintenance Organization) model and the ACOs (Accountable Care Organizations) they partner with so heavily weight and push their patients to seek out PRIMARY CARE which is WAY LESS EXPENSIVE than having patients wait until a problem gets bad and they have no choice but to go seek out care in an emergent setting immediately, which is orders of magnitude WAY MORE EXPENSIVE.

          Why are the visible and vocal leaders in this pandemic coming from the MEDICAL field, and not the PUBLIC HEALTH field?
          I recognize and acknowledge that the average general member of the population has likely met and personally encountered in real-life an MD doctor at some point in their lives.  An MD is recognizable to the general person.
          A public health practitioner is more behind-the-scenes and more rare.  The average general member of the population has never likely met in-person a public health practitioner in real life.
          For the sake of quick messaging, yes, maybe you can gain a lot of ground and traction by putting a reputable MD as the predominant vocal and visible correspondence to deliver messaging to the public initially, to help garner trust.
          However, it does a public disservice not to acknowledge and visibly have actual public health leaders who can routinely deliver this messaging in a trusted manner.
          The botched messaging (see the complicated and confusing first public draft of the red/yellow/green dual sided chart that was difficult for the average person to understand and make sense) so quickly erodes hard-fought and hard-won public trust and confidence and makes it SO MUCH HARDER for the broader population to want to enact desired behavior change, especially when that behavior change becomes critical, as it has in this pandemic.
          Behavior change is difficult, especially on such a large massive scale.Messaging matters.Reliability matters.Clarity to the average person matters.Consistency matters.Accuracy matters.
          If you had to stop random people on the street and ask them what they can and can’t do with regard to covid precautions and restrictions, when and where in a variety of settings, how likely is it that you think the random people that you stop on the street are all going to be able to give you correct (at the moment) answers?  Even just one of them?How much confusion has this mixed messaging caused?How much MORE confusion will this be trying to actually get people on the same page and go back and fix it?
          Public health people can and should be designing these intervention campaigns.  This is their job.Medical practitioners should not be doing this.  It’s not their primary function of their jobs.  Their primary function and attention is treating individual patients in clinical settings and recommending individual-based interventions based on person-specific risk.  In general, they are not versed in running broad-based, population-focused behavioral interventions; that is not what they are so very well paid for (aside from residents and fellows).Trying to get someone to wear a mask?  That’s a behavior.Trying to get people to socially-distance?  That’s a behavior.Trying to get people to understand their disease transmission risk?  That’s a behavior.Public health, at it’s core, is behavior change focused, on a population-based scale.Medical care, is not.

          1. The general public is not super aware front-of-mind of the difference between a treatment and a cure.A cure means something completely goes away.  An example would be a bacterial infection.  You give someone an antibiotic & they take it the prescribed amount of time?  They’re cured.  If you run a test, they no longer test positive for a bacterial infection.  They do not have symptoms that linger.  They can go on, living their life, and won’t need an antibiotic again unless they contract a bacterial infection again.
             A treatment means some intervention to help alleviate, but not completely remove, a condition.  Treatment is what you resort to when you don’t have a cure.  It’s second tier settling while you wait for the science and economics to catch-up and hopefully find an effective cure.  You could be waiting decades or more for a cure, if ever, in your lifetime or generations to come.  An example would be a viral infection.  Yes, you could try to give someone an antiviral cocktail, but they will never be fully cured.  An example for this is HIV.  Or a terminal cancer.  Or Congestive Heart Failure (CHF).  Or covid.  As of this moment, there is no cure for covid.  Celebrating and publicizing you have treatment is great and congratulatory.  But it’s not a cure.  Yes, you could use it as publicity to champion policy, but wouldn’t most people, especially those dying from it, rather have not had it in the first place, even if there were some “treatments?”  
             How is justifying you have ICU space and some potential treatments with inconsistent health outcomes across various population subsets a sound basis for population-wide policy?  
             It’s like saying CPR is great (and it is), and yet it’s an invasive, painful for the patient, and expensive medical intervention procedure, with not great outcomes.  The 30-day hospital readmission rate for those who have been saved via CPR and aren’t back in a critical care setting within a month isn’t great.  The odds aren’t in their favor.  Can you imagine publicizing how great CPR is and how it helps to potentially save a life in a critical moment (which it technically does), and yet ignore the fact that of those saved, there are many who are back in the same exact position within a relatively short time (a month or less) &/or who have lingering complications?  Seldom or few are back to the “way they were” prior to needing CPR.  You are just shifting and extending out not great complicated conditions.  
             Another example would be looking at pacemakers.  Yes, they help in a critical moment of arrhythmia, but depending on how you age, you may need them replaced, and specifically towards end of life, you have to have discussions and actual active decisions made with your care provider about how much longer you want the pacemaker to continue working so that it’s not constantly trying to shock you back into sinus when your other health comorbidities are accelerating and not great.  There is very little discussion about that, likely because 1) it’s not front of mind and 2) as a culture, we don’t like to think ahead to those outcomes.  A natural death isn’t necessarily a readily available outcome when you have an invasive medical intervention such as a pacemaker.

             It’s the same concept when you consider terminal cancers and whether or not medical intervention “makes sense” and to what extent, especially when treatment can so vastly impact quality of life.
             Not everyone will need CPR.  Not everyone will need a pacemaker.  Not everyone will develop a terminal cancer.  Not everyone will get covid.  But of those that do, they deserve to have these considerations front of mind when decisions are being made about their lives, especially if they aren’t in a decision-making alert capacity.  Citing the existence of ICU space isn’t a good argument or rationale for re-opening things.  Yes, it’s immensely and phenomenally better than not having ICU space and a medical infrastructure system on the verge of collapse, but you don’t want people to have to seek out and obtain critical treatment from the ICU, in general.  There is still a nursing shortage, amplified even more so, due to covid.  The nurse-to-patient ratio is critical in an ICU setting.  The number of patients who make it out of the ICU alive and get discharged isn’t great.  There are those who do, but of those who do, they often have lingering complications.  Just because you have some residual last-ditch effort hope capacity in ICU space and potential treatments doesn’t mean that we should be enabling people to become more likely to have to need the ICU, in the first place, which is what happens with relaxed covid precautions on a population, broad-scale basis.

             1. Why aren’t antibody cocktails a routine part of covid treatments, and not just reserved for the elite and well-connected?  Why aren’t these infusions more readily accessible and available, especially when as of right now, they’re one of the best treatment options, but only if you start them soon enough, and don’t have complicated pre-existing conditions (and almost everyone has at least 1 pre-existing condition)?

                NONE of the rushed Emergency Use Authorization (EUA) vaccine studies included sample populations with those who are immunocompromised.  Post-market research that has popped up through various studies, primarily through academic research institutions, has shown a significant lack of antibody generation in these populations, especially those taking steroids & other immune suppressing medications.  And yet, this information is not widely publicized and known among the general population..

                A mask is like a condom in that it tries to keep your germs to yourself in an effort to protect others.  There is social trust and exchange that needs to be present.What liability would there be for 2 partners to engage in a consensual unprotected sexual relationship with a partner who happens to be HIV+, where no informed consent disclosure was present beforehand, and only made aware, after-the-fact?  Is it ethical?  Especially for something that’s earth-shattering and life-altering as changing HIV status, specifically from negative to a positive?Yes, there are increased prevalence and better TREATMENTS available to help with quality and length of life.But as of right now, there still is no cure.
                Covid is the same.Yes, a lot of people will contract it & have contracted it.Yes, a lot of people recover.Yes, there are potential treatments, if you have $ and access to them.However, not everyone recovers.  See the 160k+ covid long haulers, that are known and aggregated.There are still people who die from covid.Do you think those people, on their deathbed, would’ve just wished people would’ve disclosed their covid status to them so that they could’ve taken appropriate and informed precautions?Where are the bioethicists in this covid conversation?  

                1. Boston is a global city.It houses a university that has the most diverse number of international students, in the US.Covid came to Boston and surged after a pharmaceutical conference where infected carriers had traveled from Western Europe.Look at the crisis that’s happening in India.  All the people who are suffering and needlessly dying and who are desperate for treatment.  The oxygen shortage there is appalling.  People who are literally fighting for their life to breathe.The majority of covid vaccines are manufactured there, and yet only 2% of people there have been able to get vaccines.How many people are here on an H1B or F1 visa and would like to go home and visit their loved ones and family members who are abroad?Unless you are shutting down all airports and banning all travel to & from abroad, what makes you think that covid variants won’t arrive here, even if you, yourself, and the people you personally know, don’t travel?Boston is not a middle-of-nowhere, remote, isolated geographic rural location.The pandemic became a pandemic, instead of an isolated epidemic, because of globalization and global travel.How did the virus travel?  Predominantly via human carriers traveling internationally on planes.The covid variants are often deriving from people hosts who were immunocompromised and were unable to be treated effectively with current market-based medical interventions.It took seemingly forever for the CDC to disclose that the NY variant came from an advanced HIV+/AIDS patient who was patient zero.It is likely that immunocompromised patient is not alone in facilitating covid variant development.And yet, the immunocompromised are left out of mainstream conversation, discussion, and wide-reaching, broad-based policy-making decisions, despite having higher-than-average odds of not just covid outcome difficulties, but also facilitation of incubation and development of covid variants that they, themselves, will likely succumb to, but not before spreading to others.

                   On a global scale, the concept of herd immunity is so far removed from a forseeable reality for many, especially non-wealthy, non-industrialized nations.
                   Many people may not travel.  Yet there is still a sizeable subset who do and who then become potential carriers.Why aren’t there more interventions focused on these high-risk folks?This is core public health.  This is not core medical-focused.
                   When exactly do you anticipate seeing frontline healthcare workers, especially those working on covid units, voluntarily ditching their covid-related PPE?Do you see them ditching their PPE in public, or taking unnecessary risks or non-precautions, especially those with young families?How consistent is that public-facing messaging when the people who first-hand know better, would never have stood behind or recommended such mask mandate removals, especially when so many globally aren’t able to be treated or vaccinated?
                   You would be incredibly hard-pressed to find a public health practitioner who would welcome these policy changes, at this stage, given everything.
                   If you have to have a bunch of caveats, footnotes, fine print asides, how accurate and great is the messaging that’s actually being disbursed?In general, it costs the general government nothing, but for select subsets, it can literally cost them everything.
                   Why hasn’t this messaging gone back to the drawing board for revision and refinement before being aired on prime time?  It’s so premature unless you are cherry-picking pockets of selective reference data.  That would never fly in peer-reviewed, publicized and promulgated industry-specific research.

                   If we truly want semblance of pre-covid times back, we need to stop hyper-focusing on our small city or small state, and broaden and open up our outlook in consideration of where we are compared with the rest of the world.  Because the rest of the world inevitably comes to Boston (see customs), and we are only one city, one node, in a very vast network.  And if you’re not sure what that looks like, switch on the news and look at the coverage of the covid crisis coming out of India.
                   Should the criteria really be whether or not we have ICU capacity as the sole basis on reopening?Why isn’t it focused on not having people in the ICU, in the first place?You wouldn’t need treatment if people didn’t get sick in the first place.There are many reasons why people end up in the ICU.  Many which those patients had no control over.Covid shouldn’t be one of them.
                   People are needlessly suffering and dying from things that we know we can actually help.Masks help.  We absolutely know this, incontrovertibly now.  There is zero ignorance here about this fact.  They are a relatively low-cost, broadly accessible, effective intervention at mitigating risk.  Nowhere else, other than the US, are masks so politicized, when they should be the absolute of anything non-political.
                   We don’t live in a clothing-optional state.Whether or not explicitly stated, there is a citywide, statewide and nationwide clothing mandate.No shoes, no shirt, no service is a widespread slogan.How is a mask that much different from a tank top vs. a t-shirt vs. a long-sleeve shirt?How is a mask that much different from a pair of shorts to a pair of pants?How is a mask that much different from a short skirt vs. a long dress?All of the longer articles of clothing offer more surface area coverage and protection against the elements.Size-wise, a mask is demonstrably smaller than pretty much any other article of clothing or outerwear or shoe.And yet, it’s developed into a controversy, here, domestically, because of politics.Aside from it’s demonstrably smaller size, a mask has the power to mitigate disease transmission risk where it’s needed most, over mouth & nasal droplets and mist.The other items of clothing and outerwear do not, because they’re not focused on serving as a physical barrier between host and others for the source of vector transmission, despite being located in near proximity to it.  A mask will do you no good if it’s not over the areas where it matters (primarily open orifices of nose and mouth).  Location matters.  Proximity matters.
                   Focusing only on a chemical barrier (vaccination, w/uncertain duration of efficacy, access difficulty and social cost to obtain) without the physical barrier (masks & PPE, in general) is NOT a comprehensive public health approach.  Physical barriers are significantly less cost, but they are not no cost, and someone has to carry that burden.  It is shifting burden, cost and trust, on the broader government you have to effectively ask permission from to obtain, vs. individual cost of physical barriers where the barrier to entry is so much lower and weighted much more on individual autonomy and ability to do something about it.  
                   Chemical barriers are not perfect.  Ex: yes, oral contraceptives are effective, but they’re not effective in women with increased BMIs.  It’s fine print acknowledged, but not widely known among the general population.  Examples of chemical barrier intervention efficacy limitations are already starting to pop up with those who have been fully vaccinated, who still contracted covid and who subsequently died.  It’s out there and known, but not widely publicized, it feels in part, since it might detract from the general pro-vaccine messaging and likely due to considerations to not want to affect vaccine hesitancy rates.  Yet it still exists and will continue to exist.  Rationalizing vaccination rates as basis for reopening, especially when it is well known that it is impossible to achieve herd immunity without all children being vaccinated (many of whom, are still ineligible to receive vaccination) is not good policy.  How many times have you sent a young child to daycare, pre-pandemic, and as a parent, you’ve ended up sick?  What parent would want to have to call out and take off work to take care of their sick kid and see them unwell, rather than wishing that they’d just stay healthy and that they had never been sick in the first place?  
                   There is a quote that the wishes of the healthy are many and vast and can be seemingly infinite, and yet the wishes of those who are unwell are singular.  Think about that for a moment.  And how quickly your fortune can change when and if you or someone you love finds themselves in that situation.  Why aren’t these people at the decision-making table crafting and enacting these broad-based policies???
                   By removing the physical barrier mandate, you’re effectively saying go do your own thing, but we won’t support your efforts and you’re on your own and if you run into difficulty, too bad, because I’m making the choice to focus my efforts and attention elsewhere.  That’s not drifting around whatever.  That’s making a conscious and active choice.  Policy and actual government is a choice.  
                   How far would an employee get in their workplace if their boss said go do your own thing, and maybe it’ll work or maybe it won’t, but I effectively don’t care or value what you’re doing, otherwise I’d incorporate it as part of your formal employee review plan, incorporate it as part of your official job description, and make it part of the basis for promoting you and giving you a raise in the future, or where I’d consider your assets valuable and look for other opportunities to exploit those gifts for wider company & personal (to the boss) benefit?  
                   How successful is that employee likely to be in such an environment?  Is that the kind of employee you see advancing, and making an entire career and life’s work there?  How would you feel if you saw that happening to your colleague or friend?  Or to you?  Is that the kind of boss who would speak and share that absent employee’s name in a room full of opportunities, growth and promise?  How much is that employer really setting that employee up for success and backing up their efforts? 
                   Would you call that type of boss an effective manager?  Yes, they’re a boss, yes, they’re technically managing, but are they managing well?  Are they the type of person years later you remember and aspire to emulate when you’re afforded and blessed with similar decision-making and visionary opportunities?  Giving them tools and knowledge to excel, feel safe, and be comfortable at what they do?  That’s what’s happening here.  Where the employer in this example could just as easily be the state, and the employee is everyone else.
                   Will employers be providing such PPE, on regular and consistent and adequate basis, to their employees, especially those without social capital in high-turnover, high-attrition jobs, when you remove such a mask mandate and state of emergency?  Especially small businesses and restaurants where there are razor thin profit margins?  Yes, lots of people want to dine out, but how comfortable do they feel doing so if back-of-the house PPE provisions, such as masks, are just optional, especially where there is a subculture of inability for those employees to call out when sick?  How comfortable do you feel when it actually affects you & the food that you personally eat and was prepared by others?  Is it going to change where you choose to dine out (as opposed to takeout), and are you then going to favor establishments that have the administrative overhead to properly instill physical PPE interventions to protect patrons and employee staff?
                   Policy decisions matter.  They affect not just intentioned target audiences, but they have ripple effects throughout the system elsewhere.  The idea is to have broad-based, comprehensive coverage, try to not do additional harm and create unintended burden.  Yes, there is always burden.  But it shouldn’t be unintended.  It should be anticipated and mitigated and quickly, adequately and appropriately addressed.  There shouldn’t be surprises.  There shouldn’t be extended and unreasonable delays.  
                   This policy, with the way it’s executed and all the abundant confusions everywhere amongst the general population and especially the conflict of the policy with the science, is rife and fertile ground for surprises, many of which, if they had actually just stopped and thought about it and consulted with people, could’ve been easily foreseen and dealt with.  
                   Where are all the other representative people at the stakeholder table who are crafting these decisions?  The everyday, vulnerable people, especially customer-facing minimum wage, public transportation, high urban dwelling concentration employees, in particular?  Why isn’t this more a bottoms-up approach, as opposed to top-down hierarchy?
                   Seniors and others who are immunocompromised don’t receive the standard flu shot.  The standard flu shot is not effective for them, on the order of 75% or more ineffective generation of antibodies.  Instead, these populations are supposed to receive a high-dose flu shot.  There is no uniform consensus or guidance regarding covid vaccination with similar demographic populations.
                   Yes, we thankfully have some vaccines that help against the then predominant strains.  But there is absolutely zero consensus within the scientific community, including the actual drug manufacturer, as to how long these vaccines are actually effective for, and more variants pop up with increasing regularity.
                   I would like to see more widespread discussion and creation of policy that accounts for the social impact of this monumental policy decision, especially, as it impacts vulnerable populations and entities with little-to-no social agency or financial asset collateral, and specifically what actions are being taken to mitigate those increased disproportionate burdens.  The renters, the employees, the gig workers, minors, students, elderly, undocumented, non-permanent residents, those who are immunocompromised, the covid long haulers, those with low incomes, the un & under-insured, those in non-personal vehicle households, those with disabilities.

       2. You are misunderstanding the 95% statistic. Those 5% who still get Covid actually *are* protected by the vaccine — their case of Covid will be much less severe than it otherwise might have been. The vaccines have been reported to be virtually 100% effective at preventing cases severe enough to require hospitalization.

    2. Thank you, *.

       You raise a lot of deep issues in your post which I read through carefully. All these issues merit continuing consideration. I appreciate your comments on MD vs PH perspective.

       I think there are always tough judgment calls to be made. We will have to live into the situation to find out how things work out and how the equities ultimately land.

       I totally share your concern for those in heavily exposed occupations.

24. The emergency law is over, but the pandemic sadly is not.

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