PHILADELPHIA – Against the backdrop of a mess of warnings, rules and decrees at the H20 washing machine counter – “No money”, “Beware”, “I’m not answering” – there was a new one on Monday morning, displayed in a prominent place. “Mandatory masks for all,” it said, “effective April 18.”
Owner Chris Lee had sealed it there over the weekend, though the new rule was not his. He was in town. As of Monday, Philadelphia’s health commissioner announced last week that everyone in the city will be required to wear masks in closed public places, except for businesses where proof of vaccination is verified upon entry.
Mr. Lee’s response was quite representative.
“I’m for it,” he said. “I guess so.”
Over the past month and a half, a number of cities, including Philadelphia, have lifted their mask mandates, which were in effect for some of the deadliest months of the Covid-19 pandemic, signaling that a return to normalcy may be imminent. But soon another strange subvariant arrived and the infections started to go up again. With a low but rapidly growing number of cases, Philadelphia became the first major American city this spring to order its residents to put on their masks again.
The solution comes at an uncertain time of the pandemic, as new variants of unknown risk emerge, while the widespread availability of home tests has complicated the official calculations of new infections. The Omicron sub-variant, known as BA.2, has reversed the decline across the country in new cases, but is spreading to a country that is better vaccinated than when the Delta variant arrived last year. There are now good options for antiviral drugs. So far, the jump in hospitalizations has not followed the jump in infections.
At the same time, many people, even some of the most cautious, have lost their appetite for vigilance and the rules have become more difficult to follow. In a bid to prevent another leap, the Biden administration extended the mandate of federal public transport masks for another two weeks, but a federal judge in Florida released the mandate on Monday. Broadway theaters recently waived the rules for proving vaccination, but extended the requirements for masks until the end of May.
As cases increase, local and state leaders across the country will have to decide whether there comes a time when recommendations are no longer enough and policies such as the mask mandate are again required.
“From a broader public health perspective, this is a constant dance we’re in, especially here in the United States, about when to put things in politics,” said Dr. Megan Rani, an emergency physician. and academic dean of the Brown University School of Public Health.
For the Philadelphia Health Department, that point was reached last week, when a growing number of cases automatically triggered the mask’s mandate. The city of 1.6 million people has generally complied with public health directives over the past two years, and disguise has become widespread even without a mandate. Still, the twist is a case in point for other cities, a test of how much patience may have been spent on pandemic restrictions, even in a place where thousands of people have died from Covid-19.
“I think it’s too cautious, but I see where they come from,” said Mike Levey, a 25-year-old digital property manager in Philadelphia who walked through Amtrak Central Station on Monday morning. He thought it was a little confusing to go back and forth in terms of office. But he added: “I understand and respect him.”
Most Philadelphians interviewed on Monday accepted the mandate, some even applauded. But this was not unanimous. Some restaurant owners saw the mandate as another reason for customers to stay home during the brutal two years for the food service business – “another blow in a series of stops and starts”, said one.
Others dismissed those fears. “In restaurants, all you have to do is carry it to the door,” said Ilen Winicour, 81, who said she was proud of her city for issuing the mandate. “The moment they put water on your table, the mask was removed.
A group of business owners and residents filed a lawsuit Saturday to end the term. Mayor Jim Kenny defended decision-making in the city as “clear, transparent and predictable”, while leading Democratic nominee for governor Josh Shapiro called such mandates “counterproductive”.
The range of opinions in the H20 washing machine contained many.
“A lot of people thought you still had to wear it,” said Ashley Thurston, 31, a correctional worker wearing a crystal crystal face mask as she folds children’s clothes.
“If I’m vaccinated, why should I wear a mask?” angry 31-year-old Miesa Romero, whose displeasure was hardly hidden under a red mask with the Temple University logo. “What the hell is the point?” she asked. “Every day is a new rule.” Coretta Nesmith, 32, sitting unmasked in a row of seats at the other end of the counter, smiled broadly. “You can tell me what I think,” she said.
Statistics released by the city on Monday show an outbreak that is still small but growing rapidly. The average number of newly reported cases is 224 per day, a relatively small figure for a large city, but an increase of 240 percent in two weeks. Eighty-two people were hospitalized with Covid-19, nearly twice as many as last Monday. But the number of deaths, which are usually weeks behind the total number of cases and hospitalizations, has not increased as dramatically in the weeks since it reached a staggering 5,000.
In the low but fast-growing numbers, the city’s health officials saw a familiar warning.
“I remember seeing that when Delta was on the horizon,” said Dr. Cheryl Betigol, the city’s health commissioner, describing the ominous days last year when Philadelphians finally enjoyed a Covid-19 vacation. while she and her colleagues watched a new option causing death and disease in Europe. “It was difficult to get people to pay attention,” she said.
When Dr. Betigol and other health officials began compiling a series of indicators to determine which mitigation policies should be implemented at which points, Delta’s experience was on her mind, she said. So they decided that a 50 percent jump in daily infections counts in 10 days – what she called “the most reliable measure we’ve seen in previous waves” – plus an increase in the absolute number of infections over 100 or hospitalizations over 50 will automatically trigger the indoor mask term.
As critics of the order are quick to point out, Philadelphia’s guidelines differ from those of the federal Centers for Disease Control and Prevention. The latest CDC guidelines place greater emphasis on hospital admission and occupied hospital beds, which are measures of stress on health care systems rather than direct indicators of infection risk; similar to deaths, these indicators tend to lag behind the trend in new cases by a few weeks. According to the CDC, Philadelphia was still solid in the “low” category when the mask mandate was restored.
“What’s the argument for opposing the CDC, opposing Dr. Fauci?” Asked Alan Domb, a real estate mogul who is a member of the Philadelphia City Council. “It’s hard to understand when all these other institutions say it’s not necessary.
Dr. Betigol acknowledged the discrepancy, but insisted that decisions were made based on specific conditions in Philadelphia, a very poor city and a city where black communities are particularly hard hit by the virus.
“We need to focus on protecting the people who are most vulnerable in the city,” she said. With everyone unknown to epidemiology and human behavior, fighting the virus requires the best-informed efforts, she explained, and adjusting if those efforts fail.
“The point is, I may be wrong – people may be laughing at me in two weeks,” she said. “But if I can save lives because I’m right, the risk is worth it.”
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