“A couple of pieces of the county’s policy is nonsensical,” Dr. Jeffrey Klausner said. “If everyone wears a mask the benefits are quite minimal. And the policy based on hospitalization counts are inaccurate.”
A letter from top-level doctors and researchers arguing against the effectiveness of indoor mask mandates, along with pushback from health departments, cities and business groups, possibly played a role in a surprise decision not to re-institute the mandate in Los Angeles County last month.
This newspaper obtained a copy of a February 2022 letter signed by doctors from UCLA’s Geffen School of Medicine and USC’s Keck School of Medicine sent to the Los Angeles County Board of Supervisors, asking the county to end the mask mandate that was in effect this past winter, claiming the policy did not work.
On July 22, some of the same doctors published their views in an op-ed in the Orange County Register, one of the newspapers in the Southern California News Group. At the time in July, the Los Angeles County Department of Public Health (LACDPH) was strongly considering reimposing an indoor mask mandate — but on July 29 decided not to do so.
The letter to the Board of Supervisors, part of a campaign to educate the board, was signed by Dr. Jeffrey D. Klausner, clinical professor of medicine, population and public health sciences at USC’s Keck School of Medicine; Neeraj Sood, professor of public policy at USC’s Sol Price School of Public Policy; James E. Enstrom, retired professor of epidemiology at UCLA; Dr. Noah Kojima, senior resident for internal medicine at UCLA’s David Geffen School of Medicine; Dr. Catherine A. Sarkisian of UCLA’s Geffen School; James E. Moore, II, professor at USC’s Viterbi School of Engineering; Dr. Gabe Vorobiof, associate professor of medicine and cardiology at UCLA Geffen School of Medicine; and Avanidhar Subrahmanyam, professor at UCLA’s Anderson School.
Supervisor Kathryn Barger, who strongly opposed the mask mandate, said she was influenced by the doctors’ letter, as well as views they shared on social media. She said in a public statement that she hasn’t seen empirical data indicating mask mandates decrease COVID-19 transmission. Also playing a factor in her opposition, she said, were decisions by public health departments in Long Beach and Pasadena, which indicated they would not go along with the mandate — and an outcry from business groups.
The cities of El Segundo and Beverly Hills also voted not to align with a mandatory indoor mask requirement.
“I do believe masking is another line of defense in protecting yourself and others,” Barger said. “But as far as mandating: It’s time has come and gone.”
The letter from the group of doctors cites the county’s statistics, and studies in Europe and some U.S. states, showing that after mask mandates were imposed, transmission of COVID-19 did not slow down. It contendes that vaccines and boosters, plus immunity from those who’ve been infected, form a safeguard against high levels of serious illness, and that masks are not necessary in mid-2022, unlike during early stages of the pandemic.
The Los Angeles County Department of Public Health does not agree, and is continuing to “strongly recommend” people wear close-fitting masks “in most indoor public places,” according to its website. Masks are required on public transportation such as buses, trains, taxis and ride-sharing services and at airports and bus terminals, subways stations, seaports and indoor port terminals; in hospitals, doctor’s offices and any healthcare setting; nursing homes and other adult/senior care facilities; jails, shelters and inside businesses that request it.
Public Health Director Barbara Ferrer said the reason she “paused” the mask mandate was because the county’s hospitalization and case numbers were dropping. She has repeatedly stressed at recent press briefings that studies prove masks drive down transmission rates. Ferrer called mask-wearing an easy, sensible step that can protect against virus spread.
But the doctors’ letter made the opposite case. After the L.A. County mask mandate took effect on June 30, 2021, the cumulative number of COVID-19 cases in the county rose well into December, their letter pointed out. “It is clear from these data that infections continued to increase despite the imposition of the mask mandate suggesting limited or no efficacy of the mask mandate,” the authors concluded.
In an interview on Thursday, Klausner said the mask mandate was followed by a gradual rise in cases, but it’s possible the mandate prevented a much steeper climb. “People might argue it might have risen faster,” he said, but added, “By the naked eye, there was no clear discernible effect of mask use.”
Klausner, along with colleagues who co-authored the op-ed piece in the Orange County Register, mentioned masking studies in North Dakota, the United Kingdom and Finland that found “the same lack of any clear benefit.” One study showed no significant benefit to the mask wearer, while another found a slight benefit, mostly in older adults. A study in Denmark found that wearing a mask produced a rate of infection 3 in 1,000 — lower than a control group that didn’t wear masks. The researchers concluded the difference was not significant. “The researchers could not tell whether the difference was due to chance or due to mask wearing,” said the letter.
However, Dr. Thomas Yadegar, medical director of intensive care at Providence Cedars-Sinai Tarzana Medical Center, said his unit has seen an “obvious” uptick in COVID-19 patients — along with increases in outpatient office visits, emergency room visits and hospitalizations.
“I think masks do work in the correct situations and for the highest-risk populations,” he said on Friday. “When in an indoor setting with a lot of other people, if everyone is wearing a mask, it can decrease the rate of infection.”
It makes sense when transmission of the BA.5 subvariant is high and is infecting more people, to wear a tight-fitting, respirator-type mask indoors, he said.
Despite the possibility of the contagious BA.5 variant slipping past a mask, Dr. Davey Smith, chief of the Division of Infectious Diseases and Global Public Health at UC San Diego, said recently that he still wears a mask when he goes to the grocery store or sees patients.
“What does it matter if it doesn’t work 100% of the time? It’s like going to a buffet where the oysters are bad. Do you eat one oyster or 12 oysters?” he said recently. Eating only one puts you at less risk of becoming sick, just like wearing a KN95 or N95 respirator mask greatly lessens the risk of COVID-19 infection.
But Klausner has not ruled out mask-wearing. “I do believe mask use has a role,” he said. “In the hospital the person has to wear a mask.” When he sees patients that have, or might have, an infectious disease, he always wears a mask, he added.
“The evidence at a population level says it has very little, if any effect. That doesn’t mean it won’t protect some individuals,” he said.
Dr. Bahman Chavoshan, director of respiratory care at St. Mary Medical Center Long Beach, said in a previous interview he believes masking is the key to limiting the spread of infection. But he backed off when asked about imposing mandatory rules, saying educating folks about the importance of masks is a better approach.
In another area mentioned in the letter signed by several doctors, USC’s Klausner also disagrees with the county’s reporting of hospitalizations — a key factor in the CDC community transmission guidelines followed by L.A. County.
A county must have more than 10 new COVID hospitalizations per 100,000 people over a seven-day period to reach the “high” risk level, which Ferrer has said could trigger a sweeping county mask mandate.
The county has been in the “high” category since mid-July and barely missed dropping to “medium” last week, posting a 10.1 per 100,000 residents, just 0.1 too high. On Thursday, the number of daily hospitalizations fell to 1,098 and to 9.9 per 100,000, which dropped the county into the “medium” transmission category, reported Ferrer.
In June, 57% of patients in hospitals in L.A. County were hospitalized for issues other than COVID-19, meaning 43% were hospitalized for complications from the virus, Klausner said. A study he conducted that focused on LAC-USC Medical Center showed that 68% of its hospitalizations were for reasons other than COVID-19, such as heart disease and diabetes. He argued that using this data would have dropped the county into the “medium” level sooner.
“A couple of pieces of the county’s policy is nonsensical,” Klausner said. “If everyone wears a mask the benefits are quite minimal. And the policy based on hospitalization counts are inaccurate.”
When asked if L.A. County Department of Public Health should report hospitalizations differently, Barger responded: “I know of nobody who had this variant (BA.5) who had become deathly ill. It is more contagious, but it is truly becoming less severe.” She added, “If you talk to public health doctors at UCLA and at USC, they’d say (L.A. County Department of) Public Health needs to reset and assess this for what it is.”
Klausner is also opposed to requiring children to wear masks in schools, saying that 70%, or more, of children attending school have been infected or been vaccinated or both, giving them immunity from severe disease.
“If you are concerned about protecting a child against COVID, you will make sure they are up to date on their vaccine. If they develop a runny nose, fever or cough, get them a medical evaluation,” he said.
From July 9 to Aug. 9, 9% of new COVID cases in the county were among school-age children, Ferrer reported earlier this month. She recommends layers of protections for K-12 students returning to school, starting with vaccines and boosters, and keeping home anyone who has symptoms, following isolation protocols, and getting tested. She also urged students and staff to wear a mask while indoors.
About 35% of school-age children ages 5-11 are fully vaccinated in the county, and 79% of children ages 12-17 are fully vaccinated, Ferrer reported.