I'm eager to relax my personal COVID precautions in public when airlines, the bus, the library, the post office, and hospitals no longer require routine masks, and restaurants and Starbucks no longer ask servers to wear them. I'm not trying to do "hygiene theater" and I do want to move forward, but with caution. 
     With fully vaccinated friends, I ready now to visit without a mask outdoors. I likely will not be "normal" until at least 70% of the US and 80% of KC is fully vaccinated -- or when known active cases in KC are close to 0. 

JULY 27, two months after the STUPID CDC advice, and after at least thousands of unnecessary hospitalizations and at least  hundreds of deaths of the fully vaccinated, the CDC finally is corrected itself:

"Revising a decision made just two months ago, the Centers for Disease Control and Prevention said on Tuesday that people vaccinated against the coronavirus should resume wearing masks in public indoor spaces in parts of the country where the virus is surging. C.D.C. officials also recommended universal masking for teachers, staff, students and visitors in schools, regardless of vaccination status and community transmission of the virus." --NYTimes
AUG 4: This NYTimes article shows the incompetence of the CDC and specifically cites the confusing mask mandate which should not have been lifted in May: 
The C.D.C. Needs to Stop Confusing the Public

EVEN FAUCI on July 4, says he'd probably wear a mask in an area with a low vaccination rate. Learn more.  Missouri is a low-vacc state, and Jackson County is worrisome.

NOW THIS: The utterly clueless CDC which was still advising kids, teachers, and staff to return to school with those vaccinated not wearing masks has now been answered today (August 19) by the American Academy of Pediatrics, which Monday called for everyone over the age of 2 to wear masks, regardless of vaccination status. I doubt the CDC folks have ever tried to manage a classroom with some kids having to do something they don't want to do and other kids free from such a requirement. 
     The self-righteous CDC and Dr Fauci continue misleading the public about the reality of COVID deaths in fully vaccinated people, although tonight on PBS (August 19) Fauci finally, when pushed, acknowledged this fact, though he tried to minimize it. It is a small fraction, but that fraction could be greatly reduced if the vaccinated wore masks except when they are certain there is no one in their space carrying the virus.

June  30.-- Los Angeles urges a return to masking, even for those vaccinated, citing delta variant. Of the 123 people infected with the delta variant from June 4 to 18, ten were fully vaccinated. The county is investigating ways that might allow the fully vaccinated  to unknowingly transmit the disease to others.

June 29: -- In May alone about 150 fully vaccinated people died. The number would be ZERO if they had not been exposed to the virus. 

[Last night] Fauci acknowledged fully vaccinated people may in some situations be well advised to wear masks. [Today] the KC Star reports a metro 33% increase in new COVID cases. Jackson County has less than a 40% vaccination status, with all metro counties but Johnson having lower rates. [July 2: St Louis has now requested fully vaccinated folks wear masks.] {July 9: The KC Star reports that the KC Health Department "has documented 42 'breakthrough' cases of COVID-19 in vaccinated patients in Kansas City."}
   The World Health Organization last Friday urged fully vaccinated people to continue wearing masks in light of delta’s rapid spread.
     Over 600,000 persons in the US have died from COVID.

     I've been furious at the CDC for its stupid, [MORE RECENT STUPDITY BELOW] dangerous, and socially awkward advice that people fully vaccinated can now go maskless into public places like stores. This results in many unvaccinated also going maskless at a time when the virus is still mutating threateningly and may find a way to defeat the vaccine. I feel for servers at restaurants who can't know the dangers they face, and businesses torn between customers who want masks in their stores and those who don't. 
     I was glad many newspaper and responsible news organizations reported thoughtful push-back (see items below for example). People with special conditions who cannot be vaccinated are at risk with the ending of social pressure to wear masks, social distance, and other mitigation procedures. And even the fully vaccinated are at risk -- the most effective vaccine is at best 95% effective, which means out of 100 people, 5 of us are susceptible to the disease if exposed to it. UPDATE JULY 4: In June .8% of vaccinated peope DIED, nearly one in every one hundred -- not just got sick, but DIED. UPDATE JULY 16: More recent figures show the death rate as .3%. This rate will no doubt improve (decrease) as medical attention becomes increasingly skillful. Survivors face becoming "long-haulers" with continued disabilities. The new variants seem to be more transmissable and so reports say they lead to greater damage from the virus.
     The new Delta variant, now in the US, spreads more easily and is more deadly. The fact that a ship of fully vaccinated and tested people resulted in two peope getting sick from COVID indicates that fully vaccinated people can be carriers as well as getting sick themselves. Yes, this is rare. Wearing masks, social-distancing, washing hands, and such will keep such inflections rare.

viral load
viral variant
exposure time
exposure likelihood
mitigations such as masks and hand-washing
vaccination status

     Now this: Through April some 10,262 reports of breakthrough infections of vaccinated people . . .  were known to have been hospitalized and 160 had died . . . . 

July 9: Now the STUPID CDC says all schools should reopen this fall with kids fully vaccinated not  wearing masks. STUPID if you know anything about the socialization of children -- some made to wear masks and others not -- and younger kids can't yet even get shots. (I haven't even mentioned teacher variation.) Try classroom and school management under these conditions. STUPID.

Likelihood of death from COVID = 
(1) exposure x (2) mitigation x (3) immunity x (4) care

(1) Exposure is compilcated by unknown characteristics of variants which exist and may develop. Exposure depends on viral load, proximity, ventilation, exposure time, and other factors.

(2) Mitigations include masking, hand-washing, social distancing, and such.

(3) If we consider vaccination as artificial immunity, then sub-factors would include
  (a) initial effectiveness (such as 95% after two weeks of the second shot) and 
  (b) degregation of the effect over time (largely assumed but unknown - a booster may be necessary)

(4) If someone is infected and seriously sick, the outcome may depend largely on the medical care received.

My fury is renewed. This was so obvious, but only now is Fauci saying this.

If Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, were right now in, say, Biloxi, Miss., he would consider wearing a mask.

Dr. Fauci is fully vaccinated. But on Sunday in an interview on NBC’s “Meet the Press,” he told anchor Chuck Todd that in parts of the country with low levels of vaccination and rising coronavirus caseloads, he might “go the extra mile to be cautious enough to make sure that I get the extra added level of protection.”

“Even though the vaccines themselves are highly effective,” he added. Just 36 percent of Mississippi residents have had at least one shot of a coronavirus vaccine.

Whether and when vaccinated people should wear masks is a question that’s been on the minds of many Americans. The Centers for Disease Control and Prevention announced in May that fully vaccinated people did not need to wear masks, even indoors, and has stuck with the guidance.

But worried about the spread of the contagious Delta variant, health officials in Los Angeles County have begun recommending that vaccinated residents wear masks in some settings. And the World Health Organization recently reiterated its advice that all people continue to wear masks and take precautions.

Though about 67 percent of Americans 18 and older have gotten at least one dose of a vaccine and almost 60 percent are fully vaccinated, vaccination rates vary sharply by region. “We’re going to see, and I’ve said, almost two types of Americas,” Dr. Fauci said on Sunday.

On July 1, The White House announced it would send out “surge response teams” with additional testing supplies and therapeutics to communities experiencing a rise in Covid-19 cases. Missouri, where the daily number of reported cases has recently doubled, requested a response team just hours after the announcement. Vaccinations in that state, too, have lagged the national average, at 45 percent.

Dr. Fauci said that 99.2 percent of Covid-related deaths in June occurred among unvaccinated people. “It’s really sad and tragic that most of all of these are avoidable and preventable,” he said.


My comment: This very balanced article makes the point 
that the CDC's advice was inadequate 
and (as I read it) misleading and dangerous.

New Yoirk Times GUEST ESSAY
You Can’t Rely on the C.D.C. 
to Make Your Pandemic Decisions
June 7, 2021

By Aaron E. Carroll

Dr. Carroll is a professor of pediatrics at Indiana University School of Medicine and a contributing Opinion writer who focuses on health research and policy.

How should we think about the risk from Covid now?

When it comes to public health emergencies like the pandemic, if people fail to be safe enough, or the danger and uncertainty are just too great to rely on individual decisions, then the government must act, as it did with stay-at-home orders and mask mandates last year. But as the country emerges from the pandemic, it’s going to fall increasingly on each of us to figure out what to do ourselves.

In normal times, warnings from health officials and mandates about what not to do often fall on deaf ears. Did you know that the Centers for Disease Control and Prevention says that women should not drink alcohol if they are of childbearing age and are not on birth control and that people shouldn’t eat raw cookie dough and should consume only about a teaspoon of salt a day? Probably not — and even if you have heard the advice, there’s a good chance you nodded and then ignored it.

The Covid-19 pandemic has been different. The last time the world faced a disease this infectious and this dangerous and for which there were no vaccines was the 1918 flu outbreak. Covid was a new crisis that needed extraordinary leadership, and many turned to the C.D.C.

That’s entirely appropriate, because what the C.D.C. is good at is protecting Americans from health threats (though yes, the C.D.C. could have communicated messages more clearly and early on, without political interference).

But there were good reasons for Americans to rely on the C.D.C. Almost no states had a public health infrastructure up to figuring out guidelines for the pandemic.

Many people also began looking to the C.D.C. to tell them what to do in everyday situations. This was also the reasonable thing to do in a state of emergency, but we should acknowledge how exceptional this state of affairs was.

Today, as the risk of Covid decreases with vaccinations, C.D.C. experts are still inundated with questions as to what is “safe.” Is it safe to travel and see other vaccinated members of the family in their home? What if one of them is unvaccinated? What if that unvaccinated person is a child? What if we want to see friends who are vaccinated, except for their children, but they’re sheltering in place and seeing no one else? What if they have a baby?

Many people, including experts, are angry that the C.D.C. isn’t clear on all of the answers. They’re upset when the C.D.C. makes recommendations too slowly, and they’re upset when the C.D.C. makes decisions too quickly. No one is there to tell us exactly what is safe and what is not.

There are a few problems with this way of thinking. The first is that safety is not binary; things are not either “safe” or “unsafe.” What people really need to understand is how risky or safe activities are, not to be told what’s forbidden or permitted. They need to know the amount of risk that comes with various activities so they can compare them. In addition, people need to interpret this information in the context of their own lives, understanding that what might be too risky for some may not be too risky for others.

The C.D.C. cannot know the nuances of every situation. So it’s no wonder that when it issues detailed advice, it often winds up confusing people instead of comforting them.

The C.D.C.’s recent change in policy on masks for those who are vaccinated is a good case in point. In an effort to attempt to address every possible scenario, the agency published a pretty complicated document that tried to tell people whether they needed to mask in a wide variety of situations.

Instead, it could have said this: When you’re vaccinated, your personal risk is substantially lower than ever before. You are significantly less likely to be infected. You’re much less likely to get sick in the unlikely event that you are infected. You’re even less likely to spread infection. Given that, masks likely provide limited benefit in most settings, so you really don’t need to wear one.

However, if you’re in a large group of people indoors for an extended period (flying on a plane, being in a classroom, shopping in Costco) then masking might still be a good idea. Additionally, you may live in areas where outbreaks are occurring, or you might have a chronic illness that places you at higher risk, and organizations or individuals may feel safer continuing to mask in certain conditions until transmission slows further.

Because the C.D.C. didn’t frame it this way, many people took its advice to mean they needed to worry whether others were following the rules, and that they might be at risk if the people around them were unvaccinated and unmasked. But the real danger in those situations is for the unvaccinated, not the vaccinated. They’re the ones who need to worry.

Better guidelines would give us a sense of how much risk comes with certain activities, not whether risk exists. Knowing the amount of risk would allow people to make decisions about what they are willing to accept for themselves and others.

The C.D.C. is typically a very conservative voice when it comes to health. People should know that if they’re waiting for a notice from C.D.C. experts that the pandemic is over and it’s safe to go back to normal, they will likely be disappointed. Instead, they will once again need to make their own choices as to what advice to follow, and what to ignore. When my daughter and I make cookies, we taste the raw dough. Until she’s fully vaccinated in a couple of weeks, she’s still masking inside and being pretty careful around others.


Now a failure to keep track of what is happening . . . .

C.D.C. Will Not Investigate Mild Infections in Vaccinated Americans
At least 10,000 vaccinated people were infected with the coronavirus through the end of April. Now the agency has stopped pursuing the mildest cases.

Roni Caryn Rabin
May 25, 2021,
11:15 a.m. ET

Julie Cohn was fully vaccinated when she went to cheer at her 12-year-old son’s basketball game in March. Midway through the match, he asked to remove his mask because he was getting so hot. She thought little of it.

Three days later, he had a sore throat. He tested positive for the coronavirus, as did his younger brother a few days later. Ms. Cohn cared for them, thinking she was protected, but she woke up with what seemed like a head cold on March 28. The next day, she, too, tested positive.

No vaccine provides perfect protection, and so-called breakthrough infections after coronavirus vaccination are rare and unlikely to lead to serious illness. Federal health officials have told fully vaccinated people they no longer need to wear masks or maintain social distance because they are protected, nor do they need to get tested or quarantine after an exposure, unless they develop symptoms.

Now the Centers for Disease Control and Prevention has stopped investigating breakthrough infections among fully vaccinated individuals unless they become so sick that they are hospitalized or die.

Earlier this year, the agency was monitoring all cases. Through the end of April, when some 101 million Americans had been vaccinated, the C.D.C. had received 10,262 reports of breakthrough infections from 46 states and territories, a number that was very likely “a substantial undercount,” according to a C.D.C. report issued on Tuesday.

Genomic sequencing could be done on only 555, or about 5 percent, of the reported breakthrough cases. Over half of them involved so-called variants of concern, including the B.1.1.7 and B.1.351 variants.

Some 995 people were known to have been hospitalized and 160 had died, though not always because of Covid-19, the new study said. The median age of those who died was 82.

The numbers suggest that the vaccines are highly effective and generally working as expected. On May 1, the agency decided to investigate only the most severe breakthrough infection cases, while still collecting voluntary reports on breakthrough cases from state and local health departments.

The agency will carry out vaccine effectiveness studies that include data on breakthrough cases, but only in limited populations, such as health care workers and essential workers, older adults, and residents at long-term care facilities, a spokeswoman said.

Some scientists support the decision to focus on the illnesses that cause deaths, tax hospitals, and overwhelm the health care system. Still, the move has been controversial.

Critics say the agency is missing an important opportunity to learn about the real world effectiveness of the different vaccines, and gather information that might help identify trends in the pandemic’s trajectory — for example, how long vaccine protection lasts, or how various vaccines compare in preventing infection with variants, or whether certain patients like older people are more susceptible to breakthrough infections.

“We are driving blind, and we will miss a lot of signals,” said Ali Mokdad, an epidemiologist at the University of Washington who spent many years as a senior scientist at the C.D.C.

“The C.D.C. is a surveillance agency,” Dr. Mokdad said. “How can you do surveillance and pick one number and not look at the whole?”

The change was announced quietly on the agency’s website this month, with a statement that the switch “will help maximize the quality of the data collected on cases of greatest clinical and public health importance.”

Asked to explain the change, a C.D.C. spokeswoman said that no vaccine was 100 percent effective, but that the number of Covid-19 cases in fully vaccinated people is small and no significant demographic trends had been identified.

The change means the agency will continue to investigate cases like the death of a vaccinated resident of a nursing home in Kentucky but not the infections of more than 20 other vaccinated residents and employees in the same home who did not require hospitalization.

It is not clear whether the agency will investigate the outbreak that infected eight vaccinated members of the Yankees organization, because most of them did not develop Covid-19 symptoms at all. (Gleyber Torres, the Yankees’ two-time All-Star shortstop, tested positive after vaccination, as did three coaches and four staff members.)

“We have to prioritize what we’re doing, and the priority is to understand the cases associated with severe disease,” Dr. Kathryn Edwards, a professor of pediatrics at Vanderbilt University School of Medicine who studies vaccine safety and effectiveness, said of the new C.D.C. policy.

Some private health care systems are also studying vaccination failures among employees that will yield useful data, she said, though such studies are not necessarily reflective of broader trends.

“It’s such a rare phenomenon, and it doesn’t change the trajectory of the pandemic,” said Dr. Amesh A. Adalja, a senior scholar at Johns Hopkins Center for Health Security. As long as the disease is not causing people to require hospitalization, “there’s marginal value to tracking it,” he added. “It doesn’t have the ability to crush the hospital system anymore.”

But even relatively mild cases of Covid-19 can lead to persistent long-term health problems, and it will be difficult to know the full scope without tracking mild infections as well.

Ms. Cohn wasn’t hospitalized, but she experienced body aches, chills and digestive problems for about two weeks. She was left with fatigue, headaches, brain fog and vertigo so severe and sudden that she crashed her car into the garage one day.

She is still not back to her daily three-mile runs with her dog because of shortness of breath. “I’m young, 43, healthy, with no pre-existing conditions, but you often find me now on the couch resting,” Ms. Cohn said.

“Don’t people want to know about this?” she asked. “Where do people like me go? What happens next? The practitioners in my life have been shocked and are trying to figure out how to move forward, but there are so many questions. And if no one is studying this, there won’t be answers.”

Another rationale given for tracking all breakthrough infections is that they are not likely to result in further spread of the virus. But the scientific evidence for this is not conclusive, some experts say.

At Rockefeller University, which routinely tests students and employees for the coronavirus, breakthrough infections were identified in two women who had been fully vaccinated and had developed robust immune responses after inoculation, according to a study published in The New England Journal of Medicine.

Both of the vaccinated women, a 51-year-old and a 65-year-old, developed mild symptoms of Covid-19; viral sequencing revealed they had been infected with variants. “One of the individuals had an extraordinarily high viral load,” said Dr. Robert B. Darnell, an investigator at the Howard Hughes Medical Institute and the paper’s senior author.

The patient is not known to have spread the disease to anyone else, he said. Still, he said, “she had twice the transmissible viral load number in a pinhead drop of saliva.”

Diana Berrent, founder of Survivor Corps, a group of people who have had Covid-19, has called for establishing a national registry of all people with Covid-19, including those who had mild and asymptomatic cases, in order to gather as much data as possible for future research.

Many scientists agree: collecting more data is always preferable to collecting less. “The virus is constantly changing, and we need to stay three steps ahead of it,” said Michael Kinch, an immunologist and associate vice chancellor of the Centers for Research Innovation in Biotechnology at Washington University in St. Louis.

“What if a variant arises that is less responsive or, Lord forbid, unresponsive to the vaccines?” he said. “The way you stop it is good old-fashioned epidemiology, which the C.D.C. has historically done very well. But if you don’t see it coming, you can’t stop it.”




I'm not yet ready to attend indoor events such as this is likely to be. I know I am being very hard-headed about "returning to normal," but I hope my posted explanation, even though you may disagree with it, seems to you at least that I have thought pretty carefully about it in my situation, as I follow the current evidence. I wrote this when it became clear to me that most of my friends were moving ahead from the pandemic faster than I felt comfortable -- and I do keep updating it -- as a way of underlining this is a broad decision, not directed to any person or invitation, but a general explanation of my hesitation to gather with anyone except under pretty defined conditions. One thing I do not say in that explanation is that, since I do weddings (double-masked, distanced, short time exposure, other safety protocols), I know that it is still remotely possible that I could transmit the disease to someone else. I cannot bear the thought of infecting a friend.  I know I am being very hard-headed about "returning to normal," but I hope my commentary, even though you may find it inadequate, will be understood in the context of our cherished friendship.