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Q&A with Dr. Joseph Kanter on COVID in Louisiana and lifting the mask mandate

joe kanter.jpg
Courtesy of Louisiana Department of Health
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Dr. Joseph Kanter receives a flu shot and a booster dose of the COVID-19 vaccine on Oct. 6, 2021.

Governor John Bel Edwards lifted the statewide mask mandate Tuesday as COVID-19 cases, deaths and hospitalizations fall sharply from the summer surge.

But he’s left the mandate in place for some K-12 schools: Those that do not follow the Centers for Disease Control and Prevention’s guidelines for quarantine. Those guidelines require students in close contact with anyone who tests positive for COVID-19 to quarantine for at least a week.

For more on the data behind the move and where Louisiana stands in the pandemic, public health reporter Rosemary Westwood spoke with Dr. Joseph Kanter, the state health officer.

Rosemary Westwood: Can you just explain why the mask mandate is being lifted right now? What is the evidence that you think makes this a good decision? 

Dr. Joseph Kanter: The public health recommendation hasn't changed. And we still follow the CDC's recommendation, which says if you're unvaccinated, you should be masking in indoor public spaces everywhere. If you are fully vaccinated, you should still mask in public indoor spaces if you're in an area of higher transmission. I still feel that that's the best recommendation.

What has changed is, with this surge abating, with our numbers coming back down to baseline, and with the real crisis lessening, the governor felt that it's no longer appropriate to be exercising that authority (of requiring masks). I think that's the right call. This is a long pandemic and it's not over. We recognize the governor's order, whether it's masking or anything else, is an exercise of authority that should only be done when the times call for it. I think it's appropriate as the pandemic ebbs and flows that the mitigation measures, at least as ordered, ebbs and flows as well.

He was very clear in the press conference, that should cases go back up, he won't hesitate to reinstitute the mask mandate. I think that's the right approach.

Certainly, we're not at the height of the delta surge that we saw in August. But looking at the map that your department puts out every day, the amount of viral spread, the risk of catching COVID-19 across the state, remains high or at the highest levels. And so how does that correlate for you? We may not be as worse off as we were, but we're still not at all doing great in terms of viral spread in Louisiana are we?

We're doing significantly better. And we're essentially at the place where we were on July 1st, as we just began the increase with delta. Percent positivity is 2.1%. That's very, very low. And you're right, that we still have a number of parishes that are in the higher two risk categories, but we're also doing about a third more testing than we were the last time our percent positivity was this low. You put that together, and I think in terms of transmission risk — you look at all the data points, hospitalizations are at just above 300 — I think you can kind of map out where we are. And I do think we're in a much better place.

What about that comment you made during the press conference on the need for increasing vaccinations? We seem to be stagnating there as well. And when you look at where vaccination rates are the lowest in the state, and where viral spread is the highest, those often overlap. In places like the southwest, only one-third of the population has had even one dose of a COVID-19 vaccine, it's not much more across the whole north of the state — around 40%. How are you going to achieve higher vaccination rates and end this pandemic?

I think ending the pandemic is the right way to think about this. We just got over the surge. And we're thankful for that. But the simple truth is, we are going to remain vulnerable to another surge just like this, perhaps even worse, unless we can get those vaccination rates up, particularly in parts of the state that are really lagging behind.

This is what causes me to lose sleep the most these days. This last surge, not only was it the most damaging — we had the most hospitalized patients, we lost the most lives during it — but it was also preventable. It was entirely preventable. And we had enough vaccine available to us to prevent it. We just didn't have enough vaccination.

So that really is my prayer. At this point in time, we're not limited by science. We're really limited by anti-science. This was remarked by a professor out of Houston a couple of weeks ago. We need to get more Louisianans vaccinated, we need to encourage people to encourage their neighbors, friends, family, and go and become ambassadors and get those around them vaccinated.

I think we continue to lead with the science, with the data. It's taking longer than we would have liked, but we're still making progress every day on that.

Masks will be required in some K-12 schools. Why not just require them outright in all K-12 schools? Why has the governor decided to make them required only in schools that do not observe the CDC's guidance for quarantine?

Again, there's a distinction here between what the recommendations are, and what the governor is ordering through his emergency power. And I think he is cognizant of exercising his emergency authority when times call for it, and we have more or less made the pledge to people that that authority won't be abused. Cases are going down. It's a safer environment now than it was a couple months ago. And so, as the governor said, he feels there's some room for local decision making.

In the Department of Health, we remain very clear that we think masking should continue in the school setting. We think schools, of course, should follow the CDC quarantine guidance. And more than that, we think we, Louisiana, have shown proof of concept of that. We were one of the earlier states to get kids back in the classroom in-person. And we did it by and large safely, better than any other states. And we did it by following the science, by following these types of guidelines.

That said, with cases going down with the crisis abating a little bit, there's the opportunity for more local autonomy. And I hope school districts make the safe decision on this.

If it were up to you would you have kept masking mandates in schools?

(If) it was up to me if I ran a school, I would have masking there 100%, and I would encourage any school that my kids go to to keep masking, at least until more students have the opportunity to get vaccinated. But I do at this point in the pandemic, with numbers low, we recognize that there's a role for local autonomy.

Q: And what about younger ages? We have seen high rates of COVID-19 in kids ages 0 to 4, those in daycares or preschools or other communal environments. Why not require masks in those settings? 

It's tougher. It's tougher for younger kids to mask. The CDC recommends masks in general for ages two and above. In this past order, we kept the age limit down to five. As the parent of a young toddler I can tell you, parents know it's pretty hard sometimes [to get children to wear masks]. But I think it's a give and take.

There's absolutely no question that the environment is safer the more people that mask, particularly if those people aren't vaccinated. I think the question is, given the cases, given the risk at any point in time, at what point does it justify the exercising of authority, and that's more or less where the decision point fell down.

Infectious disease epidemiologists I've spoken with say that this is premature, that the mask mandate isn't just a benefit for when cases are rising and the hospitals are full, it can help mitigate a potential next surge. We are heading into the winter season, which was a time of a surge in COVID-19 last year. Christmas is happening. Thanksgiving is happening. And they've said, you know, not requiring masks really takes away an opportunity to dull a new surge that might come up. In the spring, the mask mandate was lifted. And not very long afterwards, delta started spreading and it spread for a month without a mass mandate being in place in the state.

I don't disagree on the value of masks. But the pledge that the governor essentially made to the people of Louisiana during the pandemic is, you know, his actions are going to be driven by the data and in response to what the virus is doing. So I think it's appropriate as the virus goes down, transmission goes down, to relax the mandates, with the recognition that should cases go back up, the mandates and the masking will have to come back in an order, as well.

I think that's essentially contingent with the exercising of this very awesome authority that he has with the emergency declarations.

Looking forward, I think the bigger issue in setting ourselves up so we don't repeat this search is vaccinations. That's ultimately what is going to keep us vulnerable. And that's where I think the most attention has to be placed right now, is how do we encourage more people, how do we make people feel comfortable enough to get vaccinated. Because as you point out, we remain at the bottom of the pack and that's just unacceptable.

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