Top Boston doctors talk pandemic strategy as cases surge in Massachusetts, including whether a mask mandate is warranted, and share what they’ve learned about the omicron variant on NBC10 Boston’s weekly “COVID Q&A” series.
As coronavirus cases continue to surge in Massachusetts, strategy from local leadership appears to center around masks, testing, boosting vaccination rates and freeing up space in hospitals.
Cities and towns across Massachusetts began receiving free, rapid COVID-19 tests this week as part of Gov. Charlie Baker's new strategy to control the spread of the virus this holiday season.
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When asked Monday if he was considering reinstating a statewide mask mandate amid the latest surge, Baker said he has no plans to. The very next day, the Massachusetts Medical Society recommended that people wear masks in all public indoor spaces.
Baker has also ordered hospitals dealing with “critical” staffing shortages and an influx of patients to cut elective services and procedures by 50%. And he said he is exploring the possibility of activating the National Guard to help out in hospitals.
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Meanwhile, politicians and medical experts in Massachusetts have been urging people to get vaccinated against COVID-19, and the heavily mutated omicron variant's impact remains to be seen. Experts expect the current state of the pandemic will get worse before it gets better.
NBC10 Boston asked top Boston doctors on Tuesday to explain whether they think mask mandates, testing, vaccination and hospital restrictions are the most effective tactics to combat the surge during the weekly "COVID Q&A" series.
Mask mandates
Leading doctors are now recommending that people wear masks in all public indoor spaces, regardless of vaccination status, as coronavirus cases surge across the state. Baker, conversely, was less inclined to enforce face coverings.
Boston Medical Center's Dr. David Hamer and Dr. Shira Doron, the hospital epidemiologist at Tufts Medical Center, were split on whether Massachusetts should implement a mask mandate.
"I'm worried about this time period," Hamer said. "I think masks play an important role, you know, as well as obviously vaccination and boosters and so forth. So I would favor leaning toward returning, or at least considering returning to mask mandates if things worsen."
Many coronavirus metrics in Massachusetts have now reached levels last seen in January, during last winter's surge, he noted.
Health officials on Tuesday reported nearly 11,500 new breakthrough cases over the past week, bringing the total above 100,000, and 52 more deaths. Also Tuesday, another 4,039 confirmed coronavirus cases and 61 new deaths were reported, pushing the state's number of confirmed COVID-19 cases to 916,547 since the start of the pandemic and its death toll to 19,304.
"The virus is largely not being transmitted in the places where a mask mandates would make the change."
Dr. Shira Doron, the hospital epidemiologist at Tufts Medical Center
"I'm worried about the numbers," Hamer said. "We're running 4,000 to 5,000 per day, and this is pre-omicron. If omicron really does start to displace delta -- it appears to be more transmissible -- we can have a real challenge in our hands."
Though Doron is confident in the efficacy of face masks broadly, she's more skeptical of mask mandates as an effective strategy for curbing the spread of COVID.
"I think that the virus is largely not being transmitted in the places where mask mandates would make the change," she said. "Though I think masks work really well. I wear one all day long here in the hospital and I feel like it protects me."
Doron pointed to cluster analysis data from the state Department of Public Health, which indicates that the vast majority of transmission occurs in people's homes, while very little transmission takes place in grocery stores, restaurants or other public spaces.
"Places where a mask mandate change behavior are not places where transmission is common," she said. "And so I'm not sure that it would change the trajectory while I do worry that it will further cause divisiveness and anger among people who are tired of being told what to do."
A growing number of states are reinstating mask mandates, Hamer noted, including California and New York. But so far, Massachusetts hasn't followed suit. When asked Monday if he was considering reinstating the mandate amid the latest surge, Baker said he has no plans to.
Baker stressed that Massachusetts is in a "far different position" than at this time last year due to the availability of the vaccine, booster shots and testing.
COVID-19 testing
Testing plays an important role in pandemic response. Until Baker announced his new strategy, COVID-19 tests were not accessible enough in Massachusetts, the doctors said.
This week, Massachusetts began distributing 2.1 million at-home rapid tests purchased from a California-based lab to 102 communities with the highest percentages of families living in poverty, representing more than half of the state's population.
The governor's hope is that people will use these test before gathering with friends and family this holiday season, especially in indoor settings when not everyone's vaccination status is known.
"I think the testing component is great," Hamer said. "Honestly, we should be using them more frequently. But cost has been a barrier and access, actually. A lot of people complain about how hard they are to get."
"I think testing is critical, too," Doron added, noting that it can sometimes take days to book a PCR test in Massachusetts. "We really need to decrease the barriers to getting tested because once people know they're positive, they will usually do the right thing."
Both doctors emphasized that state leaders need to provide detailed guidance on how to use the tests properly and what to do with the results. Doron recommended that people who test positive with an at-home test seek an official test in order to obtain medical documentation, which can be important when booking flights and surgeries.
Hospital restrictions
Hospitals across Massachusetts are critically close to or even exceeding capacity due to staffing shortages, an uptick in COVID-19 cases and an increase in the number of people needing in-patient care.
Earlier this month, Baker ordered hospitals dealing with “critical” staffing shortages and an influx of patients to cut elective services and procedures by 50%. Certain non-essential, elective services and procedures were already reduced by 30% last month.
But Doron said that isn't enough.
"We need to be thinking about how to increase hospital capacity, even more than we are now," she said. "Right now we're doing it by curtailing elective surgery, but that's not a long term solution."
The state has lost about 500 medical/surgical and ICU hospital beds and hospitals are seeing a high level of patients, mostly due to non-COVID-19 related reasons, according to the Department of Public Health.
"What we're seeing is that we can have increasing cases and hospitalizations almost to previous levels, even in the post-vaccination era," Doron said. "This may happen again and again and we need to figure out how to deal with that."
Vaccines and booster shots
Thus far, faith hasn't waivered among doctors in vaccines and boosters to protect people against the coronavirus and its mutations.
"Vaccines are the most important thing that are going to keep our population safe," Doron said.
Booster shots are equally important, she said, citing evidence that immunity wanes about six months after initial vaccination, the ongoing surge driven by the delta variant and the "probability" of omicron becoming at least a co-circulating strain, "if not a predominant strain in the future."
"They are becoming a critical tool," Doron said of booster shots.
Similar to testing, Doron said the state should eliminate any and all barriers to vaccines and booster shots.
"We have heard that people are struggling to find appointments for booster shots or vaccines in general," Doron said. "But really bringing the vaccine to people. Make it easy for them to say, 'Yes.'"
Perhaps with that in mind, a senior Baker administration official confirmed Wednesday that Fenway Park will reopen as a mass vaccination site as soon as January in an effort to increase access to COVID-19 vaccines.
White House chief medical advisor Dr. Anthony Fauci said Wednesday that currently available booster shots work against the omicron variant of COVID-19 and do not need to be adjusted to fight the new, highly contagious strain of the virus at this time.
"Our booster vaccine regimens work against omicron," Fauci told the public during a White House COVID update on Wednesday. "At this point, there is no need for a variant-specific booster."
Fauci said the primary two-dose vaccination series from Pfizer and BioNTech is significantly compromised by omicron, but still offers considerable protection against severe disease. Protection from the two-dose vaccine against infection dropped to 33% compared with 80% before the emergence of omicron. However, two doses are still 70% effective at preventing hospitalization in omicron patients in South Africa, Fauci said.
More from the COVID Qu0026amp;A Series
A panel of Boston-based doctors talking about everything related to the COVID-19 pandemic every Tuesday at 10:30 a.m.
