POST 237. February 27, 2020. CORONAVIRUS. “Decision-makers are increasingly embracing the reality that we will have to “learn to live with” the coronavirus. But how will they know when to impose or lift restrictions?”  “Now, the CDC’s “Covid-19 community level” metrics are based on three pieces of data in a community: new Covid-19 hospitalizations, hospital capacity and new Covid-19 cases.”

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February 2, 2022

“Decision-makers are increasingly embracing the reality that we will have to “learn to live with” the coronavirus. But how will they know when to impose or lift restrictions?

Fortunately, they don’t have to guess. There are four underutilized data metrics they can use to guide decisions — not only for this surge, but for the rest of the pandemic.

First, if we want to know whether covid-19 is getting worse or better in an area, turn to the sewers. That’s right — levels of the virus in wastewater is one of the best early indicators of where the virus is spreading.

Second, keep an eye on health-care capacity. The biggest societal threat during the omicron surge was its impact on the health-care system, including on health-care workers. The Department of Health and Human Services does this already with its “Protect Public Health” data hub, and colleagues of mine have created their own “circuit breaker” tool. But these data tools don’t receive enough attention…

Third, track how many hospitalizations are actually due to covid. This is different from people who arrived at the hospital for something else but happened to test positive. Massachusetts just started reporting on this and the data are illuminating. About half of all hospitalizations there are for people being treated for covid. This means others who tested positive were not there for a covid infection; they were just captured in the routine surveillance testing…

Fourth, we must incorporate risk into our decision-making. The two biggest determinants of risk have stayed constant over the past year — age and vaccination status. The latest CDC data show that the hospitalization rate for unvaccinated adults is 67 per 100,000. For a vaccinated adults and unvaccinated teenagers, it is approximately 5 per 100,000. The rate for a vaccinated teen is 1 per million…

These four metrics can help decision-makers determine when to lift restrictions. And when they do, it doesn’t mean our work is done. The big problem remains the same — the risks for those adults who are unvaccinated is extraordinarily high. We should be spending more energy on vaccinating everyone — both in the United States and around the world — and less on imposing restrictions on those already vaccinated. Just as important as knowing when to put in controls is knowing when to pull them back.” (A)

February 17, 2022

As the pandemic has evolved and most Americans have sought vaccines for protection, and as those who chose to forgo vaccination became infected (often more than once), the risk that COVID-19 poses for most Americans has declined. It’s estimated that more than 90% of Americans have some level of immunity to COVID-19 through vaccination or prior infection.

Along with this wall of immunity, approaches adopted when we had few tools to prevent spread are no longer providing benefits that always justify their costs of social disruption, diminished classroom experiences, and economic drag.

But we’ve been slow to adapt our strategies to the evolving notions of risk. The CDC is soon expected to update its policies, moving away from national recommendations and instead tying to measures of local prevalence its guidance for the protective steps people should take. This community-by-community standard may not be enough. We’ve turned restrictions on but haven’t turned them off as conditions changed. In many cases, it’s because we’re still relying on the same metrics that we used at the start of the pandemic. These concepts for measuring risk have remained mostly fixed since that time, even as people acquired protections from the virus.

At the outset of the pandemic, we had a shared sense of the threat and a shared willingness to sacrifice a lot to deal with it. As the pandemic has evolved, and its burdens accumulated, that social compact has frayed. Now we need to shift from measures adopted collectively, to tactics taken individually by people who are judging their own individual risk against their degree of caution. This means we must accept more regional and local variation in measures adopted at the state level. The government’s role will be to make sure people have the tools they need to make those choices.

Steps that were critical in 2020 to reduce death and health care strain when we were overwhelmed are no longer justifiable. But what anchors that change? Even when actions were adjusted based on risk, in many cases it came too slow. Without deliberate guideposts, it’s hard to gauge why one posture should give way to another, and how to make these decisions….

Now in 2022, we need to leave those 2020 notions of risk behind. What was judged to be “moderate” prevalence this time last year, when we were largely unvaccinated, may be the new “low” when our vulnerability has declined. Especially as we confront a more transmissible but less severe strain like Omicron….

Yet a lot of the other constructs have stayed in place, even as the Omicron wave has started to subside. Until very recently, many children were still wearing masks in schools, with no agreed-upon standard for when that will end. When Omicron peaked, some schools reverted to remote learning. Offices are closed in many big cities. Some states and businesses are still mandating vaccines, trying to coerce a shrinking pool of vaccine holdouts at the cost of increasing acrimony, even as many of the unvaccinated have probably been infected, some more than once…

But so long as we remain mired in a 2020 doctrine for measuring prevalence and how it correlates with risk, we’re going to be unable to adapt public-health measures to the virus’s ebb and flow, or find a common touchstone for managing risk in our lives.

COVID-19 will remain a fearsome virus for the foreseeable future, but one that we must learn how to live with. Federal health officials have steered us through one of the hardest periods in our country’s modern history, and helped preserve life, even as we lost more than 900,000 of our fellow citizens.

We’ve gradually found a way to coexist with this virus. Now we need a glide path to what normal becomes and a new math to guide how we adapt to COVID-19 even if we never fully defeat it.” (B)

February 18, 2022

“The New York State health commissioner announced on Friday that the state would not enforce a booster-shot requirement that had been scheduled to take effect for health care workers on Monday.

The decision was an acknowledgment that too many workers were refusing boosters for the state’s health care system to continue functioning normally with the mandate in place. Three-quarters have “received or are willing to receive their booster,” said the commissioner, Dr. Mary T. Bassett, but the state cannot afford to lose the other 25 percent.

“The reality is that not enough health care workers will be boosted by next week’s requirement in order to avoid substantial staffing issues in our already overstressed health care system,” Dr. Bassett said in a statement on Friday. “That is why we are announcing additional efforts to work closely with health care facilities and ensure that our health care work force is up-to-date on their doses.”

She said New York officials continued to view booster shots as “critical tools to keep both health care workers and their patients safe,” and the statement said officials would reassess in three months.

While overall booster uptake among New York’s health care workers is 75 percent, the numbers vary widely among types of health care workers. For instance, according to the New York State Department of Health, 95 percent of hospice workers report that they have been or are planning to be boosted, but only 51 percent of nursing home workers say the same.

Health care workers are still required to have received their initial vaccination series under a mandate that took effect last year. Some workers challenged that requirement based on religious objections, but the Supreme Court declined to block it.

Separately, New York City fired about 1,400 public employees this week — less than 1 percent of the city’s work force — for not complying with a mandate requiring at least one dose of a coronavirus vaccine. The Supreme Court also declined to block that mandate.” (C)

February 20, 2022

“For more than a year, the Centers for Disease Control and Prevention has collected data on hospitalizations for Covid-19 in the United States and broken it down by age, race and vaccination status. But it has not made most of the information public.

When the C.D.C. published the first significant data on the effectiveness of boosters in adults younger than 65 two weeks ago, it left out the numbers for a huge portion of that population: 18- to 49-year-olds, the group least likely to benefit from extra shots, because the first two doses already left them well-protected.

The agency recently debuted a dashboard of wastewater data on its website that will be updated daily and might provide early signals of an oncoming surge of Covid cases. Some states and localities had been sharing wastewater information with the agency since the start of the pandemic, but it had never before released those findings.

Two full years into the pandemic, the agency leading the country’s response to the public health emergency has published only a tiny fraction of the data it has collected, several people familiar with the data said.

Much of the withheld information could help state and local health officials better target their efforts to bring the virus under control. Detailed, timely data on hospitalizations by age and race would help health officials identify and help the populations at highest risk. Information on hospitalizations and death by age and vaccination status would have helped inform whether healthy adults needed booster shots. And wastewater surveillance across the nation would spot outbreaks and emerging variants early.

Without the booster data for 18- to 49-year-olds, the outside experts whom federal health agencies look to for advice had to rely on numbers from Israel to make their recommendations on the shots.  (After several inquiries from The New York Times about the booster data for that age group, the agency posted it on its website Thursday night.)…

“Tell the truth, present the data,” said Dr. Paul Offit, a vaccine expert and adviser to the Food and Drug Administration. “I have to believe that there is a way to explain these things so people can understand it.”

Knowing which groups of people were being hospitalized in the United States, which other conditions those patients may have had and how vaccines changed the picture over time would have been invaluable, Dr. Offit said.

Relying on Israeli data to make booster recommendations for Americans was less than ideal, Dr. Offit noted.

“There’s no reason that they should be better at collecting and putting forth data than we were,” Dr. Offit said of Israeli scientists. “The C.D.C. is the principal epidemiological agency in this country, and so you would like to think the data came from them.”” (D)

February 20, 2022

“Gov. Gavin Newsom of California on Sunday described the new pandemic plan he released last week as a “more sensible and sustainable” approach that would lead the state out of “crisis mode” now that Omicron cases had dropped significantly and many residents were eager to move on.

His comments on MSNBC followed an announcement from state officials last week about a “next-phase” plan, which would prioritize strategies like coronavirus vaccination and stockpiling supplies while easing away from emergency response measures like mask mandates.

“A year and a half, two years ago, we had a war metaphor and we were hoping there would be a day where there would be a ticker-tape parade à la World War II,” Governor Newsom said. “At the end of the day, though, I think we are realizing that we’re going to have to live with different variants and this disease for many, many years. And that’s what this plan does, it sets out a course to do it sustainably.”

The Omicron variant sparked an enormous surge in California. Though the state has seen a sharp decline in known infections since mid-January, new cases are still hovering at more than 13,000 per day. Overall through the pandemic, the coronavirus has infected at least 1 in 5 Californians and killed more than 84,000, according to a New York Times database.

California is among the many states to loosen masking requirements in recent weeks, with Hawaii as the last state holding onto a statewide mandate. Puerto Rico also has yet to announce upcoming changes.

But federal health officials have yet to release any new recommendations that reflect the lifting of restrictions — including mask mandates in schools — in nearly every state, and the U.S. path in the next phase remains complicated.

Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, last week cited the need to “remain vigilant” so that infections continue their promising decline nationwide. She said the C.D.C. would soon be releasing new “relevant” guidelines that would suggest adjusting restrictions, including for mask-wearing, based on factors like hospital capacity, not just case counts…

California’s new plan emphasizes surveillance and preparedness, focusing on continuing to promote vaccines while stockpiling medical supplies, ensuring surge staffing, combating disinformation and increasing wastewater and genomic tracking to spot new variants. Under the plan, mask requirements would be subject to change based on the severity and volume of new infections…” (E)

February 21, 2022

As states loosen COVID-19 restrictions across the country, masking, particularly in schools, remains a controversial—and confusing—issue.

While it is true that COVID-19 case rates are dropping after the Omicron surge, hospitalizations remain high in many parts of the country, and the Centers for Disease Control and Prevention (CDC) and Biden administration say it is premature to lift mask mandates in schools. (The CDC continues to recommend that everyone wear a high-quality, well-fitting mask in all indoor places.)

Those in favor of unmasking in schools, however, say transmission among school children has never been well-studied and point to the social and emotional burden of masking, particularly in young children who benefit from seeing their teachers’ facial expressions. 

Given these various points of view, it’s no wonder that many parents are torn—and frustrated—as an increasing number of governors, including Connecticut’s, have set a date to lift mask mandates in schools, leaving the decision up to local authorities.

If your child’s school makes masks optional and you aren’t ready for them to be removed, should you make your child continue to mask up? What do we know about how masks prevent COVID-19 transmission in schools?

“Local governments are saying one thing, and the CDC is saying another. How can both of these things be true?” asks Jaimie Meyer, MD, MS, a Yale Medicine infectious diseases expert. “It seems that we are arbitrarily saying, ‘Hey, it’s time to take off the mask.’”

We talked more with Dr. Meyer and a fellow Yale Medicine expert to help make sense of this latest stage of the pandemic—and how best to navigate it—as sanely and as safely as possible.

Why are mask mandates in schools an issue?

The move to unmask started in early February when several states announced plans to ease many pandemic restrictions as the Omicron surge began to recede. It was a loosely coordinated effort that came on the heels of public health discussions and focus groups that began after the November election.

In Connecticut, the impending expiration of the governor’s pandemic-related executive orders, including a mask mandate in schools, brought the topic to the forefront. The state legislature voted to extend the mask mandate in schools until Feb. 28, after which the decision will fall to individual schools, towns, and cities.

Dr. Meyer notes that there is nothing from a health metrics perspective that is “magical” about this date.

“Why now? Why this moment? That’s pure politics. It is just executive orders expiring,” she says. “But I also think people don’t like mandates. They are tired of being told what to do. I think that really frustrates people.”

Ending mask mandates: a science- or political-based decision?

As Connecticut prepares to end its mask mandate, Dr. Meyer says she would prefer to see concrete metrics that prove it’s time to end them.

“Sometimes, mandates are needed for public health and safety,” she says. “So, it would be helpful to have a plan in place where we said that, for example, once the hospitalization rate is X and the vaccination coverage is Y—and when we’re able to better ventilate our spaces and spend more time outside—it would be OK to take the mask off. But to arbitrarily pick a date makes absolutely no sense to me. This virus will dictate what the right date is.”

Similarly, when the mandates are removed and you’re left only with personal choice, there should be metrics that allow us to say that certain measures are recommended or required for certain groups of people, she says.” (F)

February 23, 2022

“A more infectious type of the Omicron variant has surged to account for more than a third of global Covid-19 cases sequenced recently, adding to the debate about whether countries are ready for full reopening.

Health authorities are examining whether the subvariant of Omicron, known as BA.2, could extend the length of Covid-19 waves that have peaked recently in Europe, Japan and some other places.

“We’re looking not only at how quickly those peaks go up, but how they come down,” World Health Organization epidemiologist Maria Van Kerkhove said. “And as the decline in cases occurs…we also need to look at: Is there a slowing of that decline? Or will we start to see an increase again?”..

New York University virologist Nathaniel Landau has led research suggesting that Omicron BA.2 is even better than BA.1 at evading monoclonal antibody drugs developed to fight Covid-19. Nonetheless, he said a new Greek letter wouldn’t be needed unless BA.2 turned out to be more harmful to humans.”” (G)

February 23, 2022

“Chicago’s mask and vaccination requirements will end on Monday, February 28, the same day the state mask mandate is lifted, Mayor Lori Lightfoot announced yesterday. Suburban Cook County will follow suit, the Tribune reports.

Chicagoans will no longer be required to wear masks or show proof of vaccination in most indoor spaces, though individual bars and restaurants could still impose their own requirements, just as they did before the citywide vax mandate began on January 3. Masks will still be required on public transportation, in healthcare settings, and in certain school districts, including the Chicago Public Schools.” (H)

February 23, 2022

“As COVID-19 cases and hospitalizations continue to decline across the U.S., all states but one — Hawaii — have dropped their mask mandates or have announced plans to do so in coming weeks.

Retailers and cruises are following along, with Apple and Target stores lifting their own mask mandates this week. Cruise lines such as Norwegian and Royal Caribbean International have said mask requirements will be relaxed for vaccinated passengers, according to The Washington Post.

But CDC guidance hasn’t changed even as the Omicron variant recedes across the country. Vaccinated people should wear masks when indoors in areas of “substantial or high transmission,” which still covers more than 95% of the country, according to a CDC map.

As daily cases continue to fall, the CDC is reviewing its recommendations, Rochelle Walensky, MD, the CDC director, said during a briefing last week.

“We want to give people a break from things like mask-wearing, when these metrics are better, and then have the ability to reach for them again should things worsen,” she said.” (I)

February 26, 2022

Most people in the United States live in areas where those who are healthy do not need to wear masks indoors, according to new US Centers for Disease Control and Prevention guidance — a sweeping change from what earlier Covid-19 metrics recommended.

New CDC metrics indicate that about 28% of people in the United States live in a county where they need to wear masks indoors. Previously, CDC pointed to levels of coronavirus transmission within communities as a key metric for restrictions and recommended that people in areas with high or substantial levels of transmission — about 99% of the population — should wear masks indoors.

Now, the CDC’s “Covid-19 community level” metrics are based on three pieces of data in a community: new Covid-19 hospitalizations, hospital capacity and new Covid-19 cases. The CDC’s website includes a list of US counties and their current Covid-19 levels.

Under the updated guidance, more than 70% of the US population is in a location with low or medium Covid-19 community levels. For those areas, there is no recommendation for indoor masking unless you are at potential “increased risk” for Covid-19 and if so, the CDC recommends to talk to your health care provider about wearing a mask.

“We’re in a better place today than we were six months ago, six weeks ago, six days ago,” US Health and Human Services Secretary Xavier Becerra said in a statement to CNN. “Now it’s time to focus on severity, not just cases, of COVID. Because of all the hard work that’s been done and the many tools we’ve developed to tackle COVID, we can ease the guidance on mask use — not everyone in every place needs to wear a mask.”

At all levels, the CDC recommends people get vaccinated and boosted, and get tested if they have symptoms.

In areas with “high” levels, the CDC also advises wearing a mask in public indoor settings, including schools. In areas with “medium” levels, the CDC advises talking with your doctor about wearing a mask if you’re at increased risk for Covid-19. In areas with “low” Covid-19 community levels, there is no recommendation for mask wearing.

The CDC notes that anyone who wants to wear a mask should continue to do so.

The updated CDC recommendations reflect “a new approach” for monitoring Covid-19 in communities, Dr. Gerald Harmon, president of the American Medical Association, said in a statement Friday.

“But even as some jurisdictions lift masking requirements, we must grapple with the fact that millions of people in the U.S. are immunocompromised, more susceptible to severe COVID outcomes, or still too young to be eligible for the vaccine. In light of those facts, I personally will continue to wear a mask in most indoor public settings, and I urge all Americans to consider doing the same, especially in places like pharmacies, grocery stores, on public transportation — locations all of us, regardless of vaccination status or risk factors, must visit regularly,” Harmon said.

“Although masks may no longer be required indoors in many parts of the U.S., we know that wearing a well-fitted mask is an effective way to protect ourselves and our communities, including the most vulnerable, from COVID-19—particularly in indoor settings when physical distancing is not possible.”

Community Covid-19 levels

Counties with fewer than 200 new Covid-19 cases per 100,000 people in the past week are considered to have “low” Covid-19 community levels if they have fewer than 10 new Covid-19 hospital admissions per 100,000 or less than 10% of staffed hospital beds occupied by Covid-19 patients on average in the past week.

Levels are “medium” if counties have 10 to nearly 20 new Covid-19 hospital admissions per 100,000 or between 10% and 14.9% of staffed hospital beds occupied by Covid-19 patients on average in the past week.

Levels are considered “high” if counties have 20 or more new Covid-19 hospital admissions per 100,000 or at least 15% of staffed hospital beds occupied by Covid-19 patients on average in the past week.

Counties with 200 or more new Covid-19 cases per 100,000 people in the past week are not considered to have “low” levels of Covid-19. They are considered “medium” if they have fewer than 10 new Covid-19 hospital admissions per 100,000 or less than 10% of staffed hospital beds occupied by Covid-19 patients on average in the past week. They are considered “high” if they have if they have 10 or more new Covid-19 hospital admissions per 100,000 or at least 10% of staffed hospital beds occupied by Covid-19 patients on average in the past week.

“This new framework moves beyond just looking at cases and test positivity, to evaluate factors that reflect the severity of disease — including hospitalizations and hospital capacity — and helps to determine whether the level of Covid-19 and severe disease are low, medium or high in a community,” CDC Director Dr. Rochelle Walensky told reporters during a telebriefing call Friday.

“The Covid-19 community level we are releasing today will inform CDC recommendations on prevention measures, like masking, and CDC recommendations for layered prevention measures will depend on the Covid-19 level in the community,” Walensky said. “This updated approach focuses on directing our prevention efforts towards protecting people at high risk for severe illness and preventing hospitals and health care systems from being overwhelmed.”” (J)

February 27, 2022

“Gov. Kathy Hochul said the indoor mask requirement for schools statewide would expire Wednesday, March 2…

A drop in new cases of COVID-19 by a whopping 98% since omicron’s peak in early January, whose highest single-day total skyrocketed past 90,000 cases, is one of several improving metrics that the governor says supports lifting restrictions. She also pointed to a drop in hospitalizations and “strong vaccination rates.”

Counties and cities, the governor stipulated, will still have the authority to require masks in schools after the statewide order expires this week. Parents and guardians can also still send their kids to school in masks regardless of the change…

“We will lift the statewide requirement based on all the data that I’ve just outlined. However, there are some counties in the state that have a higher rate of transmission — we will allow them the flexibility to determine what’s best for their county. We would encourage them to take a look at this and follow the CDC, but this will no longer be a mandate,” Hochul explained.

It has been said that New York City, which just dropped mask requirements for students and staff while outdoors, would likely keep its indoor mask mandate through the April break, at least, though much could change in the next two weeks.” (K)

“Hawaii will soon be the only state in the country to have an indoor mask mandate, CBS News reports.

The news: Hawaii Gov. David Ige told local news station KITV that he has kept the indoor mask mandate because Hawaii has had the second-lowest death rate for COVID-19 in the United States.

What he said: “I am working with the Department of Health to determine when the time is right for Hawaii to lift the indoor mask mandate. Hawaii ranks second in the nation when it comes to COVID-deaths, in part because of the indoor mask requirement and other measures that have proven successful in protecting our community from this potentially deadly virus.

“We base our decisions on science, with the health and safety of our community as the top priority.”” (L)


MIAMI — Dr. Joseph A. Ladapo has come out strongly against mask mandates and lockdowns, only supports vaccination campaigns if the shots are voluntary and will not say whether he himself has been vaccinated.

But in pushing for State Senate confirmation of Dr. Ladapo as Florida’s next surgeon general, Gov. Ron DeSantis has found a partner in fighting what Dr. Ladapo calls the policies of “fear.”

For a Republican governor whose brash opposition to conventional public health wisdom has helped fuel obvious presidential ambitions, the appointment of Dr. Ladapo signals Mr. DeSantis’s determination to continue powering through a pandemic that has already cost 68,000 lives in Florida — this time, with what the governor can claim is a medical seal of approval.

The Florida Senate confirmed Dr. Ladapo’s appointment on Wednesday by a 24-15 vote, with all Republicans voting in favor over strong objections from Democrats…

Some of Dr. Ladapo’s positions, like his opposition to lockdowns and mask-wearing in schools, have been conservative stances for some time and are beginning to be accepted by liberal leaders now that more people are vaccinated and cases are plummeting. But these views were relatively rare among physicians in charge of public health policy at the time he was espousing them…

“Florida will completely reject fear as a way of making policies,” Dr. Ladapo said.

He did away with school quarantines and masks. When public health officials across the country were urging vaccines as a way to end the pandemic, Dr. Ladapo was raising warning flags about possible side effects and cautioning that even vaccinated people could spread the virus. He has refused to disclose his own vaccination status, which he maintains is a private matter.

Though Dr. Ladapo has acknowledged that vaccines are highly effective at preventing hospitalization and death, he said in October that “adverse reactions” to vaccines should receive more attention and urged people to “stick with their intuition and their sensibilities.”

Equally troubling for his critics was Dr. Ladapo’s failure to reject more fringe views on virus treatments, including the drugs hydroxychloroquine and ivermectin. He joined Mr. DeSantis in clamoring for the federal government to supply some monoclonal antibody treatments even after they had been deemed ineffective against the Omicron variant, which dominated caseloads.

“To say he’s out of the mainstream would be an understatement,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “His views are not only very unorthodox — they don’t make any sense.”” (M)

(A) Opinion: When should the government lift pandemic restrictions? These four metrics can provide the answer., By Joseph G. Allen,

(B) Americans Are Still Living With a 2020 Attitude Toward COVID-19 Risk. It’s Time for That to Change, BY DR. SCOTT GOTTLIEB,

(C) New York says it won’t enforce a booster shot mandate for health care workers.,

(D) The C.D.C. Isn’t Publishing Large Portions of the Covid Data It Collects, By Apoorva Mandavilli,

(E) Newsom’s new Covid plan aims to move California out of ‘crisis mode.’, By Azeen Ghorayshi,

(F) Is It Really Safe to End Mask Mandates in Schools?, BY CARRIE MACMILLAN,

(G) Fast-Spreading Covid-19 Omicron Type Revives Questions About Opening Up, by By Peter Landers,

(H) Chicago’s Mask and Vaccination Mandates for Bars and Restaurants Will End February 28, by Aimee Levitt and Naomi Waxman,

(I) Mask Mandates Ending in All But One State, By Carolyn Crist,

(J) New CDC Covid-19 metrics drop strong mask recommendations for most of the country, By Elizabeth Cohen and Jacqueline Howard,

(K) NY to End Statewide School Indoor Mask Mandate on Wednesday, NY to End Statewide School Indoor Mask Mandate on Wednesday

(L) This state will be the only one with an indoor mask mandate, By Herb Scribner,

(M) The Doctor Giving DeSantis’s Pandemic Policies a Seal of Approval, By Patricia Mazzei,