While the exact language of the next iteration of the Pitkin County public health order still needs some finessing, the message was clear from board of health members during Thursday’s meeting: When in doubt, wear a mask.
“I think everyone should just get used to having a mask in their pocket. That’s the new normal; we should get used to it,” said Jeannie Seybold, an at-large member of the health board.
That was in response to proposed language from public health officials’ recommendation that the next mandate — the current one sunsets at the end of the month — drop a sort of loophole to mask wearing, which specifies that a face covering is only required to be worn outside if someone is within 6 feet of another person of another household for more than 10 minutes.
The recommended update would lose the “for more than 10 minutes” clause.
While there was general agreement from the health board on that note, there was some discussion about how best to relay an adopted culture of stringent mask-wearing expectations with the simplest messaging possible that still respects the complexity of responding to the COVID-19 pandemic.
“There’s so much confusion, and to have anybody mathematically computing anything is probably a mistake,” board member Brent Miller said, noting the 6-foot physical distancing specificity in the public health order. “If you’re around anyone, you should have a mask.”
But that 6 feet is important, maintained Dr. Kim Levin — who in addition to serving as Pitkin County’s medical officer is also an emergency department physician at both Aspen Valley and Valley View Hospitals. While allowing that public health orders need to be easily understood in order to be effective, substituting concrete distances for potentially subjective terms such as “near” or “close” could create room for differing interpretations, she cautioned.
“I just wouldn’t want any room for interpretation, where someone’s arguing with the police about [their] interpretation of ‘near.’ There is evidence that 6 feet or two meters [create mitigating factors to transmission],” she said. “There’s been some studies done.”
To that effect, Levin dedicated a portion of her presentation to breaking down arguably the most comprehensive study on the efficacy of social distancing, wearing masks and eye protection in minimizing community spread of the disease caused by the novel coronavirus.
“We know we’re still very early in the pandemic, and there’s not a lot of research out on wearing a mask and the transmission of COVID. But there is science behind wearing a mask,” she said.
Indeed, according to research published in “The Lancet” — a peer-reviewed general medical journal considered on par with the “New England Journal of Medicine” — wearing a mask is the most effective practice an individual can undertake to control the spread of COVID-19 when social distancing is not feasible.
“The result is that a face mask could result in a large reduction in risk infection,” Levin summarized, adding that while the research found that the risk of infection or transmission was 17.4% between individuals not wearing a mask, that statistic dropped to 3.1% when masks were involved.
“I find [that] significant,” she said.
“The Lancet” research hinged on a systematic review and meta-analysis of 172 observational studies in 16 countries across six continents. Additionally and relevantly, it looked at 44 comparative studies in both health care and non-health care settings, according to the journal’s explanation of the research methods.
It wasn’t the only time published research was cited in Thursday’s health board meeting to bolster officials’ desire to see a stronger mask mandate. Laryssa Dandeneau, one of the 14 new full-time employees recently hired to round out Pitkin County’s public health department in the wake of COVID-19, cited four separate studies in her presentation as “evidence for universal masking.
Not that the board required much convincing.
“If you’re around other people, wear your mask. I don’t know if I can make it any simpler than that, and there may be downsides, but I can’t help but think we need to simplify it down to that point and put that message out,” health board member Greg Poschman said. “That way, wherever you are around other people, you put up your mask.”
Aspen Mayor Torre underscored the point and went a proverbial step further — in addition to wanting to strengthen the language in the next public health order around the mask mandate, he also lobbied to do away with yet another clause in the mandate that he saw as undermining local compliance efforts: allowing members within the same household to interact in public without masks.
“What we have right now in downtown Aspen is density. You’re walking by other people that aren’t in the same household,” he said. “That provision makes it difficult in the downtown Aspen area — not just for enforcement but compliance as well. That’s some of the reasoning that we’re looking at and considering going to that mandated mask zone.”
And while Jordana Sabella, county public health planning, prevention and partnerships manager, agreed Torre’s point was a good one, she also highlighted the geographical and corresponding cultural diversity within the county as a reason for the proposed continued flexibility in the future order.
“The idea is if they’re out there in rural spaces, that it’s really different than being in downtown Aspen,” she said. “We as the public health department really support the idea and what city council is working on: creating a mandatory mask zone. But for considering the differences that exist in all of Pitkin County, we wanted to put something into the public health order that people [in those rural areas] felt they could also follow and made sense to them.”
The definition of “informal” also came under scrutiny Thursday, as county staff also recommended the health board adopt its suggestion to reel back in gatherings not otherwise permitted as a special event or sponsored by a business to a maximum size of 10 people.
“What’s the nature of informal?” Torre posed. “I get that you’re saying a party in the park cannot happen and tables of eight are only allowed at restaurants, but could a restaurant host a party for 20 with this language?”
The answer, essentially, is yes — so long as that restaurant has submitted a COVID-19 safety plan with the county. The greater concern, per information gleaned from recent contact investigations of positive known cases, is that seemingly healthy people are trusting their friend networks as also being healthy and so are socially gathering in ways otherwise not completely safe in a COVID-19 era.
“Folks are coming together, and what we’ve been hearing with the contact tracing is people feel really safe with their friends,” Karen Koenemann, county public health director, said. “What we are proposing is that informal group size go down from 50, which it currently is, down to 10 people. Just because someone isn’t coughing doesn’t mean someone doesn’t have COVID-19, they’re just asymptomatic.”
It was with some irony that a board of health meeting in which Koenemann outlined a mitigation plan — prepared in case the concerning upticks in data reflecting the number of new COVID-19 cases among residents, number of tests being done at Aspen Valley Hospital’s respiratory evaluation site and the infection rate of positive results among those tests — was concluded by a board member’s recognition of harassment incurred by Koenemann and her team throughout the pandemic thus far.
“I know some of us in our community have received threatening letters, phone calls, things like that. They’re on the front lines, they’re doing a great job for us, and it’s not easy,” Poschman said. “I just want to express my appreciation for Karen, your staff and everyone who’s working double time in keeping us all safe.”
In a phone call with local media representatives after the meeting, Koenemann confirmed Poschman’s assertions, albeit with some trepidation.
“Some public health directors in Colorado have faced a lot of really, really horrible things: personal threats, personal vandalism. That is not happening here,” she assured.
That said, the local public health team is not impervious to negative feedback from the public that goes beyond constructive criticism, she continued, adding that the coronavirus has launched her and her colleagues into a limelight not usually experienced in her field.
“I do have a shared folder of emails in our inbox that are not very kind. I cannot tell you how incredible this team has been. We have literally been working 14 hours a day since this pandemic began, and everybody works weekends.
“It’s really hard to get the horrible emails, and it’s really hard to see the horrible Facebook posts, and I think it really is impacting this team,” she said. “I think there’s trauma involved in the response. Mental health is being impacted, physical health is being impacted. It is hard. I think this community has been overall fine — we are really lucky to have a community that understands and is fairly cooperative. But that doesn’t mean it hasn’t been difficult for us.”