New Biden BA.5 “Plan” Openly Abandons Metrics for Preventing Infection, Butchers Mask and Ventilation Policy

By Lambert Strether of Corrente.

My yellow waders got all yucky and corroded when I covered Hillary Clinton’s lunch with the FT back in June, and the repair guy is still coping with the damage. So I will not be able to give the Biden Administration’s latest “Fact Sheet” on BA.5 the full attention it so richly deserves. In policy terms, the “Fact Sheet” is not materially different from the Administrations “National COVID-⁠19 Preparedness Plan” of March 2, with the exception of a focus on “equity,” a word that does not appear in the “Fact Sheet”, presumably because it has been achieved. There’s more specific content on both masks and ventilation in the “Fact Sheet” that in the “Prepareness Plan,” which would be a good thing were the content not wholly inadequate, not to say lethal if you follow the advice. (I can’t see that the White House Office of Science and Technology, which is good on both topics, had any input whatever, which would — hold onto your hats, here, folks — support the idea that the “Fact Sheet” is a mere public relations strategy.)

Reaction to the “Fact Sheet” has been extremely muted, not to say stifled. WaPo’s headline — “Biden officials urge use of booster shots, antivirals against BA.5” — suggests that the “vax and relax” mindset is still fully entrenched in WaPo’s readership, although the story is somewhat less limited:

White House coronavirus coordinator Ashish Jha said the administration’s strategy to manage BA.5 relies on vaccination, antiviral treatments, testing, masking and improved indoor ventilation, measures that have worked to keep people out of the hospital and from dying.

(Note the abandonment of the goal of controlling infection, to which we shall return.)

The Washington Times coverage — “White House COVID coordinator: Country can weather new BA.5 variant just fine” — is similar:

The Biden administration said the fast-moving BA.5 variant of the coronavirus is a stark but manageable challenge, unveiling a plan that relies on frequent testing, antiviral drugs and up-to-date vaccinations while stopping short of an immediate expansion of the booster campaign as drugmakers reformulate their shots.

Similar except, like the Guardian‘s coverage but not WaPo’s they leave out masking and ventilation altogether.

In this post, I’ll skip over the vaccination and booster controversies, and focus on the Biden Administration’s strategic goals, and also on masks and ventilation. I’m doing this for two reasons. First, I’m committed to policy of layered protection (“Swiss Cheese Model“), which I think would both subsume Biden’s vax-first policy and be more effective in preventing airborne transmission, especially given that the operational definition of Biden’s “Preparedness Plan” has turned out to be “Let ‘Er Rip,” turning the United States into a global reservoir for SARS-CoV-2 infection. Second, I believe that the Biden Administration’s guidance on both masking and ventilation is lethal, or to put matters more politely, won’t save as many lives as it could. (The “Fact Sheet” relies heavily on CDC content, so I’ll have to stumble into that gruesome morass as well, for which I apologize in advance.)

Let us now turn to “Fact Sheet: Biden Administration Outlines Strategy to Manage BA.5,” annotating passages in our usual way.

“Fact Sheet” Strategy: “Today, the White House COVID-19 Team is announcing its strategy to manage[1] BA.5. The strategy relies on ensuring that Americans continue to have easy and convenient access to the vaccines, treatments, tests, and other tools that [2] COVID-19. These tools – even in the face of BA.5 – , keep people out of the hospital, and save lives – and we can [3].

[1] “Manage” how, exactly? Ed Yong asks the key question:

This is what “living with COVID” means—a continual cat-and-mouse game that we can choose to play seriously or repeatedly forfeit. The stakes of that game depend on a very simple question: Should we still care about preventing infections? If the answer is ‘not so much,’ which is the implicit and sometimes explicit posture that America’s leaders have adopted, then BA.5 changes little. But if the answer is ‘yes,’ as I and most of the experts I talk to still believe, then BA.5 is a problem.

In what follows, we’ll see that preventing infections is not a goal of the Administration. The metrics they “manage” by show this clearly.

[2] Notice the slipperiness between “protect against and treat” vs. “work to prevent serious illness” vs. “prevent nearly all COVID-19 deaths.” I think that, given the Biden administrations peformance on Omicron (record spike) and BA.5 (a guesstimated record spike, though CDC has butchered the case counts, so it’s hard to tell) plus the fact that the vaccines are not sterilizing and reinfection is frequent makes a claim to “protect against” weak, and the Administration is wise to slide away from it in the text that follows.

[3] As we see, the only metrics that matter are hospitalizations and (“from Covid”) deaths, and not infection. Long Covid, vascular damage, and neurological damage, all of which can come from “mild” infections, are not a metric that the Administration watches for.

“Fact Sheet” Mobilization: To confront BA.5, the Administration will continue mobilizing the full strength and capabilities of the federal government[1] and working with state and local leaders, health care workers, the private sector, and community- and faith-based organizations to ensure that the American people have easy and convenient access to and use vaccines, tests, and treatments[1].

[1] Well, maybe. Here’s a simple test you can apply yourself in the coming weeks. As readers surely know, the President’s time is the most valuable asset of any Administration. You would, therefore, expect to see “the full strength and capabilities of the federal government” embodied in the President’s presence, speaking to the issue. Now, Biden is a busy guy when not napping, so that’s probably too high a bar for this Administration. But what about President-In-Waiting Harris? Here is Harris’s schedule for the year from the Los Angeles Times:

Harris is obviously spending hardly any time on Covid at all (even when Omicron was peaking). If the Administration committed to the “full strength” bit, her schedule will fill right up with BA.5 events. However, this seems unlikely; if it were, Jill Biden would already be on it. I can’t find her schedule, but last I heard she was trying to salvage the Democrat midterms by appealing to the Hispanic Latinx vote. Of course, we can hope, but this doesn’t seem likely.

[2] “Vaccines, tests, and treatments” again shows that preventing infection does not matter to the Administration.

“Fact Sheet” Masking: Experts agree that masking in indoor, public spaces is an important tool to control the spread[1] of COVID-19. The CDC’s COVID-19 Community Levels provide individuals with clear recommendations[2] on when to consider masking in indoor, public spaces[3]. As BA.5 drives an increase in cases, the Administration continues to encourage Americans to visit COVID.gov to find the level of COVID-19 in their community and follow CDC’s recommendations on wearing masks in public, indoor settings[4].

[1] With “control the spread,” we finally get, conceptually, to transmission. However, the Administration doesn’t recommend a metric for transmission, unlike deaths and hospitalization (“You can’t manage what you don’t measure”), so the Fact Sheet’s remarks on masking are purely performative. (But don’t get me wrong: They’ll be “fighting for” them!)

[2] The CDC’s “Community Levels” metric — which has grown all over everything like kudzu — is indeed clear. It’s also wrong, and lethally so. See note [4] below.

[3] Private spaces are important too. Anecdotally — some of the best data we have, given the givens — there are many cases of households where one member became infected, but when the household adopted a layered strategy including masking, but also isolation of the infected, ventilation, and Corsi boxes, no other members were infected.

[4] Here, the Administration is recommending CDC’s Community Levels metric. Community Levels combines a leading indicator (cases) with a lagging one (hospitalization). The lag between infection and hospitalization can be as much as two weeks. Therefore, by the time Community Levels kicks in, infection in the community could already be high (important given that Covid exhibits doubling behavior. The CDC does have a map of transmission only (and explictly discourages dull normals like you from using it). That map has been solid red (dangerous) for a long, long time. However, CDC’s Community levels map, gamed as it is, has been green (safe) also for a long, long time. Eric Topol described CDC’s game-playing with metrics back in May, 2022:

[INTERVIEWER: ] But you look at the CDC’s [Community Levels] map, it shows the country where there’s a few hot spots, the orange up in New York and some yellow up in Minnesota and Michigan, but the rest of the country looks green, as if it — there isn’t a problem with this virus. What is the disconnect there?

[TOPOL: ] Well, I have called it .

That is, the CDC is — frankly, it’s . I mean, it’s starting to approach that of what we saw with the Omicron wave. And it’s continued — it’s rising quickly.

So this is really irresponsible of the CDC to give us this impression that things are copacetic, when they couldn’t be — that couldn’t be further from the truth.

In other words, if you follow the CDC’s Community Levels metric, you could be masking up two weeks too late. Don’t use it. Use the map of transmission only, the one that shows the real danger to you (scroll down to the red map with the “Community Transmission” dropdowns for Data Type and Map Metric. Ignore the CDC’s hectoring, immediately above the map, that “Community Transmission levels are provided for healthcare facility use only.”

“Fact Sheet” the Immunocompromised: The Administration has initiated a communications campaign to ensure that immunocompromised individuals and their close contacts are up to date with COVID-19 vaccination and boosters[1].

[1] Once again, anecdotes are what we have, but from what I hear, what the immunocompromised want most and don’t have is universal masking, so they can go out into the world like normal people and not worry about sharing air with the infected. (Yes, universal masking is safer than “one-way” masking.)

“Fact Sheet” Ventilation: Improving ventilation [1] help prevent the spread of BA.4 and BA.5 indoors in buildings. The Administration has provided state and local leaders hundreds of billions of dollars in federal funds that be used in schools, public buildings, and other settings to improve indoor air quality, and the Administration will continue to advance indoor air quality in buildings, including by around ventilation and filtration improvements to reduce disease spread[2], as well as by buildings and organizations that have taken steps to improve indoor air quality. These efforts will expand on the Administration’s for improving indoor air quality and reducing the risk of spreading dangerous airborne particles and the Clean Air in Buildings Challenge, which all building owners and operators, schools, colleges and universities, and organizations of all kinds to adopt key strategies to improve indoor air quality in their buildings and reduce the spread of COVID-19. Additionally, CDC has released interactive tools to help individuals at home[3], in schools[4], and in other buildings to understand how air flows in their space and what they can do to help shore up air quality and improve ventilation indoors.”[5]

[1] I have helpfully underlined the Administration verbiage that indicates this is all voluntary, and there will be no demands for compliance with any sort of regulation (dread word).

[2] Here again we have a nod to tranmission, but with no metric and no enforcement, the Fact Sheet is merely performative.

[3] Naturally, the “Fact Sheet” doesn’t actually link to the interactive tools, but I think this is the guidance for homes:

I’ve got to assume that this is a tool, and not some kind of children’s toy (although the drawing style, especially the color palette, argues for the latter. The softness is designed to make it appear harmless, which it isn’t.) A good tool would take into account: The size of the room, the number of guests, and the duration of stay. Measures would include opening doors (not just windows ffs), turning on bathroom and kitchen fans, buying a box- or window- fan to really move the air, and Corsi-Rosenthal boxes as an alternative to portable air-cleaners (“DIY alternatives using single 1”, 2” and 4” MERV 13/14 filters compare favorably to commercially available systems in terms of estimated CADR and dBA but at .”) Readers will doubtless have additional measures.

[4] The tool for schools is worse:

A good tool would take into account: The size of the classoom, the number of students, and the duration of class. Incredibly, CDC’s tool doesn’t mention opening windows or doors. Not incredibly, but even more lethally, they don’t mention Corsi-Rosenthal boxes, or even portable air cleaners. Finally, they don’t mention using CO2 meters as a proxy for shared air in the room, so parents could determine how much danger of infection their children were actually in.

[5] Throughout, although most obviously with the omission of CO2 meters, we see the Biden Administration’s wilful and crass evasion of measuring transmission.

“Fact Sheet” Covid.gov: Earlier this year, the Biden Administration launched COVID.gov, a new one-stop shop website[1] to help Americans find where to access lifesaving tools like vaccines, tests, treatments, and masks[2]. People can also type in their county to find the latest updates on the level of COVID-19 in their community[3] and related guidance[4]. And, with a click of a button, people can access resources related to testing, ventilation, and other important COVID-19 topics.

[1] The site is not at all “one-stop.” In fact, it’s a thin layer of quasi-friendly redirections, primarily to the gruesome tangled mass that is the CDC’s website, but also to other sites.

[2] Here is the Covid.gov on masks:

Let’s just say this isn’t as helpful as it could be.

[3] By “level of COVID-19 in their community” the Administration means CDC’s “Community Level” metric, which Eric Topol (see above) rightly calls a “capitulation” and a “deception”:

Note the highlighted material at the bottom: “The Community Level is low because the levels of hospitalizations, cases, and patients in hospitlals are not a strain on the local health system.” In other words, transmission as such is not a relevant metric. If CDC were organizing a campaign against drunk driving, they’d be telling people it was OK to drive drunk because the ERs aren’t full.

[4] I tried travel:

What I would really like to know is whether my airports (leaving and arriving) are in “Rapid Riser” counties, because the air travel is one ginormous superspreading event, and so airports (as we saw in Manhattan in Spring 2020) are often epicenters of transmission spikes. (Therefore, a seven-day transmission average is not enough; I really want “rapid riser”). Unfortunately, CDC now only delivers “Rapid Riser” data twice a week, which is not fast enough, given the doubling behavior of the virus. Ah well, nevertheless.

Conclusion

What we see in the “Fact Sheet” is a willful refusal to create metrics or regulation for masking and ventilation, or for transmission generally. I can only conclude that the following meme (sorry) describes not only the policy of the Biden Administration but the future course of the disease:

Let ‘er rip!