This map is the key to when US might start easing Covid-19 restrictions

By Jacqueline Howard and Carma Hassan, CNN

There is now more optimism that the worst of the coronavirus pandemic may be ending — and as other nations lift certain Covid-19 restrictions, some public health experts question whether US counties and cities should consider easing their guidance on mask-wearing or social distancing, as well.

But others warn not to relax such measures too soon.

Denmark has decided to lift all Covid-19 restrictions within the country, Prime Minister Mette Frederiksen announced Wednesday evening, adding that Covid-19 “should no longer be categorized as a socially critical sickness.”

“Denmark will be completely open from 1 February,” Frederiksen said. “Tonight we can start lowering our shoulders and find our smiles again.

“The pandemic is still here, but with what we know now, we dare to believe that we are through the critical phase,” Frederiksen added, highlighting the success of Denmark’s vaccination program and booster shots.

In the United Kingdom, people in England no longer have to show their Covid-19 vaccination passes to get into nightclubs and other large venues. Masks aren’t required in any public places, although they remain recommended on public transport. Wales, Scotland and Northern Ireland are also easing their restrictions.

But in the United States, “we know there is still much to be done to stop the spread of COVID-19 and end the pandemic. We are still seeing far too many new cases, hospitalizations, and deaths,” Kristen Nordlund, a spokesperson for the US Centers for Disease Control and Prevention, wrote in an email to CNN on Friday.

The US daily average of cases is near 500,000, with more than 1,000 deaths, according to the CDC, which encourages everyone to get vaccinated and boosted if they’re eligible.

“As we look forward to the spring, it’s important to continue practicing prevention measures that we know work — vaccinating, wearing a mask in public, indoor settings, staying home when you are sick, and washing your hands frequently,” Nordlund wrote.

Many US counties and cities rely on coronavirus transmission rates to determine when or if to ease restrictions and recommendations — and nearly every single county is still experiencing high levels of spread.

Community transmission is still key metric

In the United States, most Covid-19 orders happen at the local level.

And the CDC’s data on coronavirus transmission by county is used as a key metric in decision-making around public health policies and when certain restrictions should be implemented or lifted, Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, told CNN on Wednesday.

The CDC tracks and measures the spread of the virus by county and presents its findings on a map using a four-tiered, color-coded system that shades in counties with “high” levels of transmission as red, those with “substantial” levels as orange, “moderate” levels as yellow and “low” levels as blue.

“This is really important,” Freeman said of the data.

“It’s based on new cases per 100,000 persons in the past seven days. Low is less than 10. Moderate is another range, substantial another and high is another,” she said. “And then a secondary indicator is percentage of positive (nucleic acid amplification) tests during the past seven days.”

The CDC defines low transmission of the coronavirus as a community having fewer than 10 new cases per 100,000 people in the past week and less than 5% test positivity during the past week. High transmission is at least 100 new cases per 100,000 people in the past week, and 10% or greater percentage of positive tests.

As of Monday, nearly all counties are in the red, with high levels of transmission.

Only four are identified as having low levels: Kalawao County, Hawaii; King County, Texas; Arthur County, Nebraska; and Terrell County, Texas. Glasscock County, Texas, is identified as having substantial transmission.

“The whole country is still red,” Freeman said. “So we haven’t yet overcome this latest surge.”

In Columbus, Ohio, the recommendation for the city’s mask order is “that we need to be in CDC’s yellow category for moderate community transmission for four consecutive weeks” before the order can be lifted, spokesperson Kelli Newman wrote to CNN in an email Friday.

In North Carolina’s Mecklenburg County, there is an indoor mask mandate in place that will automatically lift once the percent positivity rate for the county falls below 5% for seven consecutive days, Raynard Washington, the county’s public health director, told CNN on Friday.

“Within that mandate, there’s actually a stipulation that’s tied to community transmission, at which once the community reaches a certain level of transmission, as measured by percent positivity, the mask mandate itself will automatically be rescinded,” Washington said.

He added that right now, the county is “a bit away” from reaching that low level.

In San Francisco, city officials announced Thursday that even though Covid-19 cases are “still high,” they are “dropping rapidly” and beginning Tuesday, city office workers, gym members and some other groups of people may remove their masks indoors if they are “up to date” on their vaccinations.

In Colorado, the state Department of Public Health and Environment on Friday removed the requirement that people must show proof of vaccination to attend unseated, public indoor events of more than 500 attendees in Arapahoe, Adams, Boulder, and Jefferson counties — as well as the City and County of Denver, and the City and County of Broomfield.

Health officials in Colorado have told reporters that the statewide percent positivity remains high, but shows “encouraging” decreases.

There is no definitive, blanket guidance from the CDC on when communities should lift certain Covid-19 policies and return to some version of normal.

But NACCHO plans to hold brainstorming and listening sessions this spring with local and federal public health officers to discuss what the end of the pandemic might look like — and how to determine when we’ve reached the end.

“NACCHO is having meetings coming up in the spring where we’re really actively focused on these discussions, but we’re hoping before then, we’ll have a little bit more direction and guidance to go on,” Freeman said, adding that the first meeting is scheduled for April.

She expects representatives from the CDC, Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response and the Federal Emergency Management Agency to be in attendance.

It is going to be a “real challenge” to determine a clear benchmark for when Covid-19 health measures should lift in the United States, Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration, said Sunday.

“Right now, you look at a lot of federal health guidance and it says that these measures should be lifted when there’s low prevalence,” Gottlieb told CBS’s Margaret Brennan on Face The Nation.

“That was the old measure. In the age of Omicron, with a much more contagious variant and with the fact that the population has a lot of immunity, so we’re less susceptible overall, we may need to rethink that,” Gottlieb said Sunday.

“We may need to decide that once we get to 20 cases per 100,000 per day that may be the point at which we start to withdraw these things,” he said. “I’m not so sure we’re going to get to 10 anytime soon. Right now, Washington DC is at 15. New York’s at 75. With this new Omicron strain that’s circling we may stall out around 20 — and that may be the point where we have to consider withdrawing a lot of these measures.”

‘We’re in a better place now’

As the United States marks two years since the first laboratory-confirmed case of Covid-19, former CDC Director Dr. Tom Frieden said last week he’s feeling positive about the direction the nation is headed.

“I am more optimistic about the pandemic today than I have been since it was declared a pandemic nearly two years ago,” Frieden, currently the CEO and president of a global health initiative called Resolve to Save Lives, told CNN on Wednesday.

Frieden added that the “flash flood” of cases stemming from a surge of the Omicron variant should soon slow, largely as a result of effective vaccines.

“We don’t know if there will be another wave, but we do know that we’ve got much stronger defenses than we’ve ever had,” Frieden said. “We’re in much better shape than we’ve ever been. But we do need to hang on for just a few more weeks, until the Omicron flood recedes, so we don’t overwhelm the hospitals, which are really stressed out.”

US Surgeon General Dr. Vivek Murthy has said he shares Frieden’s optimism that the nation is in better shape, but he urges Americans to remain vigilant against Covid-19.

“I certainly share the optimism that we’re in a better place now, and we will be in a better place in a few weeks, but I don’t think that means that we should take our foot off the accelerator,” Murthy told CNN’s Jake Tapper on Thursday, though he added that we shouldn’t underestimate the coronavirus.

“What gives me more optimism and hope, Jake, is the fact that we not only have abundantly available vaccines — we not only see that they’re working well to protect people against hospitalization and death — but we have more therapeutics,” Murthy said.

“These together, along with a targeted use of tests and masks, this is what I believe is going to help us get through future waves, as well.”

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