Hello,
I am a health policy professor at Stanford School of Medicine and Stanford Law School; my research for the past year has focused on COVID policy decisions and the evidence base underlying them. I am writing to contribute some input on the City Manager's proposal for reopening city facilities. It strikes me as out of touch with the current science, as well as unrealistic about vaccination targets, in a way that could unduly delay reopening.
Although it would be wonderful if we got to 70% vaccinated status in San Mateo County, that point may be a very long time in coming. Vaccine hesitancy remains surprisingly high, and keeping kids from picking out a library book while everyone waits to see what the holdouts will do doesn't make much sense to me, if the metrics of community prevalence are holding steady or improving. Further, some of my colleagues in infectious disease epidemiology think 80% is probably a better estimate of the number needed for herd immunity, and we may not ever get there with vaccination coverage. Instead, we may need to think about COVID as a chronic disease that circulates at low levels in the population, and keep up precautions such as masking and distancing for some time while allowing life to resume. For these reasons, I don't think using vaccination coverage as a trigger for reopening city facilities is the right call.
It also doesn't make sense to me to group all the remaining city services together for reopening triggers. Indoor gyms and libraries do not present the same risks, and reopening decisions should make use of the evidence we now have about the respective contributions of different venues to community spread. There also needs to be a risk/benefit calculus associated with each type of venue--not just a risk assessment. Senior centers, for example, have huge public benefits (and a clientele that is likely to be vaccinated at higher rates than the general public); other City services less so. Finally, of course, there is the overall incongruity of allowing on-premises dining -- a proven vector for COVID transmission -- but keeping many lower-risk activities and services closed simply because they are City operated. While reasonable people can and have criticized the State's framework, such inconsistencies undermine public acceptance of reopening frameworks when they are not evidence based.
I hope the City Council gets some further input from public health scientists before it votes on this proposal.
Thank you,
Michelle Mello
