Luis M. Alvarez/Associated Press
D.C. Health is publishing new metrics to better help residents understand their COVID-19 risk.
Luis M. Alvarez/Associated Press
When D.C. Mayor Muriel Bowser announced the imminent end of the citywide mask mandate last week, she positioned the decision as part of a fundamental reframing of her administration's thinking — and policymaking — around COVID-19.
"This does not mean that everyone needs to stop wearing their mask," Bowser said during the press conference. "But it does mean that we're shifting government response to providing this risk-based information, and recommending layering strategies as the best way to protect yourself in the community."
Instead of using government policy to mitigate spread (like mask mandates and business closures), D.C. officials are instead emphasizing personal risk assessment, and updating the way the city tracks the coronavirus to better help residents make their own decisions. On Monday, Nov. 22, the city updated its coronavirus data webpage, which for nearly two years has linked certain COVID metrics (like community spread and hospitalizations) with reopening phases.
The pivot comes as officials begin to look at COVID-19 more like an endemic disease — meaning one that always circulates at some baseline level in a particular region — as opposed to a pandemic.
"We are learning to live with COVID...and the other part of that is, the world is not necessarily set up for the unvaccinated anymore," DC Health Director LaQuandra Nesbitt said last week. "We want to make sure that our residents have all of the information that they need to be able to understand their individual risks for COVID-19, based on their own exposure, their health status, as well as our risk in the community."
So what is that new information? Here's how D.C. is going to chart COVID-19 going forward:
These are the new key metrics that D.C. officials are pointing residents to as they manage their COVID-19 exposure risk. Unlike the previous "key metrics" chart, D.C. will no longer be linking metrics to reopening phases.
The average daily case rate per 100,000 residents is one key metric the city uses to gauge how coronavirus is spreading in the community.
The city uses three different thresholds to categorize this metric: minimal community spread, moderate community spread, and substantial community spread. These three categories used to be, at least in theory, tied to D.C. 's reopening phases — meaning that when community spread surpassed or dipped below a certain number, restrictions would be loosened or tightened. (In actuality, Bowser often strayed from that system.)
In this new phase of the pandemic response, those benchmarks of spread (minimal, moderate, and substantial) will no longer be linked to any restrictions, or "reopening" phases, as the city moves away from government-mandated mitigation strategies.
"We're no longer making decisions about the reopening of D.C.," Nesbitt said last week.
D.C. will also begin including on its website the CDC's case rate, which also measures community spread (or community transmission). The CDC tracks D.C.'s case rate per 100,000 residents, but unlike DC Health's metric, which is a daily average, the CDC measures the number of new cases reported over the past week, per 100,000 residents. The CDC also uses four different benchmarks to gauge the severity of transmission — low, moderate, substantial, and high — while D.C. uses three (minimal, moderate, and substantial). This is why D.C.'s data show the city is currently reporting "moderate" spread, while the CDC's data show "substantial" spread. These conflicting points led to confusion earlier in the summer, when the CDC announced that all individuals in regions with high or substantial levels of spread resume wearing a mask indoors. Per the CDC's community transmission rate, all individuals in D.C. — regardless of vaccination status — are still recommended to wear a mask, given the weekly case rate per 100,000 residents sitting around 93, as of Tuesday.
Nesbitt said publishing both graphs (the daily case rate per 100,000 residents, and the CDC's weekly case rate per 100,000 residents) will provide a fuller picture for residents when assessing risk.
COVID-19 hospitalization rates.
When D.C. councilmembers pressed Bowser's team on why they decided to lift the mask mandate just before the holidays — when many residents are expected to travel and gather indoors — DC Health officials justified the move in part by pointing to hospitalization numbers. According to the most recent data, 5.6% of recent COVID-19 cases resulted in hospitalization, and unvaccinated residents make up 92% of such hospitalizations in the past seven days.
Going forward, D.C. will be publishing the percentage of new positive cases that result in hospitalization — a measure Nesbitt said would be more useful for residents assessing their risk level, as opposed to a metric like the hospital capacity, which the city has been publishing throughout the pandemic.
"If you're trying to get people to understand their COVID risk, and their risk of severe illness and hospitalization, it's more useful for them to know: if I get COVID, what's the likelihood that I'll end up in a hospital?" Nesbitt explained when announcing the metric changes last week. "Less useful, in terms of understanding your individual and community risk, is to know the proportion of all the people who are in a hospital for heart attack, strokes, elective surgeries, etc. — what proportion of them are in the hospital for COVID."
The hospitalization capacity and utilization metrics are still going to be used internally by DC Health, Nesbitt said.
Nesbitt said the percentage of D.C. residents fully vaccinated is another key metric that people should consult when gauging their risk. As of Tuesday, Nov. 22, an estimated 63% of D.C.'s total population has received a vaccine.
When pressed by councilmembers last week, officials in the mayor's office again leaned on vaccination rates as a justification for lifting the mandate — Donahue noted that 99.3% of residents ages 65 and up are at least partially vaccinated.
Going forward, DC Health will be publishing the vaccination rate over time, which will show percentage of fully vaccinated residents on a timeline. Previously, residents couldn't see vaccination numbers plotted out. The graph now allows D.C. to show whether, or how well, vaccination rates are improving week to week, or month to month.
Officials don't have a goal in mind — much like they are not linking mask mandates to a certain transmission metric. Instead, the vaccination rate is designed to be one piece of information that residents use when assessing their risk, or understanding the risk of COVID exposure in the community.
D.C. also publishes a break through dashboard, showing the percentage of recent positive cases that occurred in vaccinated individuals, demographic information, and hospitalization rates.
This graph charts D.C.'s percentage of residents fully vaccinated over time.
This story is from DCist.com, the local news site of WAMU.