Flagler County Health Department Administrator Bob Snyder on Thursday said that whether vaccinated or not, students indoors should be wearing masks when they return to school on Aug. 10.
Snyder’s unequivocal declaration stresses similar recommendations by the Centers for Disease Control, the American Academy of Pediatrics, and physicians at AdventHealth. But the school district is proceeding with masking only on a voluntary basis. Broward County schools, in defiance of the governor’s stance, declared this week that it would require mandatory masking and pressure builds on other districts to do likewise. But the governor is threatening to call a special session of the Legislature to rewrite the law and statutorily forbid districts from imposing masking requirements.
“Flagler County Schools is making a terrible mistake by not mandating masks,” said Dr. Paul Mucciolo, who heads AdventHealth Palm Coast’s emergency department, has been on its covid front lines from the start of the pandemic, and has two children of his own “who would be vulnerable under the current plan” he said. “They should really open up remote learning as well. Bob Snyder is spot on.”
Children 10 and younger are less likely to transmit the disease, and older children, while just as likely as adults to transmit, are far less likely to develop complications from the coronavirus, though illnesses and some hospitalizations are occurring among the young. The particular concern is that children, while not at great risk of severe illnesses or death, act as equal conduits of the disease, infecting adults who are at much greater risk of complications and death. While there are no calls to revert to school closures, masking and social distancing significantly reduces the incidence of transmission.
Publicly, schools and local governments have maintained throughout the pandemic that they follow local public health recommendations. In fact, the relationship has been more advisory, and Snyder himself has been cautious about treading further ahead of a curve that would more clearly unravel the health department’s impotence in directing public health measures, however soundly based in evidence–and in contradiction with governor edicts.
Snyder spoke on a day when Flagler set yet another record of covid infections and as AdventHealth Palm Coast set its own record of covid admissions, at 60, resulting late Thursday evening in an unprecedented declaration from the hospital system affecting its 16 hospitals in Central Florida, including AdventHealth Palm Coast: the system is on “Black Status,” curtailing most surgeries and revamping operations to focus on covid cases. Black Status is in effect at least through Aug. 4, according to a letter to physicians by Advent’s Neil J. Finkler, the system’s chief clinical officer.
Surgeries are to be limited to emergency impatient cases only. Only time-sensitive or urgent outpatient surgeries will be performed. All outpatient procedures are deferred. Support services such as labs will continue, as will attending to emergency cases such as strokes and heart attacks, while time-sensitive emergencies will be conducted only with pre-approval. “Emergent pediatric surgeries can proceed. However, time sensitive/urgent cases require oversight by chief medical officer/campus department chair,” Finkler’s letter stated.
“With the highly contagious Delta variant driving the spread of COVID-19, this remains a very fluid situation,” he wrote. “We know you and our entire workforce are exhausted from the additional pressures of the on-going pandemic and have endured unimaginable challenges. Thank you for your dedication to patient care and your efforts to help manage capacity and admissions.”
In a press release issued late Thursday, Finkler was quoted as saying that “Cases continue to rise sharply with no sign that the surge is beginning to decelerate,” and that the new status “will help us create more resources for our clinical teams, and ensure that we can continue to care for our community.” The release does not directly address the capacity question at hospitals, saying that “the reason we are adjusting our status is to ensure we have capacity in the future,” and that hospitals have flexibility, being part of a network. Clearly, however, with Thursday’s tally of 60 covid patients at AdventHealth Palm Coast alone, where the hospital has a total normal capacity of 130 beds, the crisis is unprecedented.
“We’re approaching, in Flagler County, approaching the kind of conditions that New York City faced last year,” Dr. Stephen Bickel, the medical director at the Flagler Health Department, said this morning on WNZF. “Flagler’s hospital has never been in Black Status throughout the pandemic. Black Status is sort of like crisis, all systems go, everything dedicated to trying to just keep things from going crazy and it’s hard to convey this to people because it just seems that we thought we were out of this. I’m just alerting people, I mean, there’s real danger out there, the chances of getting Covid are really high.”
Flagler County is on pace to record 700 infections this week alone, with a record 139 recorded on Thursday. When the school district issued its new protocols for the school year that begins Aug. 3 for teachers and Aug. 10 for students, masking in schools, mandatory last year, was still to be voluntary this year, with buses running at full capacity and the district opening its campuses with in-person learning only (with the exception of the virtual school option).
Snyder said he was unaware of the district changing course. “All I know,” he said, referring to David Bossardet, the district’s point man on covid procedures, is “that he indicated to me that they would be continuing to stay in contact with us, and that they would be open to changing their policy and procedures should it be warranted. And I’m assuming that they would be open to discussions if things continue to get worse. We will be available. Dr. Bickel and I to render our opinions when asked. Bickel is the medical director at the Flagler County Health Department.
Asked directly what his current opinion was regarding masking in schools, Snyder was clear: “My opinion now is that because of the severity of the Delta variant and being 50 to 60 percent more transmissible, even to the point where vaccinated people can transmit the Delta variant, and we’re seeing the results of its impact in this data, whether it’s hospital data or number of cases, surging on a daily basis, I certainly favor the CDC recommendation that if you’ve been vaccinated or not, that you still should take precautions with respect to social distancing and wearing a mask when you’re indoors, especially when you’re in congregate settings, where there’s a lot of people. Absolutely.”
But local governments have not been consulting with Snyder, as they had in previous waves during the pandemic–a silence that in itself speaks volume about the indifference of local governments, reflected in community indifference, especially among the unvaccinated, in Flagler County at large. (Superintendent Cathy Mittelstadt has been on vacation this week. Bobby Bossardet, an assistant superintendent, was expected to address the topic in an appearance on WNZF’s Free For All Fridays this morning. But a district spokesman said there was no reconsideration of masking rules for now.)
Snyder’s comments were echoes of similar urging by AdventHealth physicians who spoke during a briefing on Thursday.
“It seems logical,” Dr. Vincent Hsu, executive director of infection prevention and epidemiologist at AdventHealth, said. “Someone who’s not vaccinated even now with our indoor mandates that masking is a very reasonable approach decreased transmission in our, in our school system.
Dr. Michael Cacciatore, chief medical officer of the AdventHealth Medical Group, was also categorical: “The CDC, as well as the American Academy of Pediatrics, have made recommendations that, again, regardless of vaccination status, every school child, teacher should wear a mask. We recognize that there’s a significant number of children under 12 who are unable to get vaccinated and again with some of the transmission issues that we have seen in fully vaccinated children and adults, that risk is always there. So we advocate the positions of our public health authorities, of our scientific societies, and would follow the recommendations to to have our schoolchildren masked.”