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Editor’s note: The graph of weekly case rates in this story was updated Jan. 5, 2021, to reflect the latest local COVID-19 case data available.

When Kansas City Mayor Quinton Lucas announced the city’s most recent mask mandate in late July, he said the decision was based on the same science that directed every step he took during the pandemic. 

“I have stuck with CDC guidance throughout the pandemic and today is no different,” Lucas posted on Twitter. “We will do all we can to ensure our corner of this state is safe.”

The mayor was referring to updated recommendations from the Centers for Disease Control and Prevention that all people – regardless of vaccination status – should mask up while in public indoor settings if their communities are experiencing “high” or “significant” transmission. 

At the time, Kansas City, Missouri, fit squarely within those requirements. The city’s weekly rate of 264 new COVID-19 cases per 100,000 residents in late July was well above the thresholds of 50 cases per 100,000 people to be considered a substantial transmission area, and 100 cases for high transmission, according to the CDC. 

Yet when the Kansas City Council allowed the citywide mask mandate to expire on Nov. 4, the basis for the decision was less cut-and-dried. Ultimately, Lucas and the council deviated from the same CDC guidance they previously relied on, went against the local public health recommendations and ended the mandate just as cases were beginning to tick back up. 

Members of the Kansas City Council (Courtesy Photo/KCMO.gov)

Now – more than a month after the citywide mandate expired – Kansas City finds itself in a familiar situation. New cases during the first week of December were up more than 40 percent compared to the previous week, according to data from the Missouri Department of Health and Senior Services, putting the city’s weekly rate of new cases on par with where it was when Lucas announced the last mandate. 

“It was just getting very unwieldy,” said 3rd District Councilwoman Melissa Robinson on her vote to end the mandate last month. 

She cited difficulties with enforcing the rules and dealing with strong anti-mask sentiments as factors in her decision. “From a personal perspective, I feel like we should continue the mask mandate, but it’s just not something politically that would be feasible.”

The intensely divisive nature of mask rules has left many local public officials facing uphill battles to create or even maintain masking requirements across the country, regardless of COVID trends.

A vote to reinstate an indoor mask mandate for everyone ages 5 and older failed to pass the Jackson County Legislature on Monday. The decision came after Missouri Attorney General Eric Schmitt threatened to sue the county over the proposed mask rules for the second time – his latest move in a series of lawsuits challenging mandates across the state.  

As cases increase across the country, California and New York both announced the return of statewide mask mandates this week. But while Kansas City, Missouri, and some others still require people to wear masks while inside schools and related facilities, broader requirements applying to all adults are almost nonexistent in the local area. As of Dec. 14, only Kansas City, Kansas, has an active mask mandate for all adults.

But is another KCMO mask mandate on the horizon? Mayor Lucas’ office declined to comment on the possibility of future mandates or his decision to revoke the previous rules. 

To assess what might come next, The Beacon analyzed local COVID-19 metrics to determine how local officials made their decisions and what to look out for as the city heads into the next surge. 

The end of the last KCMO mask mandate

When the City Council voted to let the citywide mask mandate expire on Nov. 4, local COVID-19 conditions had significantly improved since the late summer’s surge. However, the situation was precarious. 

Following Lucas’ late July order that went into effect on Aug. 2, the City Council voted to extend the mandate three times per a new state law requiring local officials to vote on any public health rules lasting longer than 30 days. In between each council vote that extended the mandate, new cases, hospitalizations and deaths all dropped. 

Yet by the time council members decided to allow the citywide mandate to expire on Nov. 4, improvements had slowed substantially. An analysis of DHSS data shows Kansas City’s weekly case rate only dropped below the threshold for high transmission areas in the second week of October. The rate remained in the substantial transmission zone through the first few days of November, meaning the city still fell within the range where the CDC recommends mask wearing. 

At a public meeting one day before the mandate expired, Interim Public Health Director Frank Thompson cautioned the lull may be short-lived. 

“The last set of data that we have puts us very close to crossing back over,” Thompson told City Council members. A recent slight increase put the city’s rate just below the 100 mark that would push it into the high transmission zone. 

Though acknowledging the difficulty of enforcing long-standing mask mandates, some council members expressed concern about taking premature action. 

“There’s nothing about rescinding the mask mandate right now that makes sense,” said Eric Bunch, 4th District councilman, at the meeting. “I would prefer us to keep the adult mask mandate going and have clear data-driven off-ramps for those adult masks, and I don’t think that that’s what we see here.” 

Lucas agreed that the decision was complex, but said the city’s drop below the high threshold mark was a “bright line” indicator that they’ve been working toward. As a basis for his support to continue mask requirements for children in schools, he pointed to data showing a large portion of the latest increase was accounted for by the minor population.

“There’s nothing about rescinding the mask mandate right now that makes sense”

Eric bunch, 4th district councilman

Thompson told City Council members that based on the data, he too would prefer for the citywide mask mandate to continue, but was grateful that the rules would at least continue for children in schools. 

In an interview with The Beacon, Thompson said he understands public officials need to look at a wide range of factors when making public health decisions. 

“My job is to make recommendations based on the science,” Thompson said. “Their job is to make a decision based on all the factors they have to consider, including the recommendation from the director of health.”

Four days after the mask mandate expired, Kansas City, Missouri’s weekly case rate per 100,000 people topped 100 once more. It has remained in the high transmission zone ever since. 

COVID-19 cases are up, but no sign of a new mandate yet

To be sure, there is no single indicator that can predict the need for a return to mask mandates or other health precautions. Even the CDC’s guidance cited by Lucas and others technically only makes recommendations about what individual people should do. The agency doesn’t say how municipalities could apply the guidance to formal rulemaking.

However, if the indicators the city previously said it used to assess mask mandates still stand, it’s possible new rules could be on the way.

After the summer mask order was announced, city officials explained what metrics they were monitoring in a post that has since been deleted from the city’s COVID-19 FAQ page. At the time, it stated that any decisions on mask mandates would be based on guidance from public health professionals and health indicators including:

  1. Sustained declines in the average number of new daily reported cases, both in Kansas City and across the broader metropolitan region; 
  2. Hospital utilization and ICU availability;
  3. Percentage of the population that has been vaccinated;
  4. The ability to trace, test and isolate individuals who are potentially exposed to the virus, also known as contact tracing.
  5. The emergence of new variants and new data on transmission and risks to vaccinated and unvaccinated populations.

When the mandate expired on Nov. 4, KCMO officials could check off four of those five boxes for the most part.

Overlooking the slight case increase Thompson noted at the public meeting, overall cases and hospitalizations were down. ICU availability and vaccinations were up and the Omicron variant was still weeks away from being detected in the U.S. And although KCMO has consistently struggled with its testing and contract tracing capabilities, city officials only briefly mentioned the issue while publicly deliberating the mandate. 

The metrics today paint a different picture. 

  1. Data from the Mid-America Regional Council shows the weekly case rates for both KCMO and the broader metropolitan region exceed the threshold for the CDC’s high transmission areas and are still climbing. 
  2. Average new COVID hospitalizations in the region are up more than 90 percent since the citywide mask mandate expired, and ICU availability is down more than 30 percent. 
  3. Vaccinations are still steadily increasing, though at a much slower rate than earlier in the year. 
  4. Average daily tests in KCMO increased slightly as well, but are still well below the amount recommended by the CDC. 

In general, many of the local COVID-19 metrics are as bad today as they were when the last mask mandate was enacted and are significantly worse off than when it expired last month. 

Further exacerbating matters is the arrival of the Omicron variant. Though Omicron has not yet been detected in KCMO, public health officials say they are preparing for its inevitable arrival, and caution the public that the same COVID-19 recommendations still apply; People should socially distance, get vaccinated and wear masks when applicable. 

During a medical briefing with the University of Kansas Health System last week, Dr. Amber Schmidtke, chair of the Division of Natural Science and Mathematics at the University of Saint Mary, said the Kansas City metropolitan area is “a sitting duck” as cases surge. 

“We’re already seeing more cases than we were previously with the Delta surge that happened this summer,” Schmidtke said. “I think we really should be very concerned.” 

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Madison Hopkins is the health care accountability reporter focused on the intersection of health policy and people. Her reporting is partially funded by Health Forward Foundation. Previously, she worked...