Maybe We Need Masks Indoors Just a Bit Longer

On Thursday, the Centers for Disease Control and Prevention updated its guidance to say it did not believe that fully vaccinated people needed to wear masks or distance indoors or out, with a few exceptions, like when using public transportation.

It’s difficult for officials to issue rules as conditions evolve and uncertainty continues. So I hesitate to question the agency’s approach. But it’s not clear whether it was responding to scientific evidence or public clamor to lift state and local mandates, which the C.D.C. said could remain in place.

It might have been better to have kept up indoor mask mandates to help suppress the virus for maybe as little as a few more weeks.

The C.D.C. could have set metrics to measure such progress, saying that guidelines would be maintained until the number of cases or the number vaccinations reached a certain level, determined by epidemiologists.

And they could be explicit about the data on transmission risks. Right now, it just says “COVID-19 vaccines reduce the risk of people spreading COVID-19.” That’s too vague.

The agency could say that the fully vaccinated need not worry about personal risk or transmitting the virus in a private setting. But rules for behavior in public still need to stay in place indoors to protect the unvaccinated and the immunocompromised, because we’re all in this together.

Only about two weeks ago, the C.D.C. said that fully vaccinated people should still wear masks, even outdoors, if they were around crowds. Now we are told they need not even distance themselves in most settings, even indoors.

Opinion Conversation Questions surrounding the Covid-19 vaccine and its rollout.

That outdoor rule for the vaccinated seemed too timid, especially given how rare outdoor transmission seems to be. I’m even on board with telling the fully vaccinated their personal risk from this pathogen is no greater than any number of normal everyday risks. But why this big shift so soon? We shouldn’t just get new rules, we should get explanations.

The C.D.C. shift does not seem to fully account for the risks to the great number of unvaccinated people or the immunocompromised, especially those working indoors.

Telling everyone to wear masks indoors has a sociological effect. Grocery stores and workplaces cannot enforce mask wearing by vaccination status. We do not have vaccine passports in the U.S., and I do not see how we could. Places can either say “wear a mask regardless” or just accept that people who don’t want to wear one will not.

In the early days of the pandemic it made sense for everyone to wear a mask, not just the sick — as the C.D.C. and the World Health Organization were recommending — if only to relieve the stigma of illness. Now, as we head toward the endgame, we need to apply the same logic but in reverse: If the unvaccinated still need to wear masks indoors, everyone else needs to do so as well, until prevalence of the virus is more greatly reduced.

Even if the only people not protected by the vaccines were those hesitant to use them or who had false beliefs about them, public health principles would not allow us to say that any threat to their health is their problem, at least not while the virus is still spreading at substantive levels. Infectious diseases create risks for others.

There are those who are not yet vaccinated because they haven’t managed to navigate the process, or have started late, or are concerned because of bad experiences with the medical establishment. The immunocompromised remain vulnerable. Even if the unvaccinated were all conspiracy theorists and dead-end anti-vaxxers, we would need to take virus levels into account before discounting the risks even to them.

Plus, Covid-19 can still terribly burden our health resources, especially in those areas that still have many unvaccinated adults.

The C.D.C. guidelines are essentially implying that the risk that the vaccinated will transmit the virus to others, including their unvaccinated children, is so vanishingly low that it is not worth worrying about. But if that’s their position, they should state it clearly and explain it, not just say that “fully vaccinated people have a reduced risk of transmitting” the virus.

And is the expectation that the unvaccinated will all simply go with the guidance and stay masked? That does not fit with what we’ve observed in this country over the past year, especially with the ongoing polarization over these questions.

Finally, what happens to those who work indoors all day? At a minimum, there should have been guidance on what the immunocompromised should do to protect themselves while in workplaces where neither masking nor social distancing is enforced. The C.D.C. still recommends that only health care workers wear respirators like N95s.

The C.D.C.’s initial mask guidance was mainly intended to dampen transmission to others, so even cloth masks were sufficient. Those who will be working indoors with unmasked colleagues may need the higher level of protection that N95s provide. If I were advising employers, I’d tell them to keep up the mask rules indoors and pay attention to ventilation, regardless of vaccination status.

The people who suffered the most in this pandemic are disproportionately the working poor and the essential workers who kept things going while the rest of us could stay home. Now, for example, restaurant workers will find themselves in environments where not only do the patrons not wear masks but the staff may feel pressure not to.

Vaccines are driving down the epidemic. But the government should have considered keeping up protections a little longer because of a process called exponential decay. Essentially, on the way up, even a week or two of delay in enforcing safety precautions can be catastrophic because the process feeds on itself to amplify very, very fast. On the way down, it’s the reverse. The spread will be contained much faster if multiple measures are combined. Then, at a time to be determined by epidemiologists, we can get to the point that those who are not vaccinated, for whatever reason, can be far better protected because there will be far less virus in circulation.

If we knew we could eliminate indoor rules when cases go down to a certain level and vaccinations reach a certain percentage of the population, people would better understand rules they were asked to follow.

That would provide greater clarity, and help Americans see the clear data behind crucial government decisions and accept government guidelines.

Source