An ongoing dialogue on HIV/AIDS, infectious diseases,
May 17th, 2021
CDC’s Surprise Mask Policy — and What It Means Right Now for Me
Edvard Munch, The Sun, 1911.
Anyone else out there blindsided by the CDC’s announcement last week about masks?
Fully vaccinated people can resume activities without wearing a mask or physically distancing …
Jeepers, that was fast. Less than a month ago, I was having a conversation with my dog Louie about outdoor mask mandates, wondering when our town would drop this unnecessary (in my opinion) rule about how we live out in the fresh air — where we know SARS-CoV-2 transmission is exceedingly rare.
But now, all at once, no masks needed at all for vaccinated people? Not quite — there’s plenty of fine print:
… except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.
That means we’ll still see masks in hospitals and doctors’ offices. Planes, trains, buses, airports. And this incredibly important caveat for our immunocompromised patients is a reminder that they can’t rely on the vaccines to protect them:
Well said, @CDCgov. The whole thing, but have highlighted something particularly important that often gets missed. https://t.co/aiUOs5nu4K pic.twitter.com/3KaJldDTmo
— Paul Sax (@PaulSaxMD) May 13, 2021
I’d add that many will continue to wear masks in settings like the crowded Trader Joe’s in my neighborhood, regardless of the policies they (or other companies) institute. Let me ask you — in places with sufficient density of people in public indoor settings, with the vaccinated status of many still not known, and case numbers still at tens of thousands a day nationally, why not wear a mask?
That’s what people like me will do. (Not that you need reminding, but I’m an ID doctor, living in a very mask-friendly state.)
In this piece, Zeynep Tufekci argued for CDC’s holding out a bit longer before making this policy statement — along with setting benchmarks for case numbers before removing indoor mask-wearing in public for vaccinated people. Several others have commented that they thought the announcement was premature.
I get that. But since half the country thinks this action by CDC is too soon, and the other half too late, the CDC’s probably getting it about right, timing-wise. Remember, local jurisdictions can make their own rules, people who have been vaccinated can make their own decisions, and there is a deep hope that this action will encourage those who have not yet been vaccinated to do so — it’s a tangible benefit.
So what happens next nationally? Strongly suspect we’ll see a continued downward count of case numbers, even with less mask-wearing. This is the combined power of the vaccines, which have proven to be remarkably effective in real-world settings, the shift toward outdoor activities, and exponential decay — fewer people out there with COVID-19 means fewer opportunities for new infections, an amazingly strong force we saw in play last summer even before we had vaccines.
Look, even with far more testing, we’re already back to where we were last June, and it’s only mid-May:
The last time the US had <17,500 confirmed cases in a day was June 8, ~11 months ago, when the testing was 1/3rd as much as now.
The descent (exponential decay) continues pic.twitter.com/ehb2LHP6qb— Eric Topol (@EricTopol) May 17, 2021
Believe me, I know that COVID-19 is not yet over — new cases still are occurring, and still will occur. Some will be serious, especially in the unvaccinated or the immunosuppressed. Some others will be in vaccinated people, mostly linked to indoor transmissions, as they always have been.
Remember, with this virus — humility. Stay flexible. Respond to new data. Keep on vaccinating.
And cheer these great numbers!
17 Responses to “CDC’s Surprise Mask Policy — and What It Means Right Now for Me”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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You have more faith in the public than I do. I think people that are not vaccinated now see this as an excuse not to wear a mask and will continue not get vaccinated. I will continue to wear a mask in crowded indoor areas as well.
I’m with Andi. The people I have seen unmasked first and in the most crowded places indoors are those most vehemently opposed to vaccines and who were skeptics that the pandemic existed in the first place.That’s where I predict the next surge will start and variants will breed.
“Strongly suspect we’ll see a continued downward count of case numbers, even with less mask-wearing”…
yup, me too. in addition to vaccination and momentum of downward curve, it might also mean that defensive masking did not have quite the protective powers claimed. Especially paper ones, especially outdoors, and especially on chins.
just sayin’…
I am fully vaccinated, wear masks all the time (I am a Doctor) and my IgG test is positive in the high side but….I tested positive to coronavirus and get sick.
I’m with you Paul. Cautiously optimistic. From a public health perspective I think the CDC is getting this exactly right. Creating a policy now that puts the onus on the individual to make decisions regarding his or her own risk makes sense with the decline in cases and the power of the vaccines. I actually suspect we will see a rise in cases among the unvaccinated. I cannot say I’m shocked at the level of selfishness, entitlement and just plain ignorance that these people display in their callous diregard for the safety of others. Given the reinfection rate among vaccinated of 0.007% I feel pretty safe going maskless. And creating an incentive to get vaccinated makes a lot of sense when you look at it from the larger public health perspective.
With respect to your comment that because d the country believes the CDC has relieved the mask recommendation too late and half too early indicated the CDC has got it about right.
Deciding medical policy as though it is a negotiation eternal imposing policies is not good medicine, good science nor is it good public policy.
I feel like we should keep in mind that the number of positive cases reported may be decreasing because more people are using at-home tests rather than going to some sort of medical provider’s office to be tested.
That said, I do think that there is a group of people hesitant to get the vaccine mostly because they saw it as having no benefit to them (the “I’m perfectly healthy, my immune system can fight off the virus with no problem if I get sick” crowd). Multiple people told me that there was no point for them to get vaccinated if they still had to wear a mask. At least the new CDC guidance may serve as an impetus for those folks to get vaccinated.
“I get that. But since half the country thinks this action by CDC is too soon, and the other half too late, the CDC’s probably getting it about right, timing-wise. ”
Except the half who thinks its too soon are educated, experienced and trained members of the medical community working in virology and public health, versus the half who think its too late who are local yokels listening to conspiracy theories on Youtube. Their opinions should not be equally weighted.
Tough question– but I agree with the worry that the unvaccinated will see this as permission to go unvaccinated and then be incubators for virus mutations. Like you, I can still wear a mask in public.. But if unvaccinated start going mask-less since there is no way to police, I wonder about the public risk of more opportunity for mutations.
I do not agree with the new CDC policy at multiple levels:
1. A 90-95% vaccine efficacy (at best fjor mRNA vaccines, though potentially lower with variants of concern) is fantastic, but still not good enough at a super-spreader event for me or anyone I care about, including our President. I would have waited till transmission rates were lower before dropping masking completely for vaccinated persons.
2. Breakthrough cases are more common than the surveillance data suggests (and I have serious issues whenever the number of breakthrough cases reported by CDC is used as a proxy for vaccine efficacy). Though severe infections are rare in breakthrough cases, they are necessarily trouble free or benign. Breakthrough cases are regularly seen in our mAb infusion clinic. Even if asymptomatic, disruptions to work, etc. are a problem.
3. We don’t know how long immunity from vaccine lasts, or how well it will perform against variants that might emerge. Masking was part of a layered prevention strategy, one that could help make up for imperfect vaccine efficacy. I think even if not routine, the public should have been trained to adopt it as an extra layer of protection in risky situations. The average person isn’t as informed as Dr. Sax, and won’t necessarily continue to mask up at Trader Joe’s.
4. Masking/distancing did wonders for flu prevention. Why not keep some masking habits?
5. As a result of this new, unenforceable guidance, mask requirements are dropping all around, schools, businesses, cities etc. A carrot to get people vaccinated is no longer a carrot when it is falling out of the sky.
6. This caught everyone off guard, including those of us in public health. This is not how you roll out a major guidance change.
All that said, it is done. Hopefully the number of vaccinated persons out there will be enough to prevent a summer surge.
I’m amazed that no one ever did a population study to confirm that infectious Covid is in the exhaled breath of asymptomatic people! Instead we “assumed” it based on being able to retrieve RNA from the nasopharynx! Of course we now know that the two are not synonymous. I certainly wasn’t trained to “assume” and no study I have read has ever proved transmission via exhaled breath over fomite or even fecal oral for that matter! If I had turned in the “evidence” for transmission via exhaled breath as a high school science paper I would have gotten an “F”. How could we have NOT tested the hypothesis directly since we have the ability to do so?
An excellent article. It amazes me that everywhere I go almost everyone is still using a mask! Dr. Fauci keeps reversing himself, so where is the truth? It may be politically expedient to lift mask mandates, but I honestly think we will still be wearing masks in a year, if not more.
Keep up the good work.
I live in PA. Patients have been admitting all along, to only wearing masks where mandated. Now, with the CDC lifting masks for those vaccinated, they and the unvaccinated will be validated. I do not believe the 30% reduction in cases quoted by Walensky is good enough. I will encourage mask wearing for the rest of this year, especially with India generating new variants as I type. The current one (B1.167.2) will soon become the dominant variant in the UK and is already in nearby NY and NJ. Although the mRNA vaccines have been shown protective against the B1.167.2 out of India others are sure to follow. I agree with my colleagues above that this CDC declaration was a bit early still. As clinicians, we have been masking for years, so wearing a mask is simply ‘business as usual’. I will still encourage patients, family and friends to wear masks for a least the rest of this year.
Douglas Davis — Actually, some of the people agreeing with the CDC actually are ID specialists.
If the unvaccinated choose to not wear masks and do get infected, eventually their natural protection is just as useful for the community, and herd immunity, as the vaccine. Backwards, and costly, but effective. Let them spread it among themselves. Also let’s be honest cloth masks with an avg weave pore 300x the size of the avg transmissible virus particle/sputum combo never really provided any transmission reduction indoors. Surgical masks or better N95s did however.
Hi Dr. Sax, am curious to know if your stance has changed any since May, and the rise of the Delta Variant. I’m seeing many people advocating for a return to mask mandate, and that is also leading to interesting discussions about masks in schools in the fall.
Thank you for your reports!