About The CDC’s New Mask Guidance

Hooray — but not so fast.

That might be the most succinct way to sum up some of the reaction to the federal government’s announcement this week about COVID-19, vaccinations and masks.

Among other things, the updated guidelines posted Thursday by the Centers for Disease Control and Prevention (CDC) declared that “fully vaccinated people” don’t need to wear a mask indoors in public. They also don’t have to follow physical distancing protocols. Fully vaccinated people also don’t need to seek a COVID-19 test if they have been exposed to someone infected with the coronavirus.

There are pages of other details as well, but the mask advice got the most attention. Yet some appear to have absorbed that CDC statement while overlooking what it actually says — and what it doesn’t say.

“First and foremost, these recommendations are for vaccinated people only,” says Ajay Sethi, an epidemiologist and faculty director of the Master of Public Health program at the University of Wisconsin School of Medicine and Public Health. “And this is not a green light for unvaccinated people to stop wearing masks.”

A person isn’t fully vaccinated, according to the CDC, until two weeks after they have completed all of the shots in the series (two for the Pfizer and Moderna vaccines, one for the Johnson & Johnson vaccine).

Fully vaccinated people, according to the guidelines, must still follow “federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance” — even if those continue to require masks or physical distancing. Travelers, for instance, still must wear masks on planes, trains, buses and other forms of public transportation, as well as in and around airports and transit stations.

Local rules and conditions

In presenting the guidelines Thursday, CDC director Dr. Rochelle Walensky “was really clear that she expects states and local jurisdictions to come up with their own guidance,” says Geof Swain, president-elect of the Wisconsin Public Health Association. “And that should be based on two key factors: One, what is the vaccination completion rate in that particular area? And number two, most importantly, what is the disease transmission rate in that particular area?”

“We haven’t gotten to a high enough vaccination rate yet” for unvaccinated people to cast aside masks, says Swain. According to the state Department of Health Services (DHS), as of Friday, 38.9% of Wisconsin residents have completed their vaccine series.  (The department’s data doesn’t specify how many are two weeks out from their last dose.)

Approaching 40% is “good, but it’s not nearly enough,” Swain says — especially since the virus spread in Wisconsin, while down from its worst peaks in the late fall of 2020, is still high.

“We’re averaging around 465 confirmed new cases a day in the state,” he says. Over a two-week period, that translates to 112 cases per 100,000 residents — which is still a high case rate using the metrics that DHS subscribes to.

To reach a low level of spread, the state would have to get its count to 580 cases per 100,000 residents over two weeks, or about 42 cases a day on average,  Swain explains.

“We’re going to get there,” he says, but it might take another few months.

The CDC guidelines appear to be a response to the evidence of “how well the vaccines work in preventing transmission,” says Sethi. “I think that has given people more confidence that if they’re vaccinated, they are not going to be a major contributor to transmission.”

Ignoring the fine print

Friday morning, the city of Racine announced that it would stop enforcing its mask mandate. Late in the day, DHS posted a press release amplifying the CDC’s new guidance. The DHS statement, however, also noted “important exceptions where everyone, including those who are fully vaccinated, should continue to wear a mask,” and listed health care settings, K-12 schools, correctional and detention facilities, homeless shelters and public transportation. The state health department also pointed to the CDC’s reminder to follow local and tribal rules and business policies.

A number of public health practitioners are questioning the CDC’s announcement. Yet in other circles, the guidelines were enough to warrant sweeping changes — changes that even public health experts who support the agency say its new recommendations don’t support.

In a statement he issued Friday, Rep. David Steffen (R-Howard) claimed that the CDC’s announcement justified lifting mask requirements statewide. “The time has come for Wisconsin communities, counties, and school districts to follow the state government’s lead and repeal their face mask mandates,” Steffen stated. (The state did not repeal its mask mandate voluntarily; the state Supreme Court ended it March 31 in a 4-3 ruling that the administration of Gov. Tony Evers criticized.)

Contrary to Steffen’s statement, however, the new CDC guidance specifically assumes that local health orders are in place.

“When I see the guidelines on the CDC page, I still see the recommendation for unvaccinated people to wear masks,” says Sethi. “And I still see the guidelines for vaccinated people to follow local rules that businesses set forth, and local jurisdictions still have the authority” to require masks. “This is not a mandate to not wear masks.”

Steffen claimed that the existence of remaining local mask orders “diminishes the value and success of our vaccination program.” But the CDC guidelines don’t say anything like that.

“They are very clear that unvaccinated people still need to wear a mask,” says Swain. “That is because there’s so much virus still circulating. And if you’re not vaccinated, you are at high risk of getting infected, and you’re at high risk of having a serious infection, hospitalization or death.”

Why masks still matter

Masking skeptics often appear to assume that masks are just to protect the wearer. On Thursday, Rep. Barbara Dittrich (R-Oconomowoc) put out a statement that her “constituents express that those who wish to continue with wearing masks are perfectly capable of deciding for themselves as to whether that decision is appropriate for their own health status.”

Masks do protect people who wear them. But they aren’t the only beneficiaries.

“It is protecting the other people around who might be susceptible, in case the wearer is infectious,” says Swain. “And because there’s so much asymptomatic and only minimally symptomatic infection, people might not know they’re infectious. It’s not accurate to characterize mask wearing as only being about personal responsibility for protecting one’s own self.”

Another lawmaker Friday argued that schools should drop any mask orders. Rep. Elijah Behnke (R-Oconto), didn’t mention the CDC guidance specifically. But in his statement, he claimed that DHS data showed “children under 19 have an infinitesimally small chance of dying due to COVID-19,” so schools should not require masks in the 2021-2022 school year.

Yet younger age groups increasingly are showing higher rates of infection than older populations, according to DHS.

And without protection, Sethi observes, children — who can’t get vaccinated yet if they are 11 or younger, and who just became eligible for the Pfizer vaccine if they are 12 to 15 years old — could become one of the groups where the virus spreads most widely.

“I’m still of the belief that we should view children as vulnerable, because they’re minors,” Sethi says. “And we should not recommend that they don’t wear masks — subjecting them to a risk of catching a virus that still has a lot of unknown consequences.”

The newer variants of the virus infect people more rapidly, so it can spread more quickly among people who are unprotected.

“The virus is going to continue to circulate in people who are unvaccinated,” he says. “In some places, that’s everybody, because of low vaccine uptake. And in other places, that’s mostly younger individuals.”

The new CDC guidance reinforces the essential role of vaccines in the pandemic, Sethi adds.

“It’s really important that people get vaccinated,” he says. “That is our way out of this. And these vaccines are really safe and really effective. People who are questioning that are not following guidance that’s based on science.”

Reprinted with permission of Wisconsin Examiner.