Why Not Just Tell Everyone to Wear Masks?
An internal presentation circulated within the Centers for Disease Control and Prevention last month, and obtained by The New York Times, offered clear advice for countering the contagious Delta variant: “Given the higher transmissibility and current vaccine coverage , universal masking is essential. “
But the agency’s recommendation was considerably more nuanced, advising Americans, vaccinated or not, to wear masks in indoor public places in areas with “substantial” or “high” viral transmission.
At the time, that included at least 80 percent of Americans. As infection rates skyrocket, some experts are now asking: Would it have made more sense to call on everyone to mask themselves?
“Given the rate hike across the country, the clearest message would be, ‘In all parts of the country, wear a mask in indoor public places,'” said David Michaels, professor of environmental and occupational health. at the Milken Institute of Public Health at George Washington University.
In addition to Americans in Covid-19 hotspots, CDC officials have also recommended universal interior masking for teachers, staff, students, and school visitors, regardless of where they are and regardless of individual vaccination status.
And the agency suggested that people “might choose to mask themselves regardless of the level of transmission” if they or a member of their household were immunocompromised or at increased risk for serious illness – or not vaccinated, a category that includes all children under 12, who do not qualify for vaccination.
Also on the list: overweight, smokers or disabled people, and anyone who has been in close contact with someone with or suspected of Covid-19. That’s a lot of Americans.
“The CDC’s message was far from optimal,” said Dr. Ezekiel Emanuel, vice president of global initiatives at the University of Pennsylvania. “We need to be clear and relatively straightforward about this. “
Advice on hiding from federal health officials has changed throughout the pandemic. In February 2020, Americans were urged not to purchase masks, which were in short supply. In April 2020, authorities recommended that the masks be worn outside the home. In May of this year, the CDC said those vaccinated no longer needed to wear masks.
Agency officials did not respond to requests for comment on the latest revised recommendations. But the agency’s director, Dr Rochelle Walensky, said she was constrained by early data indicating that the Delta variant had changed the equation and that vaccinated individuals could spread the virus on the rare occasions they were. affected.
Important evidence emerged from an outbreak in Provincetown, Massachusetts over the weekend of July 4. Almost a thousand people have been infected, the majority of whom have been fully vaccinated.
But many Americans don’t know week after week whether they live in a community with high or high transmission of the virus.
The definitions are not easy to grasp: substantial or high transmission means any community where there are at least 50 new infections per 100,000 population in the previous seven days, or at least 8% of the tests are positive for the infection during this period. (The agency is holding a map.)
A simpler mask recommendation likely wouldn’t have paved the way for warrants in a state like Texas, where two state judges this week authorized officials in Dallas County and Bexar County, which includes San Antonio. , to start imposing mask requirements despite an executive order banning them by Governor Greg Abbott.
In many communities, mandates are gaining ground and nuances about transmission rates and underlying conditions have already been sidelined. It’s easy to see why: On Tuesday, the virus was spreading rapidly in 90% of the country. And the masking is quickly effective.
The masks “are actually amazing because they work immediately – they are starting to reduce transmission today,” said Julia Raifman, assistant professor in the School of Public Health at Boston University. “Each case they prevent prevents several more cases, so their effectiveness increases over time.”
Understanding the state of vaccine and mask mandates in the United States
- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of their immunization status, wear masks in indoor public places in areas affected by epidemics, a reversal of guidelines it offered in May. . See where the CDC guidelines would apply and where states have instituted their own mask policies. The battle for masks has become controversial in some states, with some local leaders defying state bans.
- Vaccination rules. . . and bbusiness. Private companies are increasingly demanding coronavirus vaccines for employees, with different approaches. Such warrants are authorized by law and have been confirmed in court challenges.
- College and universities. More than 400 colleges and universities require students to be vaccinated against Covid-19. Almost all of them are in states that voted for President Biden.
- Schools. On August 11, California announced it would require teachers and staff in public and private schools to be vaccinated or tested regularly, the first state in the country to do so. A survey released in August found that many American parents of school-aged children are opposed to mandatory vaccines for students, but were more in favor of mask mandates for students, teachers and staff who don’t. don’t have their vaccines.
- Hospitals and medical centers. Many hospitals and large healthcare systems are requiring their employees to be vaccinated against Covid-19, citing an increase in the number of cases fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their hand -work.
- new York. On August 3, Mayor Bill de Blasio of New York announced that proof of vaccination would be required from workers and customers for indoor meals, gyms, shows and other indoor situations, becoming the first city America to require vaccines for a wide range of activities. . Employees of the city’s hospitals must also get vaccinated or undergo weekly tests. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon has said it will seek to make coronavirus vaccination mandatory for the nation’s 1.3 million active-duty soldiers “no later than” mid-September. President Biden announced that all civilian federal employees should be vaccinated against the coronavirus or undergo regular testing, social distancing, mask requirements and restrictions on most travel.
Wearing a mask also helps protect children who cannot yet be vaccinated, and others who are susceptible, such as the elderly and those with weakened immune systems, who may not be able to develop. a vigorous immune response after vaccination.
Masking also helps prevent the virus from circulating, reducing the chances of it mutating, possibly into a more virulent form that can escape vaccines altogether.
“If you allow the virus to circulate freely and don’t try to stop it, sooner or later there is a likelihood that you will get another variant that could, I’m not saying it will, but could be. more problematic than the Delta, “Dr Anthony Fauci, the nation’s foremost infectious disease expert, told NBC’s” Meet the Press “show on Sunday.
The CDC noted that blacks, Hispanics and Native Americans were at higher risk of Covid-19, but said nothing more about minority communities adopting masking measures.
A universal recommendation of masking could have helped protect vulnerable communities, including communities of color, where immunization rates have lagged partly because of mistrust of the medical system and partly because of lingering problems. ‘access to health care, said Dr Rhea Boyd, a pediatrician who studies the relationship between structural racism and health.
“If you live in an area where a lot of people are not vaccinated, you have a lot of exposure to the virus,” Dr Boyd said.
Still, some pundits favor the fine line the CDC should follow when releasing shifting advice – particularly on masking, which has become a cultural and political flashpoint.
Mask warrants can threaten the livelihoods of restaurants, bars and other indoor places that serve food. In Louisiana, Governor John Bel Edwards temporarily reinstated a statewide indoor mask mandate earlier this month amid an increase in cases. But he made an exception for “anyone who consumes food or drink”.
By setting localized cues, the agency’s mask recommendation “gives everyone something to look forward to,” said Dr. Carlos del Rio, an infectious disease specialist at Emory University School of Medicine in Atlanta. “At the end of the day, the CDC is a science agency that responds to politicians. “
Still, he added: “If you are indoors you should wear a mask.”