The CDC’s Abrupt Change to Mask Guidelines Puts People at Risk

On April 27, 2021, the U.S. Centers for Disease Control (CDC) eased its guidelines on wearing masks outside, saying fully vaccinated people did not need masks outdoors unless they were in a crowd of strangers. Public health experts largely supported the new guidance. SARS-CoV-2, the virus that causes COVID-19, is mostly transmitted through the air in the form of droplets or aerosols and fresh air disperses these. While outdoor transmission can occur, especially during contact-sports, studies suggest indoor transmission is around 19 times more common than outdoor transmission. The CDC was signaling where we ought to be focusing our efforts at preventative measures: indoor settings, especially poorly ventilated spaces with lots of unmasked, unvaccinated people.

Yet, just 16 days later, on May 13, the CDC made a sudden about-turn. Without giving any warning, it abruptly changed its guidance on indoor masking, released mere days before the Occupational Safety and Health Administration (OSHA), the federal agency that oversees workplace safety, was to meet to review COVID-19 guidance for workplaces. CDC’s latest guidance seems to have given OSHA the ammunition it needed to ignore the science pointing to the risk of indoor aerosol transmission, as its website encourages employers to follow the CDC’s mask guidance. Employees in particular are now going to be in prolonged indoor contact with unmasked people, and in some areas of the country as many as 60% of people remain unvaccinated—and there’s no way to know for sure that all of those going maskless have, in fact, gotten their shots.

When an indoor mask mandate was in place, employers were forced to protect their employees and customers. That protection has now gone. The CDC’s baffling, whiplash-inducing decision has caused immense frustration among those on the frontline working on U.S. pandemic control.

In theory, the CDC’s new guidance was aimed only at those who are fully vaccinated, who are highly unlikely to catch or transmit the virus. While it makes scientific sense for vaccinated people to stop masking indoors, the guidance gave states the green light to drop indoor mask mandates for everyone. That’s the wrong approach at this stage.

Maryland, Virginia, North Carolina, Ohio and Michigan immediately ended their indoor mask mandates in the wake of the new CDC guidance, as did major chain stores like Walmart, Trader Joe’s, and Costco. These states and companies are ceding their power to implement population- and business-wide policies that protect the health of all, and instead are just hoping for the best: that the unvaccinated will still wear masks indoors to protect themselves and others from illness, long COVID, and death. But hope is a weak public health strategy.

The Biden Administration and the CDC have adopted a new rhetoric of personal responsibility that does not match the reality of the pandemic today. The government is abandoning its responsibility to keep the population healthy. It has eliminated guidance meant to protect the public’s health and placed the onus on individuals to protect themselves. Vaccination is being promoted as the only nationwide approach to prevent COVID-19. Instead of adopting a population-based strategy, in which we as a community would work together in solidarity to drive down transmission by universal masking indoors, Biden and the CDC are telling individuals that it is up to them to lower their risk. The CDC director now says “your health is in your hands” and President Biden says “The choice is yours.”

It is hard to understand the CDC’s sudden, unexpected shift towards an individualized, vaccination-only stance. The implication is that vaccines are now available to all and its up to people to get them, but the reality of the U.S. vaccination efforts is that just one third of Americans are fully vaccinated. Coming only four weeks since eligibility for vaccination was extended to all aged 16 years and older, it makes one wonder if the CDC has forgotten that it takes two to six weeks (depending on which vaccine is used) for a person to become fully vaccinated.

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It is simply not the case that anyone who wants the vaccine can easily get their shots. For example, a recent survey by the Kaiser Family Foundation found that Latinx adults in the U.S. are around twice as likely as white adults to say they want to get vaccinated as soon as possible. Yet a high proportion of Latinx adults face an array of access barriers, including fear of jeopardizing their jobs by taking time off to get vaccinated, concerns they may be challenged over their immigration status, or worries that they will have to pay for the doses because they’re not sure if it’s free for everyone (it is) or not. Fewer resources have been targeted towards offering vaccination to the most vulnerable counties, those characterized by “high poverty rates, crowded housing and poor access to transportation, among other factors,” according to Amy Harmon and Josh Holder at the New York Times. As a result, there is a widening gap in the vaccination rate between the most and least vulnerable counties.

What is particularly frustrating is that some states had established sensible roadmaps that tied the future easing of masking and social-distancing rules with specific indicators of progress in curbing the pandemic. And some of those have abandoned these careful plans given the new CDC advice. For example, North Carolina’s governor, Roy Cooper, and the state’s director of Health and Human Services, Mandy Cohen, had assured North Carolinians that the indoor mask mandate would remain in place until two thirds of residents had received at least one dose. But on May 14 Governor Cooper tore up this roadmap and ended the mandate (only 40% of people in the state have had at least one shot).

In addition, there has been almost no time for the childhood vaccination campaign to get going. On May 12, the CDC’s Advisory Committee on Immunization Practices approved the use of the Pfizer-BioNTech COVID-19 vaccine in adolescents aged 12-15 years old. It is difficult to understand why just one day later the CDC changed its mask guidance.

Given that most of the U.S. population still remains at risk, why was the CDC in such a rush to change its stance on masks? It is confusing and contradictory for the CDC to simultaneously acknowledge aerosol spread (which it belatedly and finally did on May 7) while also loosening protections against such spread.

The new guidance is also confusing when it states that fully vaccinated people must still wear masks in homeless shelters, prisons, airports and bus stations. If the agency believes that fully vaccinated people are now safe around others indoors, why do they still need masks in these settings but not inside offices, workplaces, gyms, churches, stores or other indoor settings?

The CDC clearly jumped the gun with its new guidance. It will leave vulnerable people—especially essential workers—unprotected and could increase their risk of infection.