Confused about the new CDC mask guidance for vaccinated people? You’re not alone. In a reverse course from the honor system (wear a mask if you’re unvaccinated), the CDC is now recommending all-masking in indoor public settings in areas of substantial-high “community transmission”. So what does that mean? Read on to find out.
Masking is a bit of a hot button issue. Nobody wants to wear a mask, especially all day in the summer, but it has proven to be one of our better strategies to combat the very transmissible SARS-CoV-2 virus. It will also prove to be an important part of controlling the Delta variant, which is spread more easily from person-to-person due to roughly 1,000x more virus being spewed into the air from infected individuals. Guess what can catch those extra viruses and minimize transmission? I knew you were a smart bunch, you’re absolutely right, masks!
It remains true that our best strategy for squashing this pandemic is vaccination. All FDA-authorized vaccines are highly effective at preventing severe COVID-19 and, importantly, death from COVID-19. But the United States has stalled in its vaccination efforts and we are short of the coverage needed for elusive “herd immunity”. This is especially true given the Delta variant’s ability to make so many more viruses in each infected person. Even if a vaccinated person doesn’t get sick from Delta, it is possible that they can spread this variant to someone who might not be so lucky.
Those of us in public health (and certainly the CDC) were very encouraged by the drop in COVID cases as the number of vaccinations rose over the course of the spring. So encouraged that the CDC jumped on the opportunity to tell vaccinated people that they could shed their masks. Unfortunately this recommendation was partially premature given the rise of the more transmissible Delta variant and partially naive in thinking that unvaccinated people wouldn’t also take off their masks.
Alas, cases are rising and we find ourselves in the early stages of a fourth wave. The best thing that you can do to protect yourself and others around you is to get a vaccine if you haven’t yet done so. I have thus far avoided stating this explicitly because vaccination is a personal healthcare decision that depends on your medical history. If you make the decision to forgo the vaccine in consultation with your healthcare provider, fine. But if you make the decision not to be vaccinated on your own, you are responsible for the continuation of this pandemic.
Our second layer of defense behind vaccination are social countermeasures including physical distancing, staying in highly ventilated spaces (i.e. outdoors), and masking. Which brings us back to this new CDC mask guidance, which relies on determining the level of community transmission in all counties across the United States. Community transmission is measured by the total number of new cases per 100,000 people and the percentage of positive tests over a weekly time frame. These values are then broken down into four levels, from blue (low) up to red (high). The take home message is to mask in public if your county reports at least 50 new cases per 100,000 people in the past week or is averaging a positive test rate of above eight percent over that time frame (i.e. orange or red).
The reason it’s important to calculate these values over seven days is that daily fluctuations commonly occur due to number of tests administered and delays or aberrations in reporting day-to-day. The values over seven days gives a good approximation of the transmission status on a county level, which looks like this across the United States as of July 28, 2021.
This map is updated daily for a rolling seven day transmission level for each county in the country. Find (and please bookmark) this webpage here. The data for your county can be found either by clicking on the map (which is a little difficult depending on where you live) or selecting your state and county from the drop down menus. If your county is blue or yellow and you are vaccinated, you can decide whether to wear a mask in public indoor places or not. If your county is orange or red, you should wear a mask regardless of your vaccination status. All unvaccinated individuals should continue masking no matter the transmission level where they reside. If you have unvaccinated people in your home (such as kids) or you or someone in your household is immunocompromised or at high risk, wearing a mask in public in addition to being vaccinated is an excellent idea — again, these are layers of protection, the more you have, the safer you and your family are.
One very important element of this change in the CDC mask guidance is rolling back responsibility from the individual and placing it on local public health officials. Secondly, the regulations for your area will be determined by local data, which it should have been all along. There’s no need to have a single policy for the entire country when the risk is different depending on where you are. If your county is orange or red, you should be receiving communication from your local authorities about masking up in public. Importantly, if you live in a region where counties are relatively small or perhaps you live on the border of another county, please remember to check all counties you frequent for work, shopping, visiting, etc. The virus doesn’t understand county borders, so be mindful of neighboring transmission status.
Because this map is updated daily, it is possible for a county to go from orange on one day (mask up) to yellow the next (no more masks) and back to orange (just kidding, put it back on). This feels like it could be a bit of a roller coaster, and certainly doesn’t mean the risk was zero on that in day in between. The seven day calculations should minimize this oscillation, but it could still happen for counties teetering on one of the cutoffs. I actually live in an area that is currently yellow but close to that orange cutoff. I also live seven miles from a big city within an orange county. Despite high vaccination status across the area, I think I’ll keep wearing a mask for now.
Keep in mind that it will be up to local officials to track community transmission and guide their citizens. Some might do this well and others will frustrate, but heck, who’s not frustrated at this point? I highly recommend everyone sign up for alerts from their town and/or county. Most do this via phone, text, and/or email services and many are found on social media as well.
Despite that the Delta variant is more transmissible, it’s actually not our biggest worry because vaccines work against it. What is more concerning is that continued spread of SARS-CoV-2 allows for additional mutations, just one of which could circumvent current vaccine-induced immunity and unravel all the progress we’ve made. The “pandemic of the unvaccinated” is marching us straight back into a situation where we are all susceptible. Back to where we are locked down, out of school, and isolated. Back to where we pray for our parents and grandparents, an uncle with diabetes, and cousin battling cancer. Each person who is choosing not to be part of the solution — getting vaccinated and abiding by social responsibility — is going to make us all suffer the consequences.
In the United States, every one of us has some control over this. That’s not the case everywhere in the world. We should feel extremely lucky to have an abundance of vaccines. We have the ability to come together and defeat this foe as a united front, to be patriots once again. It’s not enough to be sick of it and just ignore it. Let’s choose to be vaccinated. Let’s stay outdoors. Let’s avoid commingling multiple unvaccinated families indoors (even if the only ones unvaccinated are the kids). Let’s quarantine and get tested when appropriate. Let’s mask up in public. Let’s beat this. The sooner we do, the sooner we can get back to just living our lives, which let’s face it, is all anyone wants.