COVID-19: Updated Mask Guidance From the CDC

Paul G. Auwaerter, MD


May 24, 2021

This transcript has been edited for clarity.

Hello. I'm Paul Auwaerter with Medscape Infectious Diseases, speaking virtually from Johns Hopkins University School of Medicine.

The recent update on mask guidance from the Centers for Disease Control and Prevention surprised many with the advice that fully immunized people, 2 weeks after they've received their last dose, can return to normal activities — not needing masks when indoors, for example. This is an advancement from earlier recommendations that outdoor activity no longer requires mask wear.

I think many of us are a bit uneasy with this recommendation, mainly because many parts of the country continue to have high community rates. The new recommendation flips responsibility for helping to protect a bit to others. For example, we're now on the honor system that those who are immunized don't need to wear masks, and those who are not immunized should wear masks.

I think it's one of those opt-in, opt-out scenarios that's going to make it difficult for people, for business owners, and also for patients who are immunosuppressed to feel as safe when the rates in communities remain higher than desirable.

The concept of herd immunity has been cast aside, in a sense, that it's probably not achievable without mandatory immunization practices. The thought is that perhaps by offering this carrot that masks need not be worn, it would help foster more vaccine uptake.

I certainly hope that's the case. I think the CDC has relied upon guidance and real-world evidence — for example, from Israel, a country that's relatively highly immunized, mostly with the Pfizer/BioNTech mRNA vaccine.

Data in a Lancet article that were recently published and referenced here demonstrate that people who were immunized were 97% protected from symptomatic COVID-19 and they had a 97% protection from mortality. Importantly, most infections in Israel are due to the variant of concern, B.1.1.7, which does have increased transmissibility and perhaps increased virulence. I think this is all very encouraging. Nearly half of us in the United States have received at least a single immunization, with over one third having been fully immunized. We are clearly making inroads, and rates are coming down.

There is uneasiness among many in terms of moving fast while community rates remain high. The scripts have been changed a bit. I know businesses have often relied on the CDC for guidance, and now I think the workplace safety issues are going to be a bit murkier. There's more of a reliance on local advice from health departments in states and cities, for example, to help interpret what should be going on.

I think there will be periods of confusion and uneasiness. Many had hoped that the percentage of immunized would be higher before such guidance was given and that community rates would be lower, generally. Whatever the calculus is, the decision was made to proceed forward at this time.

Masks have continued to be a very sensitive issue for many people with many opinions. In this continuing public health emergency, it's interesting to me to see which might work. Of course, we really don't have any prior experience here, so we are relying on judgment from the CDC, and certainly, trends are hopeful in this regard.

For our more concerned patients, including those who are immunosuppressed and may not respond as well to the vaccine, there still needs to be care taken with their day-to-day activities. I think it's also more of a potential issue with business owners and some frontline workers who may be exposed and not yet immunized.

We'll have to see how this works overall. I truly hope it helps drive immunization to higher levels. Certainly, that's a good message there, but I had hoped that we could still be cautious and keep driving down the number of infections and the potential for more variants to be generated before we head into the next respiratory season.

This obviously will all be monitored very closely. It's also a situation where, for our patients who may not be quite as protected by the vaccine, if they have early symptoms and a diagnosis of COVID-19, we have to be ready to administer monoclonal antibodies to stave off more severe COVID-19.

As always, there are twists and turns with this coronavirus, not only for the virus itself but also for recommendations and maneuvers. I know many of you need to help advise patients on what to do, and even some of our patients who own businesses are calling and asking for advice.

This does have to be individualized to some degree, but if community rates remain fairly high in your area, I think continuing with mask wear while indoors makes very good sense.

Thank you so much for listening.

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