Masks on or off? Still a gray area

Travel | Hayley Smith 18 May 2021

As covid-19 vaccinations increase and cases continue to decline, health experts are considering whether and when face mask guidelines can become more lenient.

"We do need to start being more liberal as we get more people vaccinated," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases on ABC's This Week.

But Fauci also said the United States was averaging about 43,000 coronavirus cases daily and noted that "we've got to get it much, much lower than that" to effectively reduce the risk from the virus. When the case count drops lower, he said, "the risk of any infection - indoor or outdoor - diminishes dramatically."

Fauci's statements were, in part, a response to comments by Scott Gottlieb on CBS' Face the Nation. The former Food and Drug Administration commissioner said outdoor mask restrictions should be lifted and that indoor restrictions could begin to be loosened in areas where prevalence of the coronavirus was low, vaccination rates were high and testing was successfully identifying infections.

"If you've been vaccinated, your risk is very low for having a bad Covid outcome, and your risk of getting an asymptomatic infection that you could spread to others is also reduced," said Gottlieb, who also sits on the board of Pfizer. "The data does support that, so we could start drawing some firm conclusions and basing our public health advice on that."

But even after the Centers for Disease Control and Prevention said fully vaccinated people could stop wearing masks outdoors unless they were in a crowd of strangers, many are continuing to mask up as they weigh the risk. Some say it's hard to break the habit.

"It's been ingrained in us over the last year," said Aaron Lemos, who still pulls a mask over his face whenever he passes strangers outdoors.

"Would I like to not wear a mask? Yes. But for the sake of my family and the community, I feel I should still wear it," he said. "Until we ensure that Covid will be manageable, like the seasonal flu, then I will still wear a mask."

The larger conversation around face masks came after the CDC updated its Covid-19 science brief to emphasize the virus's airborne transmissibility.

Transmission occurs in three principal ways, the agency affirmed, including the inhalation of aerosol particles, deposition of virus droplets onto mucous membranes such as the mouth, nose and eyes, and touching mucous membranes with "soiled hands contaminated with the virus."

Peter Chin-Hong, professor of medicine and an infectious disease specialist at the University of California, San Francisco, said the CDC's update was not new information but a "reinforcement that some settings are much riskier than others," including indoor gatherings.

And although there is some consensus around outdoor rules, Chin-Hong said, it may be too soon to throw masks off completely while indoors. "I don't think we're there yet," he said. "Even if you are vaccinated, the more people you bring together, the higher the chance of non-responders getting together where they can transmit. The larger the group, the higher the chance that two people didn't get protection."

He also noted that many people might continue to wear masks out of habit or for personal reasons that might have nothing to do with Covid-19. "Essentially, it's one thing that we have control over in the pandemic. And if we have better acceptance of people wearing masks to protect other people when they have a cold or something, I'm all for that."

Fauci echoed that notion when he told NBC's Meet the Press that mask wearing could become a seasonal habit. This year's flu season was "practically nonexistent" because of Covid-19 public health protocols, he said. "During certain seasonal periods, when you have respiratory-borne viruses like the flu, people might elect to wear masks to diminish the likelihood that you'll spread these respiratory-borne diseases."

Varying levels of herd immunity and disparities in vaccination rates within communities mean that a one-size-fits-all approach probably won't apply.

"Population guidance is always very crude and applies to everyone in general, whereas on an individual level there are tons of different situations, not just from person to person but place to place," said Chin-Hong. "That makes it very challenging to make an overall guidance that hits everyone, and every location in the country, equally."

Some have taken that individual approach to heart. "I no longer wear a mask if I'm walking outside alone, or around other fully vaccinated people," said Geoff Pilkington.

But he will still wear one if he's uncertain whether those around him have been vaccinated.

"People should not be shaming fully vaccinated people for choosing not to wear masks and social distance around other fully vaccinated people"he said. "However, people should also not be shaming those who are fully vaccinated who want to be extra cautious and choose to wear a mask at all times."

los angeles times (tns)


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