New mask guidelines: Great for some, confusing for others. What experts say this does to the CDC's credibility.
Loosening mask restrictions for people who are fully vaccinated is either a great way to reward those who get their shots or a communications disaster that threatens to undermine America's progress against the pandemic.
That was the consensus – or lack of one – after the Centers for Disease Control and Prevention announced Thursday that people who are fully vaccinated no longer need to wear masks, even indoors, except in crowded indoor settings like airplanes, buses and health care facilities.
Some communications experts reacted with dismay to the decision, saying that while the agency may have been describing a limited loosening of restrictions for the vaccinated, what the public heard actually heard was "all limits are off."
"The pandemic isn’t over but, alas, that is the take-away message of the CDC’s announcement," said Peter Pitts, president and co-founder of the Center for Medicine in the Public Interest, a patient advocacy group. "It is a communications mistake with significant dangerous unintended consequences."
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Instead, the CDC should have framed their announcement as a "teachable moment" emphasizing the importance of vaccination, said Pitts, a former associate commissioner for external relations with the Food and Drug Administration.
The CDC had faced criticism for moving too slowly. Now some are saying it's going too fast.
"The ... turn is not based on science," Lawrence Gostin, faculty director of the O'Neill Institute for National and Global Health Law and Georgetown University Law Center, said in an emailed statement. "The basic epidemiology has not changed from its last guidelines just weeks ago."
There is no difference in infection risk, Gostin said, between a supermarket, restaurant or gym, where the CDC no longer requires masks for people who are fully vaccinated, and an airport or bus, where face coverings are still required.
The announcement is part of a pattern of contradictory decisions the CDC has made during the pandemic, which threaten to undermine the agency's credibility, Gostin said in an interview earlier this week.
But some saw the CDC's decision as providing people another good reason to get vaccinated.
"We are still in the pandemic and we still have progress to make," said Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. "But this is showing us where we're headed."
Sell said she thinks it makes sense to "peel things away one layer at a time," the way the CDC has been doing, and get rid of the "public health theater" that has kept mask rules in place even though it's clear that the available vaccines are very good at preventing infections.
Others agreed. “Many people in the infectious disease field have been communicating with the CDC to move in this direction, to loosen up, recognizing the vaccines are wonderfully effective,” said Dr. William Schaffner, a professor and infectious disease expert at the Vanderbilt University School of Medicine in Nashville.
CDC Director Dr. Rochelle Walensky said Thursday that her agency's guidance changed as more scientific studies showed the real-world effectiveness of the vaccines is extremely high, protecting more than 90% of recipients against any symptoms of COVID-19, preventing nearly all serious disease and death, and even blocking most asymptomatic cases.
Plus, COVID-19 cases have dropped by about a third in the last two weeks, reaching their lowest levels since last fall in some places.
"This is an exciting and powerful moment," Walensky said in a Thursday briefing. She emphasized the importance of more people getting vaccinated to protect themselves, reduce the caseload and reduce the risk of a new spike or new variants.
Still, she offered a few warnings. "If you develop symptoms, you should put your mask back on and get tested right away," she said. "The science is also very clear about unvaccinated people: You remain at risk of mild or severe illness of death or spreading the disease to others. You should still mask, and you should get vaccinated right away."
The new measure may help appeal to people who have been slow to get shots, some said.
Some people haven't been moved by pleas to get vaccinated to help their community, but they might respond to the idea that getting vaccinated will allow them to go mask-free indoors, Sell said.
"This is the benefit of getting vaccinated," Sell said.
A recent Walgreens survey found U.S. adults who were initially hesitant to get vaccinated said they eventually received their shot to protect loved ones and others, because they were pressured by friends and family, or were required by an employer.
While survey respondents said they looked forward to the freedoms of being fully immunized such as returning to the gym and dining out, it wasn't their primary reason to get vaccinated.
“There’s a variety of reasons that people may not be getting this vaccine and without that understanding it’s hard to rationalize whether this change in policy is likely to actually shift vaccine uptake among those that are unvaccinated,” said Rachael Piltch-Loeb, associate research scientist at New York University School of Global Public Health and a preparedness fellow at Harvard T.H. Chan School of Public Health.
“Is it really an incentive," she wondered, "or just perceived as an indication that the pandemic is over, and things can go back to normal and I can go on my happy way without being vaccinated at all?”
Should you give up your mask?
Not everyone is ready to put away their masks.
Only about one-third of the U.S. population fully vaccinated and it's impossible to know whether someone is going without a mask because they are fully vaccinated or because they don't want to wear one.
Also, it's not clear how much protection the COVID-19 vaccines provide for people who are immunocompromised or take medications that weaken their immune systems.
"Personally, I am still not going to be comfortable going into a crowded space without a mask," said Dr. Robert Wachter, chair of the department of medicine at the University of California, San Francisco. He said he'll be ready to let his guard down when more people have gotten shots and infection rates in San Francisco keep coming down.
The Society for Healthcare Epidemiology of America warned that masks are still essential in health care facilities and in communities where the rate of infection remains high.
In health care settings, the society warned in a statement, "transmission can occur through unprotected exposures in common areas to asymptomatic or pre-symptomatic co-workers or visitors, whose vaccination status may also not be known."
And the union representing grocery workers said lifting the mask mandate for indoor spaces puts their workers at risk for infection.
“While we all share the desire to return to a mask-free normal, today's CDC guidance is confusing and fails to consider how it will impact essential workers who face frequent exposure to individuals who are not vaccinated and refuse to wear masks," United Food and Commercial Workers International President Marc Perrone said in a statement Thursday.
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The disagreement among experts shows just how difficult it is to communicate public health messages.
"Good communications is hard," Sell said. "There's not a lot of funding being put toward dealing with risk communications."
Though it has made some mistakes during the pandemic, he said, the CDC "is the shining star of the federal agencies, the best public health agency in the world, and they've performed extraordinarily well," he said. "Their biggest downfall has been in their messaging."
He described continued vaccine hesitancy among the American public as a "catastrophic failure" of communications by the CDC to show that COVID-19 vaccines – among the best ever developed – are safe and essential.
The problems started under the last presidential administration, but haven't been solved yet, he said, adding that he's not seeing enough vaccination outreach "on the ground" to reach out to people where they live, work, pray and spend their spare time.
"Vaccine hesitancy is unacceptably high and is our single barrier to getting back to normal," Gostin said. "The end of the pandemic in the United States is in sight, but this confusing and contradictory guidance makes it more likely that we’ll be battling the outbreak longer than necessary."
Still, some support the decision to loosen mask restrictions.
"This is the right call – it’s further evidence of how spectacularly well the vaccines work," Wachter said. "Overall, it’s excellent news and another important step toward 'normal.'"
Contact Karen Weintraub at firstname.lastname@example.org.
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