C.D.C. Says Some Vaccinated Americans Should Wear Masks Again

Revising a decision made just two months ago, the Centers for Disease Control and Prevention said on Tuesday that people vaccinated against the coronavirus should resume wearing masks in public indoor spaces in parts of the country where the virus is rising.

CDC officials also called for universal masking for teachers, staff, students and visitors to schools, regardless of vaccination status and community transmission of the virus. However, with additional precautionary measures, schools should return to face-to-face classes in the fall.

The recommendations are another ominous twist in the course of the American pandemic, a war-weary admission that the virus is outstripping vaccination efforts. The agency’s move follows rising case numbers in states like Florida and Missouri, as well as increasing reports of breakthrough infections of the more contagious Delta variant in fully immunized people.

“The Delta variant shows its willingness to outsmart us every day,” said Dr. Rochelle Walensky, director of the CDC, at a press conference on Tuesday.

The CDC said Americans should return to wearing masks in areas where there have been more than 50 new infections per 100,000 residents in the past seven days, or more than 8 percent of tests positive for infection over that period. Health officials should reassess these numbers weekly and amend local restrictions accordingly, the agency said.

For example, based on these criteria, all residents of Florida, Arkansas, and Louisiana should wear masks indoors. Almost two-thirds of US counties qualify, with many concentrated in the south.

The agency said that even vaccinated Americans in areas without surges could consider wearing a mask in indoor public spaces if they or someone in their household has a weakened immune system or is at risk of serious illness, or if someone in the household is not vaccinated is.

This includes vaccinated parents of children under the age of 12 who are currently not eligible for the vaccinations.

CDC officials were convinced of new scientific evidence showing that even vaccinated people can become infected and transmit the virus in large quantities, perhaps even similar to what happens in unvaccinated people, confirmed Dr. Walensky at the press conference.

Data from several states and other countries show the variant behaves differently than previous versions of the coronavirus, she added, “This new science is worrying and unfortunately warrants an update to our recommendation.”

“We at CDC didn’t make this decision easy,” added Dr. Walensky added. “That burdens me heavily.” Americans are tired and frustrated, she said, and mental health challenges are growing.

Following the agency’s announcement, White House staff were instructed to return to wearing masks indoors. The Biden administration is considering vaccinating all federal employees or undergoing regular tests and job restrictions, similar requirements to New York City and California.

“Because of the unvaccinated, we have a pandemic and they are creating tremendous confusion,” President Biden told reporters on Tuesday. “The more we learn about this virus and the Delta variant, the more we have to worry. And only one thing we know for sure – if these other hundred million people were vaccinated, we would be in a completely different world. “

The CDC needs to reconsider its recommendations, said Dr. Anthony S. Fauci, the government’s senior advisor on the pandemic. “I don’t think it can be said that this is just a flip-flop. You are dealing with new information that science provides. “

The vaccines remain remarkably effective against the worst of the consequences of infection with any form of coronavirus, including hospitalization and death. But the new guidelines explicitly apply to both unvaccinated and vaccinated people, a sharp departure from the agency’s position since May that vaccinated people are not required to wear masks in most indoor spaces.

These recommendations, which appeared to signal an end to the pandemic, were based on previous data suggesting that vaccinated people rarely become infected and almost never transmit the virus, making masking unnecessary.

But that was before the arrival of the Delta variant that makes up the majority of infections in the United States today. And others can follow. “The big concern is that the next variant that might come up – just possibly a few mutations away – could bypass our vaccine,” said Dr. Walensky.

Whether or not masks become ubiquitous again may depend on local surveillance and contact efforts, which vary from state to state. Many Americans just don’t know what infection rates and positive test rates are near them on a weekly basis.

Based on the scientists’ findings on the Delta variant’s ability to cause breakthrough infections, “this is a step in the right direction,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center in New York.

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July 27, 2021, 9:15 p.m. ET

The American Federation of Teachers and the National Education Association, the two leading teacher unions, strongly supported the CDC’s move towards universal masking in schools.

“Masking in schools is an important means of dealing with the changing realities of virus transmission, regardless of vaccination status,” said Randi Weingarten, President of AFT. “It is a necessary precaution until children under the age of 12 can receive a Covid vaccine”. and more Americans over 12 are being vaccinated. “

Other union officials said the guidelines did not go far enough and would not protect frontline workers and key workers in supermarkets, retail stores and meat packers.

“A national mask mandate is the only way to finally get this virus under control,” said Marc Perrone, President of United Food and Commercial Workers International.

Whether state and local government officials are willing to follow the agency’s instructions is far from certain. And there is sure to be resistance from pandemic-weary Americans, especially in regions of the country where vaccination rates are low and concerns about the virus are subdued.

Some jurisdictions, such as Los Angeles County and St. Louis County, have already reintroduced mask requirements in response to rising cases. But officials in some Los Angeles County communities have said they will not enforce a mandate. And the Missouri attorney general has filed a lawsuit against the city of St. Louis to stop the act.

Companies are also likely to find that new mask recommendations make plans to return to their offices in places where the virus is spreading difficult and may require new mandates for employees to get vaccines.

The Washington Post, for example, said Tuesday it would require proof of vaccination as a condition of employment when workers return to the office in September after hearing concerns from many employees about the occurrence of coronavirus variants.

If companies believe that such mandates would be beneficial, “we encourage them to do so,” said Dr. Walensky at the press conference. “We really encourage all activities that would motivate further vaccinations.”

Understand the state of vaccine mandates in the United States

As recently as last week, a CDC spokesman said the agency had no plans to change its masking guidelines unless there was a major change in science. Now researchers have begun to uncover worrying data.

The delta variant is considered more than twice as contagious as the original version of the virus. Some research now suggests that people infected with this variant carry about a thousand times more virus than those infected with other variants, and that they may stay infected longer.

CDC officials have been swayed by new research showing that people who have been vaccinated can carry large amounts of the variant virus in their noses and throats, suggesting they can spread it to others as well.

Large viral loads can help explain reports of breakthrough infections in groups of people who have been vaccinated. For example, an outbreak that began in Provincetown, Massachusetts after the July 4th celebrations there has included at least 765 cases, according to Steve Katsurinis, chairman of the Provincetown Board of Health.

Of the 469 cases reported in Massachusetts residents alone, 74 percent were in people who were fully immunized, Katsurinis said.

Smaller clusters of breakthrough infections have been reported after weddings, family gatherings, and dinner parties. Some of those infected had symptoms, but the vast majority were not seriously ill, suggesting that the immunity created by the vaccines is quickly containing the virus.

Vaccines “are not a force field,” said Jennifer Nuzzo, an epidemiologist at the Bloomberg School of Public Health at Johns Hopkins University. Instead, the vaccination trains the immune system to recognize cells that become infected with the virus.

“The term ‘breakthrough infection’ is probably a bit of a misnomer,” she said. “It’s probably more realistic that we’re talking about ‘breakthrough diseases’ and how much of it occurs.”

Dr. Walensky acknowledged that some vaccinated people can become infected with the Delta variant and could be contagious, but claimed that it was a rare occurrence. So far, vaccinated people make up only 3 percent of hospital admissions, officials found.

Dr. Gounder and other experts said it was unclear how often vaccinated people passed the virus to others, but it could be more common than scientists predicted when the original virus spread last year.

Vaccinated people – especially those with weak immune systems or otherwise at high risk – should consider wearing masks even in areas with low transmission, said Dr. Scott Dryden-Peterson, an infectious disease physician and epidemiologist at Brigham and Women’s Hospital in Boston. “Masks can effectively reduce the amount of virus we breathe and prevent us from getting sick, thus increasing the effectiveness of our vaccine. It’s a good idea almost everywhere in the US, ”he said.

Infections have skyrocketed in the United States, averaging more than 56,000 daily cases (as of Tuesday), more than four times the number a month ago. Hospital admissions have also increased in almost all states, with deaths rising to an average of 275 per day.

According to experts, federal officials need to formulate clear plans for testing and long-term masking.

“The question is, what are the offframps for the masking?” asked Dr. Nuzzo. “If we want to keep encouraging people to get involved, we have to give them a vision of what we’re working towards.”

The CDC should have simply told all Americans to wear masks indoors, said Ali Mokdad, an epidemiologist at the University of Washington and a former CDC researcher.

“If you look at the country, every state sees an increase in transmission,” said Dr. Mokdad. “So why not say, ‘Everyone in the US should wear a mask indoors?’ The whole country is on fire. ”

The coverage was contributed by Roni Caryn Rabin, Neil MacFarquhar and Daniel E. Slotnick in New York and Annie Karni and Sheryl Stolberg in Washington.

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