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The announcement by the Centers for Disease Control and Prevention (CDC) that fully vaccinated people do not have to wear face coverings indoors, unless specified by their states or local jurisdictions, triggered a backlash from public health experts.

They called the new guidelines premature — rightly so — and said that the coordination and rollout should have been better planned with the states and the rest of the Biden administration. While the criticism is accurate, the guidelines reveal another deep problem that the CDC can’t fix on its own: Americans don’t trust each other, and around half don’t fully trust the CDC.

A big concern has been that unvaccinated people, who could have Covid-19 and not know it, could choose not to wear masks or face coverings when out in public. This means to me that Americans are concerned not only with what the CDC said or did, but whether some of their fellow citizens are going to abuse these guidelines.

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Mistrust will be a long-standing public health ripple effect from the Covid-19 pandemic.

This isn’t solely the CDC’s fault, since it does not dictate or implement mask mandates. Those come from governors and states. I should know: I worked on the Covid-19 response for the Commonwealth of Massachusetts for most of 2020. Through this work, I came to understand that CDC guidelines are analyzed, interpreted, and implemented in different ways by different states depending on local factors.

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While I agree that mask mandates should remain in place for a while longer, I don’t agree that the CDC deserves most of the blame for states that have removed their mandates. The CDC was transparent with the public that fully vaccinated individuals do not need to mask in most circumstances: this is true. But what is true for an individual isn’t necessarily what is true for a community.

The goal now should be to communicate this nuance more clearly to the public, a responsibility that should be shouldered by the states just as much as by the CDC.

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Consider what would have happened had the CDC withheld its announcement because, like many Americans, CDC officials decided they can’t trust what people will do in public settings if states end up dropping mask mandates. The agency would have been criticized for infantilizing Americans and withholding information to the public, which surely won’t build trust. At a time where public trust in the agency is already faltering, the stakes for each public policy decision are high.

And this is the CDC’s second mask blunder: in the spring of 2020, as the pandemic raged, its advice to the public was not to wear masks at all.

I remember scratching my head when the CDC made that first recommendation. Some of the arguments I heard from colleagues in public health — many of them seasoned experts — were that if we told people to wear masks they would suddenly stop doing other preventive activities, such as physically distancing from each other. This presumption was based on the idea that people would not understand that masks were additive; instead, they would become reckless and end up worse off.

This argument, known as risk compensation, has been used in many ways, including to argue that requiring people to use seat belts would create riskier drivers.

In short, experts did not fully trust the public to act safely. So they withheld tools that could have protected them. Yet this risk compensation didn’t end up happening. For some people, the opposite happened, with masks becoming a visual reminder to stay six feet or more away from others.

Weeks later, when the CDC recommended that people should wear masks, the public’s trust had been lost. Some people questioned why the change was made; others were understandably upset to know that they had not been trusted to protect themselves.

This time, as the agency once again decided to weigh in on wearing masks in public, it was forthright on the benefits of Covid-19 vaccines, and may have hoped that the goal of not wearing masks in public would further incentivize people to get their shots. But the argument from public health professionals, as well as members of the public, has again been that people are too irresponsible or selfish to follow the guidelines, and unvaccinated people will abuse this system.

To be sure, no one knows know what will happen next. Where mask mandates are dropped, some unvaccinated people will stop wearing masks in public. It’s also possible the new mask guidelines will indeed be the incentive some people need to get vaccinated.

The bigger concern here is not with what the CDC actually said, but with the fact that there is a deep lack of trust in our society. People don’t feel like they can rely on one another to follow guidelines that aren’t enforced with mandates or penalties. And while there’s good reason for why that trust has evaporated, the CDC’s choice to release or withhold information to us all should not depend on whether some people might abuse that information. The public deserves to be told the truth about where the science stands; the public also deserves competent governors and public health department chiefs who can communicate nuance and decide what policies make sense to implement at a community level.

There’s no question that trust must be rebuilt between members of the public, and between the public and health agencies and leaders. But for this to happen, we must all acknowledge that the lack of trust is what’s bothering us.

Abraar Karan is an internal medicine physician at Brigham and Women’s Hospital in Boston and a clinical fellow in medicine at Harvard Medical School.

  • OK, some people will always game the system. Some people will claim to be vaccinated when they are not. So what? Vaccinated cannot catch it from them nor give it to them. If they get sick, it will be on them. The CDC should just give out best practices-it’s not their job to make naughty people behave.

  • Does it occur to anyone that the CDC was undermining their own message about vaccines by insisting that everyone keep wearing masks vaccinated or not? That implies that the vaccine is not effective. If so, why should anyone get vaccinated?

  • “Fully vaccinated” people can have and transmit COVID without knowing it, too. S o why make pariahs out of unvaccinated people? If a person wants to go for the Darwin award by not being vaccinated, shouldn’t that be their prerogative? If the vaccinated people are protected by the vaccine, what do they have to fear? Seems like a fork-tongued message to me.

  • If I recall correctly, the thinking in March 2o20 went that if we were told to mask, there would have been a run on masks, thereby depriving first-line workers, who needed them most. That was a tough call, since certainly many public health proponents knew then that everyone needed to mask. But it was a pandemic, and we don’t get to know the right answer in advance. And, interestingly, since the CDC made its latest recommendation, there has been a definite uptick in vaccinations. So maybe it wasn’t so bad after all.

  • If you are vaccinated and not wearing a mask then why would you be concerned about others not masking up. You are vaccinated!

  • Where do the people that have had Covid and recovered fit in? The CDC did not account for them at all in their mask recommendations.

    • Those 99.98% of us that had Covid and recovered have the real antibodies, not the pseudo antibodies that may have been produced by the vaccine. Yet all anyone wants to talk about are the vaccinated and masked. SMH.

  • The new rule about fully vaccinated not needing masks is a good thing. Some may say that those who are not vaccinated may lie about it. But guess what, these same people were not wearing masks when it was required and most shops did not enforce the rule. So it doesn’t make a difference for them, but for the fully vaccinated rule-abiding people, it makes a big deal.

  • How can we trust alot (not all) of people when from the start a huge amount griped about wearing a mask to protect others. There is a HUGE depletion of respect in generations born after around 1980 till now. When you even ask about anyone wearing a mask including themselves to protect elderly parents it didn’t matter. Sad sad world to be in.

    • Yes, and when I was a child we had to walk seven miles to school through the snow. Uphill. Both ways.

  • When the Director of the CDC quotes a single publication as evidence that vaccinated masks can come off and she refers to that study as a meta-analysis when it is a systematic review, my confidence dropped. As an epidemiologist I read a large number of these studies and in particular their materials and methods section. Right there you know what type of study you are dealing with and what the paper’s power may be. The CDC is hemorrhaging credibility and might best look for outside, independent analysis before making any future recommendations.

  • And therein lies the fault with how this was all dealt with from day one….One is correct and necessary for one community within a State is not true of ALL communities. Every one is different with differing population counts, different businesses / manufacturing facilities, some are very rural while others are densely populated….These variables exist even within a county level.

    Speaking as someone with emergency response experience but who is outside of the medical field…..And as someone who was aware of and warned others of what would become Covid via Promedmail long before it became a household word and fear…I agree with what was done to initially contain the disease overall….But many small communities in my largely rural State that had zero to extremely minimal exposure / spread were subjected to “guidelines” that made little sense given where they were in the Pandemic. That alone sparked the roots of distrust. Then add in all of the other waffling, indecisions, changes, etc…..And yes, the CDC looked as though it was inept even if that was not the case.

    To be fair….Pandemics such as this one are RARE. There was no modern day precedent for how to handle it beyond the basic containment plans that were in place in many County, State, and Federal emergency management agencies and facilities like the CDC. EVERYONE AROUND THE WORLD WAS WINGING IT and adjusting as best they could. NO ONE GOT IT RIGHT.

    That said….That mistrust exists and if, God forbid, any of these vaccines turn out to have more frequent and serious mid to long term health effects…..That trust will NEVER be regained.

    • You are absolutely correct. I have been told several times that these vaccines are tested and proven safe. However, there is no way to know what the long term effects are.

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