Since the CDC’s mid-May guidance on wearing masks, we’re no longer all in this together

Before there were magnificently effective Covid-19 vaccines, “We’re all in this together” was a crucial message for Americans. More than a message, it was a fundamental fact of the pandemic, even if we were too polarized to feel it or act on it.

That message was shattered when the director of the Centers for Disease Control and Prevention, Rochelle Walensky, issued her bombshell announcement on May 13 that people who are vaccinated — but not those who aren’t — can safely ditch their masks in most indoor venues.

Walensky’s proclamation provoked widespread outrage from experts and the public, not because she was wrong on the science (almost nobody said that) but because she was willing to “follow the science” to a divisive, polarizing conclusion that left policymakers in the lurch.

At the end of June, Walensky provoked something more like confusion than outrage when she stood by her mid-May advice in the face of contrary advice from the World Health Organization and even the Los Angeles County Department of Public Health. The L.A. authorities said vaccinated people should resume wearing masks indoors; WHO was stricter still, basically urging the vaccinated to take the same precautions they had been taking when unvaccinated.

What was most shocking about Walensky’s mid-May announcement — and remains shocking two months later — is that the CDC suddenly had different recommendations for the vaccinated and the unvaccinated. The unvaccinated, the agency said (and still says), are a tiny threat to the vaccinated. The vaccinated are a tiny threat to the unvaccinated. The unvaccinated significantly threaten only each other — and those who are immunocompromised.

We’re not all in this together anymore.

Some commentators have opined that there are now “two Americas,” the highly vaccinated (mostly blue) places and the less vaccinated (mostly red) places. It’s certainly true that Vermont, with nearly 77% of adults fully vaccinated, is a safer state in which to go unmasked than Mississippi, with 43% fully vaccinated.

But the distinction between vaccinated and unvaccinated individuals cuts even deeper than the distinction between mostly vaccinated and largely unvaccinated places. I’d feel safer vaccinated and unmasked in Mississippi than unvaccinated and unmasked in Vermont.

I wish I could say that the CDC is sticking to its guns on mask-wearing because it knows its guidance is based on the science. But the agency routinely hesitates to change its recommendations when scientific evidence changes, worried that accusations of flip-flopping might do more harm (especially reputational harm) than hanging onto outdated claims. So you can’t conclude much from the CDC’s steadfastness.

Taking the WHO’s guidance to heart might also be a mistake. As Walensky rightly said on NBC’s “Today,” “WHO has to make guidelines and provide information to the world” — including countries where the virus is surging, overcrowding is rife, the vaccinated are a small minority, and the vaccines are suboptimal.

So maybe L.A.’s advice is the one to heed: “To be extra safe, it is strongly recommended that you wear masks indoors in public places when you don’t know everyone’s vaccination status regardless of your vaccination status. … Until we better understand how and to who [sic] the Delta variant is spreading, everyone is asked to wear masks to help slow the spread of the virus.”

I like that “extra safe” reference. It implicitly acknowledges that what Walensky asserted in mid-May is still true, the Delta variant notwithstanding. In most parts of the U.S., including Los Angeles, it’s still pretty safe for fully vaccinated people to not wear masks, even indoors and even in mixed company. But it’s a little less safe this week than last week, and it’s likely to be a little less safe next week than this week, because Delta is spreading fast while vaccination rates have slowed and 32% of adults 18 and up (and 44% of the whole U.S. population) are still completely unvaccinated against Covid-19.

Nearly all of the CDC’s advice is just that — advice. With some exceptions, the CDC doesn’t set U.S. health policies. State governments do that, or city governments insofar as the state permits. And individual employers and venues set their own policies too, insofar as the state and city permit. Even President Biden couldn’t impose a national mask mandate, though he could (and did) impose one on federal property and interstate mass transit.

So the CDC’s advice that people who have been vaccinated don’t have to wear masks posed an instant policy dilemma. It wasn’t the CDC’s policy dilemma. All the agency had to say — and it made sure to say it — was that people should continue to obey mask rules wherever such rules existed. As one CDC document put it, fully vaccinated people can resume activities “without wearing masks or physically distancing except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance.”

The CDC’s scientific pronouncement came without policy guidance. It left states, cities, and businesses with four bad options:

• The mandate. Keep making everyone mask up. Force vaccinated people to take this unneeded precaution in order to force unvaccinated people to keep protecting themselves, each other, and the immunocompromised.
• The honor system. Request (or urge or beg or even “require”) unvaccinated but not vaccinated people to wear masks but don’t monitor or enforce the policy. Some unvaccinated people will inevitably go unmasked. They won’t significantly harm vaccinated people, but they will cause more infections among the unvaccinated and immunocompromised.
• The vaccine passport. Find ways to distinguish people who are vaccinated from those who aren’t. Set the former free and require the latter to continue taking precautions, hopefully increasing their incentive to get vaccinated.
• Splitting the difference. State and local governments might make masks optional if and when case count and positivity levels get low enough, and require them again if and when those metrics rise again. Stores might alternate “masks required days” and “masks optional days.”

As we are learning, Delta is significantly more transmissible than prior variants. The more prevalent Delta becomes, the riskier it is for unvaccinated people to be unmasked in indoor public spaces. The risk they pose is mostly to each other. But they pose an increasing risk to the vaccinated as well, especially the immunocompromised whose vaccines might not have worked as well as most people’s. And of course even successfully vaccinated people can get infected. The combination of more Delta and more unmasked, unvaccinated people means more contact between you and the virus. That means your vaccine-induced immunity is challenged more often. And the more often it’s challenged, the likelier it is to fail.

So to some extent, we’re all in this together again — a lot less so than we were before we had vaccines, but a little more so than we were before Delta entered the picture. Vaccinated people have good reasons to wish unvaccinated people would mask up. But without vaccine passports and folks to check them, I can’t think of a way to get unvaccinated people to mask up while vaccinated people breathe free. The only practical way I see to make the unvaccinated wear masks is to make everyone wear masks.

There’s a stronger case today for universal mask-wearing indoors than there was in mid-May. But I don’t think it’s a strong enough case yet. I’m still with the CDC, not the L.A. health department. But if case counts and hospitalizations keep rising as they have been since early July, the case for mandatory mask rules will keep strengthening.

That’s the scientific case, not the political case. It’s politically easier for a state, city, or business to loosen its Covid-19 rules than to tighten them again. I suspect only a substantial increase in the death count could make renewed mask mandates politically palatable in much of the country.

But vaccinated people are free to take their own precautions. Some of those who doffed their masks in late May might decide to don them again by late July. (Some, of course, never doffed them.)

Beyond July? Who knows? Delta isn’t the last variant we’re going to confront. President Biden’s premature “Independence from the Coronavirus” July 4 celebration notwithstanding, the pandemic isn’t over, not even in the U.S.

I doubt things will get as bad in the U.S. as they were before vaccines were available, but they’re likely to get worse than they are right now. Despite the recent increase in cases and hospitalizations, from a longer perspective we’re in a lull. Enjoy it to the max, but let’s not count on it lasting.

I am fully vaccinated. Except when I have to, I’m not wearing masks again – at least not yet. But I’m keeping them handy and watching the numbers.

Peter M. Sandman, a long-time risk communication consultant, came out of retirement in early 2020 to try to help from the sidelines with Covid-19 risk communication. All of his articles, columns, and interviews on Covid-19 risk communication are all available at psandman.com.