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Op-Ed: The CDC’s new COVID mask guidance creates a confusing ‘new normal’

The hands of two side-by-side people, one of which holds a phone and a mask.
The CDC loosened guidelines for vaccinated people, with masks no longer being necessary when outdoors or in most indoor situations.
(Los Angeles Times)

The new “masks off” announcement from the national Centers for Disease Control and Prevention leads us to a new question in the war on COVID-19: What’s next?

What’s next is the CDC’s confusing “new normal.” The agency’s unexpected turnabout on mask rules has left Americans asking a slew of questions that no one can answer — at least not yet.

How will we know who is unvaccinated? Will significant unmasking cause surges in places where there is low vaccination and high risk? How will businesses enforce mask rules? Will local and state governments, eliminating COVID rules, drive up new infections and increase the chance of a vaccine-resistant variant? Will vaccinated people, if unmasked in packed public buildings, be able to transmit the virus if they contract it? Will people lie about their vaccination status?

At this point in the pandemic, clear and consistent messaging to the public is critical to public health. The CDC’s announcement this week, unfortunately, fell short of that.

Over the coming weeks, the agency needs to update its recommendations as we see changing social effects. And it needs to acknowledge that more questions will emerge depending on new COVID research.

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It doesn’t help that we are already living in a messy world in which epidemiologists and the risk-averse continue to contend with a portion of the population who will likely never get vaccinated. Many in this population never believed in masking or social distancing rules, egged on by conservative leaders who are mostly vaccinated. No wonder public anxiety is at record levels.

But in the meantime: Breathe.

In my world of emergency medicine, the new CDC recommendation was not viewed as alarming or one that should change behavior entirely.

We know that the vaccines work to prevent serious illness and death from COVID-19. But because of the vaccine-hesitant, we in healthcare will be wearing our full protective gear at work and masks in some places for a long time. So will you — on airplanes, in some businesses and in hospitals. If you’re smart you’ll wear one in any place where vaccinated and unvaccinated people might mix, such as a bar, the theater or the subway. If you travel you might need a vaccine passport — or you could be forbidden from using one — (hello, Florida!).

Confused? The next campaign in our war on COVID will be the dance of risk versus benefit.

Remember the horrible time before vaccines, the surges of sickness? Followed by the scramble to get miracle vaccines into arms? Now we’re at the phase where there are more doses and appointments available than takers.

Vaccination centers are closing and states are requesting significantly smaller quantities of doses. Meanwhile COVID is ripping through vulnerable populations in places like India, which are desperate for vaccines and oxygen.

When we have to offer million-dollar lottery prizes to the vaccine foot-draggers (hello, Ohio!), we know we’re done with convincing people with arguments based on health benefits or appeals to basic decency. The fear raised by the questions left unanswered by the CDC guidance feels like things did at the start of COVID, when so much was unknown. But it is not the same.

If you’re vaccinated, you’re safe. It is extremely unlikely that you will get hospitalized or seriously ill from COVID. If you’re vaccinated, you very likely won’t pass the disease to your family or children.

Masking, hand washing and social distancing help protect both vaccinated and unvaccinated people, everywhere. You should be prepared to do all these things where required, and if conditions change and a resistant variant emerges.

The CDC is betting on the proven power of the vaccines that helped prevent COVID-19 surges in places where vaccination was high. Since variants breed faster with higher case counts, it is almost certain that increasing vaccination will decrease the number of variants.

If you aren’t vaccinated, you should be nervous. Rebels who believe COVID is a hoax may try to blend in with the vaccinated. The virus will continue to circulate, looking for — and finding — the vulnerable.

The vaccinated can choose to wear masks in places where they feel uncomfortable. For the unvaccinated, the choice will be accepting a high and increasing risk of illness, until they decide to get the shot.

The CDC changes announced Thursday don’t immediately alter mask rules in California, but they have raised some questions.

Yes, there is a small percentage who will never get the vaccine, no matter what. President Biden and the CDC are betting that the new guidance will push more Americans to get a shot — and bring the country somewhere closer to herd immunity.

Those anti-vaxxers will benefit too, of course, but they will probably still believe that their continued good health came from exceptionalism — not from the faith the rest of us had in science and vaccines.

Some fear the CDC is moving too fast in lifting COVID-19 mask guidance for the vaccinated.

Mark Morocco is a Los Angeles physician and professor of emergency medicine.


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