Expert: With masks, it’s never wrong to be more cautious

Expert: With masks, it’s never wrong to be more cautious

By now you have likely experienced sensory overload from CDC’s new masking guidelines but your understanding of it may not be any clearer. Essentially, CDC has made a distinction between those who are fully vaccinated and those who are not.

According to the guidelines, fully vaccinated people can now ditch their masks in most places if they choose – with a few exceptions like airplanes and healthcare settings. That part is sensible, as we know the vaccines are incredibly effective at preventing both severe disease and transmission to others. For the most part, fully vaccinated people should feel confident that they are protected from getting COVID-19.

But here’s the problem, and it may be a big one. We have no national system to prove vaccination status. The paper vaccination cards you receive are more records of vaccination than proof. They can easily be manufactured on a home computer, and not unexpectedly fraudulent vaccination cards have already surfaced. The only reliable proof of vaccination is electronic; you would have to sync your phone to a state or federal database and then receive a token such as a QR code. You could then use that electronic proof to gain access to businesses and events that require proof of vaccination for entry.

The intent of the CDC guidance was to incentivize unvaccinated people to get vaccinated. The thought was that allowing freer access to public places for those who are vaccinated would spur the unvaccinated to roll up their sleeves and then join their unmasked counterparts.

Ironically, the new rules may have the opposite effect. The resulting “honor system” is likely to be anything but. The new rules may therefore carry with them grave consequences, especially in certain populations. Unvaccinated people who remove their masks in public continue to risk their own health and the health of their families.

Some national chains have announced they will be following the new CDC guidelines and allow fully vaccinated patrons to enter without masks. Since no proof of vaccination is required, it seems likely that both vaccinated and unvaccinated people will drop their masks. How can we measure it? As of today, ~ 37% of the US population is fully vaccinated. Tomorrow when you visit one of those businesses or any others that have adopted the CDC guidelines, estimate what percentage of the patrons are not wearing masks. It is likely it will be more than 37%.

And that doesn’t even take kids into account. We began vaccinating kids aged 12-15 just last week, so none of them are fully vaccinated yet (it takes two weeks after the second dose). And no child younger than 12 has yet to receive even a single vaccine dose. So, while vaccinated parents entering a business should have their children remain masked, those kids will now be potentially exposed to unvaccinated, unmasked adults – increasing their risk of getting infected and transmitting the virus to others.

And there is another group we should be concerned about – the immunocompromised, those with weakened immune systems. We know from studies that immunocompromised patients -such as those who have received kidney or liver transplants – can have a very poor response to the COVID-19 vaccines. So technically those patients are “fully vaccinated,” but they are likely still susceptible to severe infection and even death. We must therefore urge our immunocompromised family members and friends to remain masked in all indoor public settings. Unfortunately, this was not addressed in the CDC guidelines.

The new guidelines are also likely to disproportionately impact underserved communities, especially those of color. These communities have significantly lower vaccination rates than affluent communities and will therefore likely have higher numbers of new cases when people drop their masks. Accelerating transmission of disease in these communities will only serve to broaden the already significant gap in health equity between the haves and the have nots.

While the intent of the new guidelines was to provide clarity, the early returns suggest they have done anything but. Time will tell if this was the right strategy. Some have expressed concern that the guidelines were released too early, and they would prefer to wear masks in public until they feel more comfortable. This is perfectly acceptable – it’s never wrong to be more cautious.

Dr. Robert Citronberg is Executive Medical Director of Infectious Disease and Prevention for Advocate Aurora Health.

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Comments

3 Comments

  1. Toni Soward-Gatford May 17, 2021 at 2:09 pm · Reply

    Thank you, Dr Citronberg. These were some of my exact concerns when I first heard the announcement. I certainly hope with all that is in me that it doesn’t, but I wouldn’t be surprised by the emergence of a new wave of infection under these new guidelines.

  2. M. Ramona Nimmer May 17, 2021 at 4:46 pm · Reply

    “The only reliable proof of vaccination is electronic; you would have to sync your phone to a state or federal database and then receive a token such as a QR code. You could then use that electronic proof to gain access to businesses and events that require proof of vaccination for entry.” This statement terrifies me; it sounds eerily like an enormous violation of privacy and personal freedom.

  3. Mary Karraker May 19, 2021 at 8:23 am · Reply

    I checked through the LiveWell app… Immunizations are available to see as a subset to the Health Summary. So it is nice to find and be able to show, if needed.

About the Author

Dr. Robert Citronberg
Dr. Robert Citronberg

Dr. Robert Citronberg is Executive Medical Director of Infectious Disease and Prevention for Advocate Aurora Health.