The CDC’s recommendation the vaccinated public can shed their masks and not socially distance in many situations was condemned by some observers who said it will cause confusion, noncompliance, and a possible spike in cases.

In wanting to convey a message of progress and optimism while rewarding and encouraging vaccination, the CDC seemed to some critics to be suggesting the pandemic was over, with images of people throwing masks in the air like new graduates circulating on social media.

It may be more a problem of communication than policy, but many people might skip the important caveats included in the recommendation, which, as of May 16, 2021, stated: “If you are fully vaccinated, you can resume activities that you did prior to the pandemic. Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.”1

‘It’s Still Impossible to Know’

Lawrence Gostin, JD, a professor at Georgetown University Law Center in Washington, DC, said in an emailed statement “the CDC is in an impossible position facing intense pressure to loosen its guidance on masking and distancing for vaccinated people. It has now lurched from overcaution to abandoning caution.”

The problem, pointed out by many others, is “it’s still impossible to know who is fully vaccinated and who isn’t, and it’s unlikely that only those fully vaccinated will return to normal activities,” Gostin said. “The public will not feel comfortable in a crowded indoor space if they are unsure if the maskless person standing next to them is or is not vaccinated. The U.S. has no ‘proof of vaccination’ system, and the Biden administration refuses to support such a system of verification.”

The Infectious Diseases Society of America and an organization of HIV physicians said in a statement that “The CDC recommendations should not send the message that the pandemic is over. … [W]e support the CDC recommendations, which are based on the latest scientific evidence. We also emphasize that the recommendations make no change to mask-wearing guidance in healthcare settings, schools, and public high-traffic areas including airports, as well as on airplanes, buses, and other forms of public transportation. Less than half of the U.S. population is fully immunized. Increased vaccinations will be necessary to control and finally end the pandemic.”2

Touching on the general perception of unclear messaging and that the announcement took some public health officials by surprise, IDSA concluded by stating, “CDC communication and coordination with state and local health departments and clear, actionable messages to the public remain critical to safely relaxing mitigation measures.”

Do Not Make Perfect the Enemy of Good

The CDC did the best it could in a difficult situation with the strong incoming vaccine efficacy data and some realpolitik demands to let the vaccinated go without masks, says William Schaffner, MD, a nationally known vaccine expert and professor at Vanderbilt University School of Medicine.

“I had the impression that CDC had a fair number of suggestions [for the recommendation] from the field in public health and infectious diseases,” he says. “They thought that the effectiveness of this vaccine was so good, and cases now were coming down. The country had to move in that direction.”

CDC Director Rochelle Walensky, MD, certainly heard that message in a recent appearance before Congress, he says.

“They were saying that you have to move forward,” Schaffner says, adding the most frequent question public health officials and clinicians are asked by those who are fully vaccinated is “What can I do now that I could not do previously?”

“We needed to provide some reward for people who are vaccinated,” Schaffner says. “Does that mean all the problems go away? Of course not. There will be some rascals — people who are unvaccinated but take off their masks. We will just have to live with that.”

Some communities may not have enough vaccine supply, many locals who refuse immunization, or spikes in COVID-19 infections. “Masking should remain in place. The local situation is going to be imperative,” said Christie Alexander, MD, associate professor at Florida State University College of Medicine. “I think [the CDC guideline] is based on science, but we can’t look at science in a vacuum,” she said at a recent webinar. “In some communities, people should probably continue to wear masks. It has to be individualized in a sense that way.”3

Unfortunately, the “blanket statement” will be heard differently by various groups, including those who probably were not vaccinated and wore masks as little as possible.

“I have recently been reading some articles about how those who aren’t vaccinated are like, ‘Oh, great. We don’t have to wear masks now,’ Alexander said. “That’s where it gets really tricky because we’re not going to be wearing armbands that say you’re vaccinated. It’s going to get really difficult in that regard.”

The irony, of course, could be those who are vaccinated — particularly the elderly and the immune compromised who may not have mustered a full immune response — will be more likely to still wear masks around those they do not know.

“I think part of the calculation in liberalizing the social distancing and masking recommendations was to kind of incentivize vaccination,” said Melanie Swift, MD, MPH, occupational medicine specialist at the Mayo Clinic. “It’s a bit optimistic to think that the same people who have refused to be vaccinated will comply with masking on the honor system.”3

Speaking at the same webinar, Swift recommended healthcare workers err on the side of caution in the community as the vaccine is not perfect and some people might contract an asymptomatic infection. It also bears repeating that even mild infections could lead to “long COVID-19” in those who decline vaccination. Unfortunately, vaccinating after this miserable panoply of neurological symptoms has set in — sometimes indefinitely — does little good.

REFERENCES

  1. Centers for Disease Control and Prevention. Science Brief: COVID-19 vaccines and vaccination. Updated May 27, 2021.
  2. Alexander BD, Gandhi RT. IDSA and HIVMA respond to new CDC masking guidance for fully vaccinated people. May 17, 2021.
  3. How to win over vaccine skeptics: Live expert panel for May 20, 2021. Newswise.