The Centers for Disease Control and Prevention revised its guidance on wearing masks Tuesday. In a reversal of its earlier position, the agency is now recommending that some fully vaccinated people wear masks indoors if they live in areas with significant or high spread.
Currently, much of the country falls into that category — with the exception of the Northeast and parts of the Upper Midwest. The CDC provides this link if you want to see the area of spread in the county where you live.
"This was not a decision that was taken lightly," said Dr. Rochelle Walensky, the CDC's director, acknowledging that people are "tired and frustrated."
But Walensky pointed to new data showing that while vaccinated people still account for a small amount of risk, in rare cases they can get infected and spread the virus to others.
"The delta variant is showing every day its willingness to outsmart us," Walensky said.
" When we examine the rare breakthrough infections and we look at the amount of virus in those people, it is pretty similar to the amount of virus in unvaccinated people," she said. And, it's possible that because of this higher viral load, people with breakthrough cases of delta may be able to spread it.
"Unlike the alpha variant that we had back in May where we didn't believe that if you were vaccinated, you could transmit further, this is different now with a delta variant," she explained.
The CDC move comes as the highly transmissible delta variant fuels a surge in cases around the country, and multiple cities have reinstated indoor mask mandates, including in Los Angeles County and St. Louis. For weeks, many public health experts had been nudging the agency to change its policy, arguing that fully vaccinated people should wear masks in indoor settings, especially in areas where transmission of the virus is high.
"We have places that are now reporting over 300 cases per 100,000, so an extraordinary amount of viral transmission," Walensky said. And she again urged people who have not been vaccinated to get their shots.
"The highest spread of cases and severe outcomes is happening in places with low vaccination rates and among unvaccinated people," she said. And "the associated illness, suffering and death could have been avoided."
In addition, the agency recommends that all teachers, staff and students of K-12 schools wear masks, even if they are vaccinated. As the delta variant spreads, particularly in areas where vaccination rates are low, kids remain unprotected against the virus. The vaccines are not authorized for children under 12, and many teenagers have yet to get vaccinated.
The nation's leading group of pediatricians also recommends mandatory masking in schools for all students (over 2 years old), staff and teachers regardless of vaccination status.
In May, the agency signaled it was safe for fully vaccinated people to stop masking in most settings. At that time cases were dropping significantly, and the vaccination campaign was in full swing. Nearly 2 million shots were administered on the day the policy was announced. "You can do things you stopped doing because of the pandemic," Walensky said at the time.
The hope was that dropping the mask mandate would encourage more people to get vaccinated. Back in April when the outdoor mask mandate was lifted, President Biden said that for those who haven't been vaccinated, or feel they don't need to be, "this is another great reason to go get vaccinated now."
But three months later about 30% of adults in the U.S. haven't been vaccinated. And polls suggest that up to 80% of unvaccinated adults are unlikely to change their minds.
The decision to lift the mask mandate in the spring wasn't well thought out, said Dr. Zeke Emanuel, a health policy researcher at the University of Pennsylvania, and the agency has been delaying taking action as the delta variant spreads.
"I think the CDC position on masks has been behind the eight ball almost every step of the way," he said. "I don't think that they've been on top of the mask issue."
The pressure on the CDC to amend its masking policy in schools has been growing. School administrators don't have the resources to monitor who has been vaccinated or not, said Dr. Judy Guzman-Cottrill, a pediatric infectious disease expert at Oregon Health & Science University.
And, absent universal masking, kids will be left unprotected — or may be tempted to take off their masks. "I worry that some students will be singled out for wearing masks at school, and this can lead to bullying and peer pressure to unmask, even when it's not safe to do so," Guzman-Cottrill said.
AILSA CHANG, HOST:
Amid a surge in cases fueled by the delta variant, the CDC has changed its mask recommendations. The agency now advises that fully vaccinated people should wear masks indoors in areas where the coronavirus is circulating widely. The agency has also changed course on masking in schools, recommending universal masking regardless of vaccination status. Joining us now with more details is NPR's Allison Aubrey.
ALLISON AUBREY, BYLINE: Hi, Ailsa. Good to be here.
CHANG: So tell us more about this change in guidance.
AUBREY: Sure. For weeks, there's been a growing chorus of public health officials saying it makes sense for vaccinated people to mask up in crowded indoor spaces. This is because while the vaccines are very effective, Ailsa, they're not 100%.
AUBREY: And today, CDC director Rochelle Walensky pointed to new data that suggests the delta variant behaves differently. Not only is it more contagious, but people who get breakthrough infections could be contagious.
ROCHELLE WALENSKY: Some vaccinated people infected with the delta variant after vaccination may be contagious and spread the virus to others. This new science is worrisome and, unfortunately, warrants an update to our recommendations.
AUBREY: And this is why the CDC now says if you live in an area with substantial or high spread of the virus, you should mask up indoors even if you're fully vaccinated.
CHANG: Wait. Wait. So what parts of the country have substantial or high spread?
AUBREY: You know, it's really a huge swath of the country, with the exception of the Northeast and parts of the upper Midwest. As I look at the map, throughout the South and the lower Midwest, it looks like almost all of the counties are in orange or red. The same is true for much of the West Coast. So, you know, you can check out a CDC map online. It breaks it down to the county level.
CHANG: OK. And tell us more about this change in guidance from masking in schools now.
AUBREY: Sure. Yeah. The CDC now recommends universal indoor masking for all teachers, staff, students and visitors to schools, kindergarten through 12th grade, regardless of vaccination status. And this is a change from earlier this month when the agency said that fully vaccinated students and teachers didn't need to wear masks. Dr. Walensky says this is due to rising case counts and low vaccination rates.
WALENSKY: With only 30% of our kids between 12 and 17 fully vaccinated now, in a real effort to try and make sure that our kids can safely get back to full in-person learning, we're recommending that everybody wear masks right now.
CHANG: I mean, Allison, all of this is kind of a big swerve in policy - right? - because back in May, the CDC had said that vaccinated people could take off their masks in most settings, right?
AUBREY: Yeah, that's absolutely right. But, you know, a lot has changed. In May, new cases were dropping significantly. And back in May, about 2 million vaccine shots were being administered every day, so there was this great sense of optimism.
AUBREY: But two months later, about 30% of adults remain unvaccinated. New cases are surging. Nonetheless, a lot of experts have said the CDC has been too slow to respond. Here's Dr. Zeke Emanuel of the University of Pennsylvania.
ZEKE EMANUEL: The CDC's position on masks has been behind the eight ball almost every step of the way.
AUBREY: So today's announcement is seen by some as the agency sort of playing catch-up after weeks of experts saying, hey, look, cases are rising. Many people remain unvaccinated. It makes sense to mask up.
CHANG: That is NPR's Allison Aubrey.
Thank you, Allison.
AUBREY: Thank you, Ailsa. Transcript provided by NPR, Copyright NPR.