Masks off: The nuance behind the CDC’s controversial decision

In other times, a “masks off” announcement might have been celebrated. Instead, the Centers for Disease Control and Prevention stepped straight into controversy.

The confusion was palpable.

Debates immediately spun out over whether the CDC’s decision to remove masks was backed by science. Some experts quickly condemned the decision. The largest nurses’ union came out strongly against the new guidance. Yet the CDC is the nation’s largest public health entity with reputable medical scientists.

So, who is right, and why?

First off, it’s clear the CDC’s recommendation came as a shock to most. Until now, the CDC remained adamant on mask wearing — even in light of the studies they would later cite as evidence for removing them. Mere days prior to the new guidance, a poll of over 700 epidemiologists showed a vast majority anticipated one year or more of wearing masks. Upon the CDC announcement, CNN’s chief medical correspondent, Dr. Sanjay Gupta, outright stated the CDC mishandled the change, adding that it was inappropriate to surprise medical experts with such decisions. Clearly, the delivery was botched, contributing heavily to the backlash.

Second, as CDC Director Rochelle Walensky conveyed, it is true that for the majority of fully vaccinated people removing masks both indoors and outdoors in non-crowded spaces is currently safe. This is based on research that demonstrates low-to-no transmission of the virus among fully vaccinated people, as well as studies that show the vaccines are extremely effective in preventing severe disease and death. This is all great news.

However — and it’s a notable however — there are at least three significant caveats to these studies that the CDC acknowledges: 1) It’s known to be safest to remove masks among other fully vaccinated people, or with unvaccinated people who are correctly wearing masks, 2) these studies are based on our current understanding of variants and may change quickly, and 3) it may not be safe for people who are immunocompromised, even if they received full vaccination.

The latter is particularly noteworthy. At almost the same time as the new CDC mask rules, a study published in JAMA — a premier medical journal — found that 46% of solid organ transplant recipients failed to develop detectable antibodies to both the Pfizer and Moderna vaccines, even after a second dose. Although this study did not evaluate for memory B-cell or T-cell responses — both of which may aid in fighting SARS-CoV-2 infections — this amplified existing concerns for those who have generalized autoimmune weaknesses, including people with lupus, rheumatoid arthritis, Type 1 diabetes, cancer and more. Coupled with other research, it’s now known that millions of Americans may not be fully protected, despite having received full vaccination. This makes going mask-free for this population especially risky.

Third, while it’s true the vast majority of fully vaccinated people are currently safe, it’s also true that we’ve not come anywhere close to reaching herd immunity — a safety threshold reached when enough of a population is vaccinated and transmission — and therefore variants — is greatly reduced. As cases therefore remain high in some regions, it’s not the time to lift mask mandates without measures in place for vaccine enforcement.

This makes the new CDC guidance murky: How do we know if someone is fully vaccinated — and therefore able to be mask-less — without asking for proof? The answer is that we can’t, but if unvaccinated people ditch the masks against the honor system, this will increase the risks for everyone.

Taking all three truths in context, the controversy becomes more clear. Why would a federal entity hastily present a new guideline that isn’t broadly applicable throughout the U.S. — even if the rationale is largely rooted in science?

For that, I don’t really have an answer. I do, however, have what I would have offered as a viable alternative.

The CDC should have presented the American public with clear vaccination goals, that upon reaching them would prompt mask removals over the coming weeks and months. This would have addressed each consideration above, and allowed leaders and businesses time to adapt. It would have also spurred Americans to get vaccinated, and given experts time to more effectively convey why and how mask guidelines were changing, alleviating concerns.

Regardless, the cat is now out of the bag and it’s not wearing a mask, meaning I will continue to wear my mask indoors and in crowded spaces a little while longer.