When the Centers for Disease Control and Prevention last month unveiled that relaxed masking recommendations, some people no doubt sighed in relief and thought it was about time.
People have become increasingly comfortable being out shopping, attending live events, or meeting up with friends at restaurants. And many are ready to cast aside their masks.
Still, a recent pointed to an underlying tension. Just as a large swath of the American public, 62%, said that the worst of the pandemic was behind us, nearly half were worried about easing covid-related restrictions 鈥� like indoor masking 鈥� too soon. The poll, conducted in February, found that 49% of adults were either 鈥渧ery worried鈥� or 鈥渟omewhat worried鈥� that lifting pandemic restrictions would cause more virus-related deaths in their communities. About 50% were 鈥渘ot too worried鈥� or 鈥渘ot at all worried鈥� that death tolls would rise in their communities.
The CDC鈥檚 move triggered some of the same mixed feelings from the public that the poll uncovered and laid bare a split within the health care community.
On the one hand, there鈥檚 applause.
The CDC鈥檚 protocol change is an indicator that the nation is approaching a 鈥渢ransition from the pandemic phase to an endemic phase,鈥� said Dr. Georges Benjamin, executive director of the American Public Health Association. Rather than pushing messages of prevention, Benjamin said, the agency is changing its focus to monitoring for spikes of infection.
On the other hand, there is criticism 鈥� and worry, too.
鈥淲hen I hear about relaxing regulations,鈥� said Dr. Benjamin Neuman, a Texas A&M University professor and chief virologist at its Global Health Research Complex, 鈥渋t sounds a lot like people giving up. And we鈥檙e not there yet, and it鈥檚 a little bit heartbreaking and a little bit hair-pulling.鈥�
What Are the New Guidelines, and How Are They Different?
Before the update, the CDC considered a community at substantial or high risk if it had had an infection rate of 50 or more new cases for every 100,000 residents in the previous week.
According to the agency鈥檚 new community-based guidance, risk levels can be and are determined by looking 鈥� over a seven-day period 鈥� at three factors: the number of new covid cases in an area, the share of hospital beds being used, and hospital admissions.
This change had a profound impact on how covid risk was measured across the country. For example, the day before the CDC announced the new guidelines, were considered areas of substantial or high risk. Now, just 14% of counties fall into the high-risk category, according to the agency.
The CDC doesn鈥檛 make specific mask recommendations for areas at low risk. For areas classified as medium risk, people who have other health problems or are immunocompromised are urged to speak to their health care provider about whether they should mask up and take other precautions. In areas deemed to be high risk, residents are urged to wear masks in indoor public spaces.
鈥淭his more stratified approach with this combination of those factors gives us a better level of understanding of covid-19鈥檚 impact on our communities,鈥� said Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. 鈥淪pecifically, the impact of severe disease and death.鈥�
But people shouldn鈥檛 get rid of their masks yet, she said. Even as the nation鈥檚 infection rates fall, the virus continues to spread on a global scale. 鈥淲e have to fully recognize that there are so many people on this Earth who are unvaccinated internationally, and this is where the variants come from,鈥� Althoff said.
Roses and Thorns From Experts
The same week the CDC rolled out its new guidelines, a national seven-day average of about 71,000 new covid cases, along with 5,400 hospital admissions. Around 2,000 people were dying because of the disease every day.
It鈥檚 numbers like these that led some public health experts to question the CDC鈥檚 timing.
鈥淚 think we have prematurely opened and prematurely unmasked so many times at this point, followed by remasking and reclosing and just seeing our hospitals absolutely swamped, that I don鈥檛 really trust this,鈥� said Texas A&M鈥檚 Neuman.
There have been 鈥渢oo many times,鈥� he said, when the CDC has put down its guard and the virus came back stronger. 鈥淲e鈥檙e basically taking our foot off the accelerator in terms of what we鈥檙e doing to slow down the virus, and that just means that there will be more virus going around and it鈥檚 going to keep swirling around,鈥� he said.
The CDC鈥檚 goal for easing mask mandates, Neuman speculated, was to create regulations that are more appealing and easier for people to abide by, because 鈥渋t鈥檚 hard to sell prudence as something really attractive.鈥澛燩lus, public health officials need to have a program that the entire country can follow, he said. The battle against the virus can鈥檛 be won with policies 鈥渢hat people follow in blue states but not in red states,鈥� he added, 鈥渂ecause the virus is very much a collective risk.鈥�
There also are questions about how effective the new approach is at signaling when risk is increasing.
Joshua Salomon, a professor of health policy at Stanford University鈥檚 medical school, said that although the CDC designed its new guidance to incorporate a stronger indicator of surges, it has 鈥渁 very late trigger.鈥�
Salomon, along with Alyssa Bilinski, an assistant professor of health policy at Brown University, and found that a rough rule of thumb during that period was that 21 days after most states rose to the high-risk level, the death rate hit three people for every million. That equals about 1,000 deaths a day at a national level.
The updated CDC guidance 鈥渋s intended to provide a sort of warning that states are entering a period in which severe outcomes are expected,鈥� he said. But the new approach would not sound that alarm until death rates were already reaching that 鈥渜uite high鈥� mark.
Others, though, point to another set of numbers. They say that with 65% of Americans and 44% boosted as of March 8, relaxing covid protocols is the right decision.
The new strategy is forward-looking and continues to measure and track the virus鈥檚 spread, said the APHA鈥檚 Benjamin. 鈥淚t allows a way to scale up and scale back the response.鈥�
Since the guidelines are based on seven-day averages, he added, they are a good way to monitor communities鈥� risk levels and gauge which set of mandates is appropriate. 鈥淪o if a community goes from green to yellow to red,鈥� he said, referring to the CDC鈥檚 that tracks counties鈥� covid levels, 鈥渢hat community will then need to modify its practices based on the prevalence of disease there.鈥�
The guidelines, Benjamin said, are 鈥渟cientifically sound, they鈥檙e practical.鈥� Over time, he added, more communities will move into the low and moderate categories. 鈥淭he truth of the matter is that you just cannot keep people in the emergency state forever,鈥� he continued. 鈥淎nd this is never going to get to zero risk. 鈥� [Covid鈥檚] going to be around, and so we鈥檙e going to have to learn to live with it.鈥�
What About Those Who Are Not Eligible for a Vaccine or Are Immunocompromised?
The CDC鈥檚 relaxed recommendations do not prevent anyone from wearing a mask. But for millions of Americans who are immunocompromised or too young to receive a vaccine, less masking means a loss of a line of defense for their health in public spaces.
Children younger than 5 are not eligible to receive a vaccine yet, and people who are immunocompromised and are susceptible to more severe cases of the disease include cancer patients undergoing active treatment and organ transplant recipients. People living with chronic illnesses or disabilities are also vulnerable.
鈥淵ou only have control of so much,鈥� Neuman said. 鈥淎nd if you鈥檙e exposed to enough of the virus and you鈥檙e doing all the right things, you can still sometimes end up with a bad result.鈥�
Masks are most effective when everyone in a room is wearing one, Neuman added, but the new mandate is similar 鈥渢o victim-blaming 鈥� basically saying, 鈥榊ou have a problem and so here鈥檚 the extra burden to go with your problem.鈥欌��