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Tuesday, June 28, 2022

Universal Face-Mask Mandates Are Returning: What to Know

A storefront face-mask sign in Los Angeles, California.
Photo: Frederic J. Brown/AFP via Getty Images

A week ago, Los Angeles County became the first major metropolitan area to reinstate a mask mandate in indoor public spaces for both unvaccinated and vaccinated residents. And amid a nationwide surge of new COVID-19 fueled by the more transmissible Delta variant, America’s largest county isn’t the only place where universal mask mandates are back on the table. The Delta wave has thus reignited the politically charged debate over face-mask mandates. While the science backing the effectiveness of face masks is clear, officials at the federal, state, and local level have offered a range of conflicting guidance regarding face masks, often divided along partisan lines. Especially confusing has been whether fully vaccinated people should wear masks after the CDC recommended they no longer need to unless mandated. On Sunday, Dr. Anthony Fauci suggested in an interview that the CDC may yet revise those guidelines. Below is a look at the state of this debate, where and why mandates are being reconsidered, and what public-health experts have had to say.

Mask mandates that apply to both vaccinated and unvaccinated people are primarily meant to protect the unvaccinated, who account for nearly all new COVID cases, hospitalizations, and deaths in the U.S. Simply put, vaccinated and unvaccinated people continue to share indoor spaces where it’s easy to spread COVID, and there is no practical way to distinguish between them or enforce a mask mandate that applies to only the unvaccinated. So the only way to make sure unvaccinated people are wearing masks is to require everyone to.

The other factor is the rise and danger of the Delta variant, which is the most transmissible strain of the coronavirus yet seen.

Universal mask mandates also protect vaccinated people from exposure to the Delta strain. COVID vaccines provide strong protection against all known strains of the coronavirus, and only a small fraction of new COVID cases amid the Delta wave are being reported among vaccinated people — and a much smaller fraction of new COVID hospitalizations and deaths. But so-called breakthrough infections are happening and come with some risk, particularly for people who have weak immune systems.

Most universal mask mandates throughout the country had been rescinded ahead of the Delta wave, after the CDC updated its guidelines in May to recommend that people who were vaccinated no longer needed to mask up in indoor public spaces in May. The agency said that unvaccinated Americans still needed to wear face masks indoors and that state, local, and business rules continued to take precedence, but the new guidelines nonetheless triggered a de facto elimination of mask mandates nationwide.

More than two months later, despite the rapid spread of the Delta variant, the CDC has continued to stand by its recommendations. That may yet change, but in the meantime, numerous local officials have begun to take action on their own. Few have gone as far as Los Angeles County officials have, but many, citing the threat of Delta, have publicly urged everyone, regardless of vaccination status, to put their masks back on indoors.

The city and county of St. Louis, Missouri, announced late last week that it will once again require residents to mask up indoors, regardless of their vaccination status, starting July 26. Missouri, where just over 40 percent of residents have been fully vaccinated, is one of the states being hit hardest by the Delta wave. Missouri’s Republican-controlled state government opposes mask mandates, however, and the state’s attorney general said Saturday he will challenge St. Louis’s mandate in court.

Indeed, there are multiple GOP-controlled states that have already sought to legally bar or restrict local mask mandates, including large states like Texas and Florida — the latter of which now accounts for one out of every five new cases of COVID-19 nationally. All of these efforts to eschew or block mask mandates have framed the issue as a matter of protecting personal freedom, while some lawmakers have tried to downplay or discredit the necessity of face masks.

There has also been a return of expanded, albeit less-than-universal mask mandates. For instance, Nevada’s Clark County has once again mandated that all employees of businesses in the county wear face masks while at work regardless of their vaccination status. Less than 40 percent of residents in the county, which is home to Las Vegas, have been fully vaccinated. Meanwhile Southern Nevada Health District officials have urged the unvaccinated and vaccinated alike to mask up indoors, and county officials have warned they’ll require mask-wearing if the public doesn’t follow that recommendation. They aren’t the only local officials to have given that warning in recent weeks, but it remains to be seen how many more communities will attempt to reinstate universal indoor mask mandates.

With the new school year fast approaching, a simultaneous debate is raging about mask mandates in schools where in-person learning is set to resume this fall. While available data continues to indicate that children are the demographic least likely to develop serious complications from COVID infections, that doesn’t mean they are invulnerable or cannot transmit the coronavirus to others. Since children under the age of 12 aren’t eligible for COVID vaccines, they represent a large segment of the country’s unvaccinated population. Thus far, less than 40 percent of Americans aged 12 to 17 have received at least one dose of a COVID vaccine.

On July 9, the CDC released updated COVID guidelines for schools, recommending that all unvaccinated kids over the age of 2 should continue to wear face masks in school, while teachers and kids who have been vaccinated could go without — unless it was required by their school. Since the CDC guidelines are only a recommendation, it’s left to local governments and school districts to determine whether or not to require face masks in schools, and for whom.

Then on July 19, the American Academy of Pediatrics released its own updated recommendation which went further than the CDC’s. The AAP advised that vaccinated kids over the age of 2 should still wear masks in schools, citing the risk of new COVID variants and how difficult it will be for schools to determine who is and is not vaccinated.

Whether or not kids will have to mask up at school will depend on what local and state officials require wherever they live. Boston; Washington, D.C.; and Madison, Wisconsin, have all announced that they will require all public-school students and staff to wear masks regardless of vaccination status. California is requiring face masks in schools, but deferring enforcement to local school officials. Arkansas, which has one of the lowest vaccination rates in the country and is currently experiencing one of the nation’s worst Delta-fueled outbreaks, has banned school mask mandates. So have Texas, Iowa, and multiple other states with GOP-led governments.

Parents across the country have also launched lawsuits challenging both school mask mandates and the bans against them.

That’s not clear, but they might. The Biden administration has reportedly been weighing what it can do to promote the use of face masks, but is also apparently set on following the CDC’s lead. The CDC, meanwhile, is facing pressure from some public-health experts to readjust its guidance on face masks, as well as renewed criticism of its move to relax them in the first place.

On May 13, the CDC said that fully vaccinated people could safely resume indoor and outdoor activities without the need to wear face masks or practice social distancing. The decision, the CDC said, was based on research confirming the real-world effectiveness of COVID vaccines. The CDC did not lift its requirement that everyone, regardless of vaccination status, needed to wear masks while using public transportation. It also made it clear that Americans still needed to follow state, local, or business rules requiring masks. Soon after the announcement, however, states and many businesses simply updated their own mask rules to align with the CDC’s stance and in doing so relegated mask wearing among the unvaccinated to the honor system. In the end, only one state, Hawaii, kept its universal indoor mask requirements in place.

The CDC’s surprise rollback drew criticism from many public-health experts, who warned the move was premature and highlighted how difficult it would be to reinstate mask rules again if needed. Proponents of the move have argued that relaxing the face-mask guidance offered an incentive that would encourage more people to get vaccinated, but there is scant evidence it had that effect.

The CDC’s decision also preceded the rapid rise and dominance of the extra-transmissible Delta variant among the unvaccinated, both globally and in the U.S. Critics of the move have argued that while it is scientifically sound, safe advice for the fully vaccinated to go mask-less indoors, the CDC’s rollback also effectively eliminated mask requirements for everyone else and left unvaccinated people more vulnerable, just as Delta was getting a foothold.

In late June, the World Health Organization urged everyone globally, including the fully vaccinated, to continue to wear face masks indoors, citing the increased risk of Delta. But with the U.S. far outpacing most of the world in vaccinations, and data indicating that the vaccines administered in the U.S. provide very effective protection against all known variants, including Delta, the CDC has maintained its stance on masking.

On Thursday, following a report that the Biden administration was considering a change in messaging regarding face masks, CDC director Rachel Walensky told reporters that CDC scientists continue to review new data about the coronavirus but that, for now, there is no need to revise its guidelines. “Fully vaccinated people are protected from severe illness, and we’ve always said that communities and individuals make the decisions that are right for them based on what’s going on in their local areas,” she said.

“In areas that have high and low amounts of vaccination … if you’re unvaccinated, you should absolutely be wearing a mask,” she added. “If you’re vaccinated, you have exceptional levels of protection from that vaccine, and you may choose to add an extra layer of protection by putting on your mask and that’s a very individual choice.”

Then on Sunday, Dr. Anthony Fauci said that revising face-mask guidelines was “under active consideration” at the CDC.

Getting vaccinated is the best way to protect against COVID-19, including the Delta variant. Full vaccination remains very effective at both preventing COVID infection and spread, as well as protecting people who are vaccinated from becoming seriously ill should they somehow contract a breakthrough COVID infection.

Mandates aside, public-health experts continue to insist that fully vaccinated people face very little risk of COVID infection, and even less risk of serious COVID illness. That being said, it is — and never was — zero risk.

Some experts have suggested that people who are vaccinated should consider a number of factors when deciding whether or not to wear a face mask, including how much COVID is spreading in their area, where they will be spending time in public, and how much exposure they will have, then or later, to people facing greater risk from infection, like the unvaccinated or people with weak immune systems.

Yes, it can. While nothing provides better protection than getting vaccinated, face masks are still the second-best way that people can protect themselves and others against COVID infection, including against the Delta variant. That being said, masks likely provide less protection against Delta than they do against previous, less transmissible variants — which makes using a better mask and making sure it fits properly all the more important. Simply put, the Delta variant appears to be better equipped to exploit the weaknesses of loosely fit and/or lower quality masks, and in environments where the risk of COVID transmission is higher — like crowded, poorly ventilated indoor spaces, or situations where potential exposure lasts longer — the better the mask, the lower the risk.

Not if they don’t want to. Most coronavirus experts continue to emphasize that vaccinated people can safely go mask-less around other vaccinated people. The only exceptions, for now, would be if a vaccinated person had developed a symptomatic, so-called breakthrough COVID infection, or if taking extra precautions around vaccinated people who may have less immunity, like those with weakened immune systems.


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