By Chas Danner
The CDC on Tuesday advised all Americans, including people who are fully vaccinated, to mask up indoors in public places again, anywhere in the country that is seeing significant spread of COVID-19. In addition, the agency also wound back its guidance on face masks in schools, and is now advising all students and staff to wear masks during in-person learning, regardless of their vaccination status. The CDC’s new guidance came as a direct result of the rapid U.S. spread of the Delta coronavirus variant, which has led to a surge of new cases in recent weeks, primarily among the unvaccinated.
Ahead of the CDC’s policy reversal, the Delta wave had already prompted many local officials across the country to reinstate universal indoor face mask mandates or advisories. Following the CDC announcement on Tuesday, Nevada quickly announced that it would once again require everyone in the state to wear face masks indoors in public. The House, too, announced that masks would be required for any work indoors on their side of the Capitol. Meanwhile, the debate over face masks remains politically fraught, particularly since officials at the federal, state, and local level have offered a range of conflicting guidance regarding the matter, not always informed by science, and often divided along partisan lines. Regardless, more mandates — and confusion — now seem likely. Below is a look at the state of this debate, what the CDC’s new face mask guidelines mean, where mask mandates are coming back, and what public-health experts have had to say.My Week In New YorkA week-in-review newsletter from the people who make New York Magazine.
A storefront face-mask sign in Los Angeles, California. Photo: Frederic J. Brown/AFP via Getty Images
What are the new CDC guidelines, and why did it change course?
The CDC now recommends that everyone wears a face mask in indoor public places, regardless of their vaccination status, in any community where there is substantial or high transmission of COVID-19 — which means anywhere where there have been 50 new COVID cases confirmed per 100,000 residents within the past seven days. That currently applies to almost two thirds of the counties in the U.S, not just including the southern and midwestern states experiencing large outbreaks, but a majority of counties in Nevada, Colorado, and Utah, as well as every county in New York City.
Regarding schools, the CDC now recommends that all students, teachers and school staff members in the U.S. wear face masks at school, regardless of vaccination status — but emphasizes that schools should still resume in-person learning.
The CDC also said that vaccinated people should get tested for COVID-19 not only if they develop COVID symptoms, but if they were recently in close contact with someone who had a suspected or confirmed case.
As to why the agency changed course, CDC Director Rochelle Walensky cited emerging data about the the Delta variant, which she said was effectively a different virus from any other strain, in that it could lead to outbreaks among both the unvaccinated and vaccinated alike. And while vaccines continue to provide strong protection against severe illness and death, so-called breakthrough infections remain possible, and in the case of Delta breakthrough infections, may be transmissible to others, both vaccinated and unvaccinated. Specifically, Walensky cited research showing that vaccinated people with Delta breakthrough infections may have just as much viral load as unvaccinated infected people do.
In general, mask mandates that apply to both vaccinated and unvaccinated people have primarily been 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. On the other hand, while breakthrough infections are uncommon and very rarely lead to serious outcomes, they still come with risks, particularly for people with weakened immune systems, or as the CDC fears, the capability to spread COVID to others.
Where mask mandates are coming back, and where they are being opposed
Ahead of the Delta wave, almost all universal mask mandates throughout the country had been rescinded 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 (unless required to by state, local, or business rules). Now the CDC has partially reversed itself, citing the Delta wave, but even before that happened, numerous local officials had begun to take action on their own. Some, including Los Angeles County in California, St. Louis County in Missouri, and Provincetown, Massachusetts, had already reinstated mask mandates for the unvaccinated and vaccinated alike.
On Tuesday, Nevada became the first state to realign its statewide mask policy with the CDC, requiring indoor mask wearing in public for all state residents and visitors, effective Friday. USA Today has compiled a state-by-state roundup of other current mask rules here, and also reports that it’s not yet clear how the countries major retailers will respond to the new guidance.
There also continues to be partisan political pushback. For instance, Missouri’s Republican-controlled state government opposes mask mandates, even though the state, where just over 40 percent of residents are fully vaccinated, is one of the places that has been hit hardest by the Delta wave. Missouri’s attorney general has already sued to block St. Louis County’s mask mandate.
Indeed, there are multiple GOP-controlled states that have already sought or vowed 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. Most 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. On Tuesday, several Republican governors, including Florida’s Ron DeSantis, Arizona’s Doug Ducey, and South Dakota’s Kristi Noem, reiterated their opposition to universal mask mandates, despite the new CDC guidelines. CNN reported Wednesday that at least 24 Republican congressmen went maskless on the House floor on the first day of the reinstated mask mandate for the House, potentially risking a fine for defying the rule.
What about masks in schools?
With the new school year fast approaching, a simultaneous debate has been 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 Tuesday, the CDC recommended that all students, teachers, and school staff nationwide wear face masks while in school (which is also what the American Academy of Pediatrics recently advised).
Just weeks prior, the CDC had released new guidelines recommending that only the unvaccinated needed to mask up 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.
Boston, Washington, D.C., and Madison, Wisconsin, have all announced that they will require 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. And in light of the CDC’s new guidelines, it’s now likely that many more state and local officials will follow suit, if they haven’t already.
On the other hand, 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.
Meanwhile, parents across the country have also launched lawsuits challenging both school mask mandates and the bans against them.
The CDC had been facing pressure to revise its face mask guidelines
Both the Biden administration and the CDC had been facing pressure from public-health experts to readjust the guidance on face masks in light of the Delta wave.
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 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 had maintained its stance on masking.
The return of mask mandates does not mean vaccines are ineffective
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.
Should vaccinated people wear face masks, no matter what?
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, there has never been 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.
And 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.
Do face masks protect against the Delta variant?
Yes. 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.
Authentic NIOSH-approved N95 respirators — which are now far more widely available to consumers than in earlier phases of the pandemic — offer the most protection. Authentic FDA-authorized KN95 masks made in China, and South Korean KF94 masks, when purchased from reputable vendors, can provide nearly equal protection at less cost. All of these masks are designed to fit tighter to the face than surgical masks, which are the next best option, provided they are fit properly. Cloth masks provide less protection — especially against the Delta variant — but are definitely better than no mask at all, particularly if made from multiple layers of non-woven fabric. Cloth masks also make up nearly all available child-sized options.