Is the CDC Moving Too Fast to End Mask Requirements? An Explanation of What's Behind Today's Recommendations.

A few hours ago, President Biden and Vice President Harris walked out for a rose garden press conference, both smiling ear to ear, both without masks.

The visual from the leaders who have always modeled good public health behavior reflected a marked shift in the recommendation from the Centers for Disease Control and Prevention earlier in the day: the CDC now says that people who have been fully vaccinated against COVID-19 can resume regular activity indoors or outdoors, without masks and without physical distancing. As President Biden said during his remarks, "Get vaccinated — or wear a mask until you do."

But this shift has raised many well-meaning questions, especially from those concerned about using the honor system to ensure that those who do not vaccinate mask up. Without the backing of the CDC and local health departments, businesses are also likely to find it difficult to enforce mask mandates of their own. Some worry whether the ability to blend in and lie about vaccination status without suffering consequences (like having to wear a mask) will bolster anti-vaxxers and further disincentivize them from being vaccinated.

These are all valid, well-intended questions. To answer them, it is first important to understand the nature and purpose of public health measures. Mask-wearing, physical distancing, and staying home when possible were all public health response measures that were used to combat the pandemic.

At a human level, that was a social responsibility response. People could have been carrying the virus and be passing it onto others without even knowing it, and making sure we did not either pass it on or catch it from others, in that situation, was the responsible thing to do. Just as importantly, because the COVID-19 virus has an unusually high infection rate and relatively high rates of severe illness and death (compared to other similarly transmissible viruses), a high number of people becoming infected and ill at the same time would overwhelm the health care system.

Early on in the pandemic, scientists and public health experts talked about 'flattening the curve,' which simply referred to bringing down the infection rates so that too many people aren't infected and ill at the same time. When the economy and businesses started to reopen on a limited basis last summer and fall, experts warned that the reopening did not mark an end to the pandemic. "Reopening doesn't mean it's safe; it means they have room for you at the hospital" became a popular saying to note this line of caution.

Understood in this context, public health measures are meant to do two things: (1) to tame the uncontrolled spread of disease, and (2) to keep the health care system from being overwhelmed.

The CDC is relaxing the guidelines because, at this point, they believe both goals can be achieved without a strict mask and social distancing mandate. There's a very good case to be made for why they're right, and CDC Director Dr. Rochelle Walensky made that case today during the White House coronavirus briefing in three charts.

First, the new daily COVID infections have fallen quickly since January and have sustained a downward trend for weeks. The current (5/5 - 5/11) 7-day average of 37,000 cases is not just 23% lower than the previous 7-day average, but also a decrease of a whopping 85% since January 8.

Second, the 7-day average of hospitalizations is down by about 12% to about 4,100 from 4,700 a week ago, and by about 75% from the January peak of 16,500.

And lastly, the 7-day average of new deaths from COVID has fallen to below 600.

This is an amazing feat of accomplishment for an administration that entered office with a raging pandemic at new heights and tamed the beast in barely 100 days in office. They have also managed to deliver over 250 million vaccine doses into arms, including very high proportions of at-risk populations.

If nothing else, it should give all of us confidence that this administration knows what it's doing.

But it also tells us a few key things in terms of the evolving public health response:

First, hospitals have room for you! While it's still true that unvaccinated people can get each other infected, severely sick, or killed, the health care system has plenty of capacity to treat the sick. On that note, treatment options have also radically improved and expanded since the early days of the pandemic, resulting in much of the drop in the number of people dying from it.

Second, a great deal of information has been unearthed about the effectiveness of masks. While during the early phases it was thought that masks were primarily to protect others from catching the infection from the wearer, science has found that masks are highly effective in protecting the wearer as well.

Lastly, the vaccines are being proven highly effective against even asymptomatic infection, meaning a vaccinated person is not only highly protected against severe illness or death but also largely inoculated against being an unwitting carrier and passing it onto someone who is not vaccinated. Just in the past week, peer-reviewed studies published in the Journal of American Medicine and the CDC's Morbidity and Mortality Weekly Report (MMWR) show this to be true.

The combination of these factors means that in the United States, we are arriving at a point when the threat from COVID-19 is starting to move from being a major public health threat with the possibility of mass casualties in a short period of time and which must be managed through restrictive measures to a personal responsibility phase.

The 'vax up or mask up' message coming from the White House is a message focused on personal responsibility. Either the vaccination or the masking is now a choice of personal responsibility. The message is that those who are unwilling to choose either would remain exposed themselves but will not be able to infect in large numbers those who are engaging in a safe practice - either masking or vaccination.

In other words, those who want to protect themselves against the COVID-19 now broadly have the tools to do so, regardless of the behavior of others. That has reduced the need for strict public health intervention.

That leaves one last question: Does today's decision reduce the incentives for people who are not yet vaccinated to actually be vaccinated?

While that is a valid point, it could also be argued that if people do not get any social benefits of vaccinating, that, too, can be a disincentive to vaccinate.

Much better ways of incentivizing vaccinations exist: requiring vaccination to be let in the doors at clubs and bars, requiring proof of vaccination to return to in-person learning among students (who are eligible for the vaccine), employers requiring their employees to show proof of vaccination (or mask),  businesses providing discounts for vaccinated customers, and even peer pressure.

All of these will be important tools to vaccinate more people, but the CDC has likely judged that the time has come to transition to targeted measures from broad universal ones. That is why, with the caveat that if things go in the wrong direction, measures can be snapped back in place, they are sanctioning a good-paced return to normalcy.

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