With New Mask Guidance Comes the Challenge of Following It

FRIDAY, May 14, 2021 (HealthDay News) -- While millions of Americans rejoiced in the news on Thursday that the fully vaccinated can now skip masks in most indoor and outdoor settings, some worried that it will be nearly impossible to distinguish those who have gotten their shots from those who have not.

"I think the challenge is that it's impossible to determine who is vaccinated and who is not vaccinated," said Gov. David Ige of Hawaii, where a mask mandate will stay in place, The New York Times reported.

The head of a union representing 1.3 million workers in the food industry noted that enforcing the new guidance will likely fall on the shoulders of essential workers.

"Millions of Americans are doing the right thing and getting vaccinated, but essential workers are still forced to play mask police for shoppers who are unvaccinated and refuse to follow local COVID safety measures," Marc Perrone, president of the United Food and Commercial Workers International Union, told the Associated Press. "Are they now supposed to become the vaccination police?"

During a media briefing on the new mask guidance, President Joe Biden made it clear that the federal government was not going to take on that role.

"We're not going to go out and arrest people," added Biden. "If you haven't been vaccinated, wear your mask for your own protection and the protection of the people who also have not been vaccinated yet."

That inability to tell who is and isn't vaccinated prompted Lawrence Gostin, a public health law expert at Georgetown University, to declare the CDC guidance "confusing and contradictory."

"The public will not feel comfortable in a crowded indoor space if they are unsure if the maskless person standing next to them is or is not vaccinated," he told the AP.

The new guidance caught state officials by surprise and raised questions about how the guidelines would be carried out. Some states lifted mask mandates immediately, while others took a more cautious approach, the Times reported.

On Thursday, the governors of Massachusetts, New Jersey, New York, North Carolina and Virginia, and the mayors of New York City and Washington, D.C., all said they were taking the new guidance under advisement before adopting it. Los Angeles County also said that it and the state of California were reviewing the new guidelines, the Times reported. In deference to local authorities, the CDC has said vaccinated people must continue to abide by existing state, local or tribal laws and regulations, and to follow local rules for businesses and workplaces.

The guidance also seemed to catch many retailers by surprise. Macy's, Target and the Gap said they were still reviewing it, while Home Depot said it had no plans to change its current rules requiring customers and workers to wear masks in its stores, the Times reported.

Nearly 119 million Americans are now fully vaccinated, 42.5% of the population, CDC data shows. A person is considered fully vaccinated two weeks after their last dose of vaccine.

Despite concerns about how to enforce the new mask guidance, the move was welcomed by infectious disease experts.

"Ample evidence indicates that vaccinated people contribute little to the spread the virus," said Luis Schang, a professor of molecular virology at Cornell University's School of Veterinary Medicine, in Ithaca, N.Y. "With the continuous increases in the number of vaccinated people – reaching now about half of the eligible population, in addition to those who have been naturally infected – the proportion of people who may be asymptomatically infected and shedding virus continues to decrease."

The balance is continuously shifting more and more, such that the marginal risk of not practicing universal mask usage and social distancing by vaccinated people, in particular in outdoor settings, becomes much smaller than the benefits of returning to a more open society," she said.

Still, "we should remain vigilant," Schang said, "and ready to promptly change our behavior again if yet another effort was ever required."

The nation's top infectious diseases expert agreed a turning point has been reached.

"We've got to liberalize the restrictions so people can feel like they're getting back to some normalcy," Dr. Anthony Fauci said in an interview, the Times reported. "Pulling back restrictions on indoor masks is an important step in the right direction."

"You can't inhibit people from doing the things they want to do, which is one of the reasons they wanted to get vaccinated in the first place, because other people are not getting vaccinated," he added.

In releasing the latest guidelines, CDC officials pointed to a growing body of evidence that shows the shots work, even against more contagious variants of the virus. They also factored in the country's rapidly declining caseload, and the rarity of breakthrough infections in people who are fully vaccinated.

"This is a day that I think will be marked as a true turning point in the pandemic in the United States in that we have three vaccines that are highly effective, we have enough vaccines for everyone in our country who's 12 years and older to get vaccinated who wants it, and we're being told that it is safe to roll back a number of the measures that we've come to rely on for controlling this pandemic," Richard Besser, former acting director of the CDC and president and chief executive of the Robert Wood Johnson Foundation, told the Washington Post.

"The idea that people who are fully vaccinated can take off their masks, can go outside, can go inside, be around people and not have to worry about COVID anymore, that's absolutely huge," he said.

Public health experts were also optimistic that the updated guidance might even prompt some vaccine-hesitant Americans to get vaccinated.

"Young people say, 'Why should I get vaccinated? I'm not going to die of this.' What they want to hear is, 'You can take your mask off,'" Carlos del Rio, a professor of medicine at Emory University in Atlanta, told the Post.

Pfizer vaccine given OK for use in adolescents

In a decision that clears the way for schools to reopen safely next fall, U.S. health officials on Wednesday gave their final stamp of approval for Pfizer's coronavirus vaccine to be offered to children aged 12 to 15.

The decision came as COVID-19 cases and deaths in this country have plummeted to their lowest levels in months.

COVID-19 deaths are now averaging around 600 per day, the lowest tally since early July, with the number of lives lost dropping to single digits in well over half of states, the AP reported. Meanwhile, confirmed infections have fallen to about 38,000 per day, their lowest level since mid-September. Reported cases have declined 85% from a daily peak of more than a quarter-million in early January.

Dr. Amesh Adalja, an infectious disease specialist at Johns Hopkins University in Baltimore, told the AP that vaccinations have played a pivotal role in the lower case numbers.

"The primary objective is to deny this virus the ability to kill at the rate that it could, and that has been achieved," he said. "We have in effect tamed the virus."

Federal health officials plan to keep those case numbers down with increased vaccination efforts.

Taking a significant step in that direction, an advisory committee to the U.S. Centers for Disease Control and Prevention voted on Wednesday to recommend the vaccine for use in adolescents. CDC Director Dr. Rochelle Walensky adopted the recommendation on Wednesday evening.

"For vaccination to do its job, we must do our critical part. That means vaccinating as many people as possible who are eligible," Walensky said in a statement. "This official CDC action opens vaccination to approximately 17 million adolescents in the United States and strengthens our nation's efforts to protect even more people from the effects of COVID-19. Getting adolescents vaccinated means their faster return to social activities and can provide parents and caregivers peace of mind knowing their family is protected."

In a show of support for the CDC's decision, the American Academy of Pediatrics (AAP) on Wednesday issued a new policy statement that recommends the coronavirus vaccine for all eligible children ages 12 and older.

"This is truly an exciting development that allows us to protect a large population of children and help them regain their lives after a really rough year," said AAP President Dr. Lee Savio Beers. "As a pediatrician and a parent, I have looked forward to getting my own children and patients vaccinated, and I am thrilled that those ages 12 and older can now be protected. The data continue to show that this vaccine is safe and effective. I urge all parents to call their pediatrician to learn more about how to get their children and teens vaccinated."

The American Medical Association (AMA) also applauded the move.

"We know that adolescents 12 years of age and up are at risk of severe illness from COVID-19 and can contribute to transmission of COVID-19 to others," AMA President Dr. Susan Bailey said in a statement. "Having safe and effective vaccine available to this age group will help them return to normal activities and help protect more people from the spread of COVID-19."

Though children are less likely to suffer severe COVID, the coronavirus has infected more than 1.5 million children and sent more than 13,000 to hospitals, more than are hospitalized for flu in an average year, according to CDC data, the Times said.

As of Friday, the U.S. coronavirus case count passed 32.8 million, while the death toll topped 584,400, according to a tally from Johns Hopkins University. Worldwide, over 161.2 million cases had been reported by Friday, with nearly 3.3 million people dead from COVID-19.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

SOURCES: Associated Press; The New York Times; Washington Post; U.S. Centers for Disease Control and Prevention, news release, May 12, 2021; American Academy of Pediatrics, news release, May 12, 2021; American Medical Association, news release, May 12, 2021