What you need to know about the CDC’s new mask guidelines

By Laurie McGinley and Lenny Bernstein

The announcement by the Centers for Disease Control and Prevention on Thursday that people who have been fully vaccinated against the coronavirus no longer need to wear masks in most places was hailed as the path to liberation for many who have endured through the strictures of the pandemic. But the new recommendations also raised an array of questions and complications for businesses, consumers and parents — and the answers might not be clear for some time.

Does the new CDC recommendation mean that if I am vaccinated I no longer have to wear a mask anywhere?

No. The CDC wants vaccinated people to wear masks in health-care settings and on planes, buses, trains and other public transportation. Also, everyone will have to abide by state and local mandates to wear masks where they remain in place. Businesses and other private entities can still require employees and patrons to wear masks, and some are likely to do so.

Some critics have said the guidance creates confusion because it allows fully vaccinated people to go maskless in grocery stores, restaurants and gyms but not on airplanes and trains. Henry Walke, a CDC medical officer who has been leading the agency’s coronavirus response since last July, acknowledged that the lines are not completely clear.

But he said the CDC believes that fully vaccinated people are protected, “and the risk is to the unvaccinated people.” The difference, he said, comes down to an individual’s ability to choose settings. On an airplane or train, people are “unable to make choices about who is sitting near them for a period of time,” he said.

The CDC also did not address schools. For children under 12 who cannot be vaccinated yet, it is unclear how they and their teachers should behave. Schools are beginning to figure that out. For 12-to-15-year-olds, vaccination is just beginning, so many academic terms will have ended before adolescents are two weeks beyond their second shots. Policies should be in place for the fall. Children are much less likely to develop covid-19, the illness caused by the virus, than adults.

Who will enforce the new recommendation that only people who are vaccinated go without masks?

Also unclear. The only way to know for sure whether someone is vaccinated is if the government, businesses or others require documentation. The Biden administration has been reluctant to go in that direction, and owners of restaurants, bars, gyms, movie theaters and other indoor venues naturally do not want to become the mask police.

But they may want to keep some rules in place to protect customers and employees. The CDC is assuming, based on scientific data, that even if someone nearby isn’t vaccinated, people who are fully vaccinated have enough protection to be confident they are safe.

The bottom line, several analysts said, is that the guidance relies on an “honor code” that Americans may or may not adhere to.

What does this mean for stores?

Target, Home Depot, Harris Teeter and Wegmans Food Markets are among the chains that will continue to require masks in store, though they are reviewing the new CDC guidance and reevaluating store policies.

Others, such as Trader Joe’s and Walmart, have updated their policies and will no longer require fully vaccinated shoppers to wear masks, though it is unclear how the retailers will determine which shoppers have been inoculated.

Lisa LaBruno, a top official with the Retail Industry Leaders Association, which represents retailers, complained in a statement that the CDC announcement on masks “creates ambiguity for retailers because it fails to fully align with state and local orders.” She urged customers “to follow a store’s safety protocols including wearing a mask and social distancing. Frontline workers deserve this respect.”

What about restaurants and other businesses?

Restaurants, like other businesses, will have to continue to follow state and local mask mandates, to the extent they still exist.

Many might err on the side of caution and continue to require masks for all patrons and workers, regardless of their vaccine status, said Rogge Dunn, a business employment lawyer in Dallas. That could avoid potential shutdowns or reputational damage from a coronavirus outbreak.

In addition, such “bright-line rules” for restaurants could avoid possible conflicts with customers over trying to verify vaccination status at the door, Dunn said. “Customers might say, ‘I left [my document] at home, or it’s in my purse, or the car. And if you don’t believe me, I’ll go someplace else,’” he said.

But some businesses immediately relaxed their mask policies.

In Nevada, where the state dropped its mask mandate Thursday, casinos began changing their requirements. Wynn Las Vegas said in a statement that guests would no longer be required to wear masks in public spaces if they are fully vaccinated, while unvaccinated guests still will be required to have them. “The resort trusts guests to take the appropriate precautions based on their personal vaccination status,” Wynn said.

In addition, the company said, employees who can show they have been vaccinated will not be required to wear a mask at the resort, as they have been previously. Those who have not provided such verification will be required to wear masks.

Lorraine M. Martin, president of the National Safety Council, a group of 16,000 U.S. businesses and organizations, said the CDC’s revision “is going to be both helpful and something we have to figure out and navigate.”

For the relatively few employers that are requiring workers to be vaccinated, Martin said, the ability to shed masks will make work environments seem more like they were before the pandemic. But most companies have not required vaccination, she added, so work settings “are in a state of having both vaccinated and unvaccinated employees. The protocols are going to need to be different for them, because it’s an environment where we can’t verify the vaccination or not.”

The result, she said, is likely to be that fully vaccinated Americans will need to don a mask for work. Employers “have to play it safe so everyone continues to be safe,” Martin said.

How will essential workers be affected by the change?

Some worry that these employees — whose work often involves in-person, critical jobs that cannot be done from home — will be put at risk of interacting with unvaccinated people who choose to go without masks.

“Are we going to have a lie-detector test at the front door?” asked Marc Perrone, president of the United Food and Commercial Workers, whose union represents 1.3 million workers in meatpacking plants, grocery stores and nursing homes.

Thomas A. LaVeist, dean of the Tulane University School of Public Health and Tropical Medicine and co-chair of Louisiana’s covid-19 health equity task force, said he believes front-line workers, who are disproportionately people of color, will be indirectly affected by the federal government’s decision “because I think more companies will begin to mandate their employees get vaccinated.”

Overall, he said, the CDC decision was overdue. For people in the wait-and-see category on vaccination, which includes a significant number of Blacks and Latinos, the change is “a little bit more weight on the scale that tips it more toward getting vaccinated,” he said. “I don’t think it’s going to make everyone get vaccinated, but I think that some people will.”

Susana Morales, a primary care physician at Weill Cornell Medicine in New York, where she is also vice chair for diversity, said she visited the CDC’s website Friday and found a recipe for confusion: Mask-wearing rules were relaxed for individuals, but “it still has up there specific guidance for restaurant workers, for health-care workers and for other front-line workers that talks about masks.”

“When you think about why a lot of people of color and other folks were infected, it was because of being front-line workers,” she said, minutes after learning that a friend’s father had died of the coronavirus. “This is one of those issues where it’ll be really important for the CDC and [the Occupational Safety and Health Administration] and state level and local public health officials to think about exactly what to recommend for high-risk workplaces.”

What are pediatricians telling parents?

Pediatricians are warning parents to remain vigilant because most children are still not eligible to be vaccinated.

For children under 12, Grace Lee, associate chief medical officer for practice innovation at Stanford Children’s Health, said she believes in continuing the guidance that has been followed for most of the pandemic. “Keep it outdoors, keep it small,” she said. “If I had kids under 12, I would want them to wear a mask in school. Wear a mask when we’re in a public space with a lot of people. And indoors, for sure I would have the mask.”

What is the risk to kids right now?

“Many people are responding to this new policy as if the pandemic is somehow over, and that’s just not true,” said John V. Williams, chief of the pediatric infectious diseases division at UPMC Children’s Hospital of Pittsburgh. Adolescents ages 12 to 15 were approved for the vaccine only this week, so few have any protection.

“The disease is transmitting and the risk of severe disease is low in children, but it’s not zero,” Williams said. He pointed out that more than 300 children have died of covid-19. And roughly 15,000 children have been hospitalized — far more than in a typical flu season.

“Parents should think about it like they think about car crashes,” Williams said. “Statistically, the risk of serious injury in a car accident is very, very low. But you better believe I make sure my kids put on a seat belt every time they get in the car.”

Bonnie Fass, a pediatrician with 30 years of experience in the Philadelphia region, welcomed the new CDC guidance even as, she said, it left parents having to make their own judgments according to their personal situations and the day-to-day circumstances they face.

“Would you take your child to a big, busy birthday party right now? I wouldn’t, masked or unmasked,” Fass said, explaining that she would continue to wear a mask in a grocery store and expects many parents would encourage their children to mask up.

Fass said she hopes further guidance will be issued that might help parents make decisions.

Susan Lipton, chief of pediatrics at Baltimore’s Sinai Hospital, also said she would advise parents to keep kids in masks in public and for vaccinated parents to model that behavior.

“It’s easier to keep them with the good habits they’ve learned,” Lipton said. “It’s the unknown that’s a big risk,” she said, particularly in crowded indoor situations like grocery aisles.

CDC’s Walke, responding to concerns among parents about risks to children under 12, said cases of covid-19 are dropping “so we have lower community transmission, so the probability of encountering someone who is infected is lower. With family members being vaccinated … that also provides a buffer.”

He also noted the new CDC policy applies only to people who are fully vaccinated. Unvaccinated people, including children, are supposed to wear a mask for a range of indoor activities — going to the barber shop, the grocery store, the gym.

How does the new mask recommendation affect people with compromised immune systems?

In some people with weakened immune systems — those on heavy duty cancer drugs, for example, or anti-rejection medications following organ transplants — coronavirus vaccines are less effective. The patients may not be fully protected even if they are fully vaccinated. That means they would be wise to keep wearing masks even after they get the shots, some doctors say.

Laura Makaroff, a senior vice president for the American Cancer Society, said immunocompromised patients should talk to their doctors about precautions they need to take. Until then, “they should follow previous guidance, which means masking in public settings,” she said.

What are the potential effects of the change?

Supporters, and even those who don’t entirely agree with the timing of the CDC decision, say it could be helpful by encouraging people to get vaccinated.

“If this leads to 5 or 10 percent more people being vaccinated than would have otherwise, then it’s a super-great call,” said Robert Wachter, chair of the department of medicine at the University of California at San Francisco. “Yeah, maybe a couple more people will get mild cases of covid from it. But it’s a reasonable thing to do and message how important vaccination is.”

Others think it will have no effect on vaccination rates.

“To my knowledge, there is no hard data suggesting that these recommendations will motivate people to get vaccinated,” said Megan Ranney, an emergency medicine physician and professor at Brown University. “I sure hope it will — but most of the research to date says that people aren’t getting vaccinated because of lack of knowledge about the vaccine or because of lack of access about the vaccine.”

Washington Post