Top health experts weigh in with their own advice on when masking up still makes sense
by Rachel Nania, AARP, Updated July 28, 2021
Editor’s Note (July 28, 2021): The Centers for Disease Control and Prevention is now recommending that some vaccinated Americans wear masks — especially those who are in areas where COVID-19 transmission rates are considered high or substantial. Teachers, students, staff and visitors at schools are also encouraged to wear masks, regardless of vaccination status. The guidance was issued on July 27 following new data that show “in rare occasions” some vaccinated people can become infected with the delta variant and spread the virus to others. You can check the CDC's website for a county-by-county look at transmission rates in your region. And you can read the full story on AARP. This story was originally published July 14. 2021.
Vaccinated and wondering whether you should still wear a face mask when out and about?
You're not alone.
Despite the Centers for Disease Control and Prevention (CDC) telling fully vaccinated Americans they no longer need masks in most situations, plenty of people are still wearing them. A poll from Vox and Data for Progress taken shortly after the CDC rescinded its mask guidelines for vaccinated individuals found that more than half of vaccinated people are still wearing masks. Another survey conducted after the CDC's mid-May policy reversal found that 4 in 10 vaccinated individuals continue to mask up.
And amid a recent spike in new cases caused by the highly transmissible delta variant, the World Health Organization is urging vaccinated people to keep wearing their masks. Health officials in Los Angeles County and Saint Louis are also recommending residents mask up in public indoor settings, regardless of their vaccination status.
These mixed messages create “a tremendous amount of confusion” when it comes to masks, says Monica Gandhi, M.D., an infectious disease physician and professor of medicine at the University of California, San Francisco.
AARP asked three experts for their best advice on what fully vaccinated adults should be doing. And while there is no one-size-fits-all answer, there are a few things to keep in mind.
1. Know what's happening in your community
One thing is clear: The three federally authorized vaccines are very effective at preventing illness caused by a coronavirus infection. And so far, their defense has proven strong against the emerging variants of concern, including the delta variant, which is now the dominant strain of virus circulating in the U.S. Still, no vaccine is a 100 percent sure thing.
One way to think about the vaccines is like a very good raincoat, says Leana Wen, M.D., an emergency physician and visiting professor of health policy and management at George Washington University's Milken Institute School of Public Health. “If it's drizzling outside, you're going to be fine; you will be protected and not get wet. However, if you keep going in and out of thunderstorms, at some point you could get wet.”
For the latest coronavirus news and advice go to AARP.org/coronavirus.
In this analogy, the weather represents the amount of virus circulating in your community. If vaccination rates are high in your area and the number of new COVID-19 cases is still relatively low, the rain is less of a threat. However, many areas of the country, especially where vaccination rates are low, are seeing a spike in new cases, likely caused by the delta variant. “When there's a lot of virus around you, think of that as being in a thunderstorm,” Wen says.
The reason it's important to consider community transmission rates is because breakthrough cases (where a fully vaccinated individual becomes infected), while still rare, are more likely to occur when you're surrounded by more virus, explains Gandhi, pointing to the wave of breakthrough cases among many vaccinated health care workers in India during the country's deadly spring surge.
The CDC's website provides a county-by-county look at levels of community transmission. If your area is labeled as one of “substantial” or “high” transmission, you may want an added layer of protection when out in public.
"It would make sense to me, even if you're vaccinated, if you're living in an area of high community transmission and low vaccination, to consider wearing a mask when in indoor crowded spaces,” Wen says. “If you don't know that people around you are fully vaccinated, you could use an abundance of caution and wear a mask in those situations."
2. Consider your own risk tolerance
In addition to looking at what's happening in your community, it's also important to consider the level of risk you're comfortable with. There are plenty of people, especially those who are otherwise healthy, who may decide that getting back to pre-pandemic life is worth the small chance of getting mildly ill.
"That becomes very different if they're living at home with people who they could potentially infect,” says Wen, who like many Americans has small children who are not yet eligible for the vaccines. The risk of a vaccinated individual contracting COVID-19 and passing it on to others is very low, according to the latest research. But it's not zero, which is why Wen still wears a mask in crowded indoor settings, like the grocery store or church.
People who are immunocompromised or have other health conditions that make it harder to fend off illnesses may also be more cautious when going out in public. Then there are folks “who are very risk-averse and don't even want a mild or asymptomatic breakthrough, and that's fine,” Gandhi adds.
William Schaffner, M.D., an infectious disease expert and professor of medicine at the Vanderbilt University School of Medicine, offers up another analogy to help people understand risk tolerance. He suggests thinking about everything we do to prevent the spread of COVID-19 like a series of slices of Swiss cheese. “Each one produces a barrier, but none of them is perfect. They each have little holes in them,” he says.
The vaccine is the thickest layer of cheese and the one with the fewest holes. “But it still has some holes. After all, under the best of circumstances, the vaccines are 95 percent protective — you didn't hear me say 100 percent. And we know that some people who are immunocompromised in a variety of ways may not respond optimally to the vaccines. So there are still opportunities to do some other things, particularly if you wish to be extra cautious,” Schaffner says.
Federal health leaders have echoed the importance of individual choice in the matter. National Institute of Allergy and Infectious Diseases Director Anthony Fauci said in a recent press briefing that older adults and people with underlying health conditions “might want to go the extra mile of protection” by wearing a mask when in an indoor area in a community where there's a high degree of infection and a low level of vaccination.
"That is not a mask recommendation; that's just for consideration of each individual [with] their own level of the risk that they would like to take,” Fauci said. “And there are many individuals who would feel — because of age or because of an underlying condition — that they might want to wear a mask.”
3. Different settings may call for different actions
All three experts agree that masks really aren't needed when you're outside — consider the fresh, open air a “safe zone,” Gandhi says. Even unvaccinated individuals don't need masks in most outdoor settings, according to the CDC.
There is one exception: an outdoor sporting event where thousands of fans are seated close together and lots of shouting and cheering is taking place. Some stadiums have sections specifically for fully vaccinated fans. However, if you're in an area where you could be around unvaccinated people, you may want to bring your mask with you.
The same consideration should be given for a beach trip or other outdoor travel excursions. Spending time on the beach or hiking in the woods is a very low-risk activity. “But there's the hotel, there's the restaurant, we go to playgrounds, we go to other things, particularly in indoor venues,” Schaffner says. Plus, it's important to remember that masks are still required on planes, buses, trains and other forms of public transportation in the U.S.
Dining in restaurants is one activity many Americans are anxious to get back to. Wondering whether it's safe to do so, since you'll be without a mask for the majority of the meal? That's one scenario where your personal risk tolerance comes into play.
Schaffner and his wife recently dined indoors with a group of friends. “That was a big move for us,” he says, noting that he has yet to get on an airplane and still prefers virtual meetings to in-person conferences. However, everyone at his table was fully vaccinated and the servers wore masks. Some restaurants also present fewer risks than others, with lots of space and good ventilation. “But if you're going to be packed in a bar and no one is wearing masks and it's really loud and people are shouting at one another and it's not very well ventilated, that is a very high-risk setting,” says Wen, who adds that she will not go to indoor restaurants unless she's certain the people around her are fully vaccinated.
"Think about it this way: Risk is cumulative. So the chance of you going to a restaurant and acquiring coronavirus that one time, if you're vaccinated, is probably low. But if you're going to a crowded bar every night, especially in an area of high coronavirus transmission, at some point, the raincoat [or the protection provided by the vaccine] may not work and you could get infected,” she says.
Heading back to the office soon? Many businesses are bringing employees back to the office after a year and a half at home. But few companies are requiring workers to be vaccinated.
Wen's advice? Ask your co-workers about their vaccination status. “If they're fully vaccinated, I would have no limitations on interacting with them; I would have no limitations on being in a crowded conference room with people who are fully vaccinated without masks,” she says, adding that being around other vaccinated individuals is a very safe situation. “However, if these are people who are unvaccinated, then there is risk. And you should consider whether you can reduce that risk by not being in these settings.”
If you are fully vaccinated and still decide to wear a mask at the office, there's no need for most people to go back to a snug-fitting N-95 mask or even a double mask for added safety measures. Those recommendations “were really in the context of no vaccination,” Gandhi says. “Especially if you're in the office all day,” make sure your mask is comfortable.
Visiting with young, unvaccinated grandkids is another scenario where individual preferences come into play. It's unlikely that vaccinated grandparents will infect little ones, but it's important to pay attention to how you feel, Gandhi says.
If you're coming down with any symptoms of illness, “in this era of the delta variant,” get tested first, she says. “But if you feel well, you should feel very secure that you're not going to pass [COVID-19] on to an unvaccinated grandchild.”
The risk is also low that unvaccinated kids will get their vaccinated grandparents sick, based on what we know about how well the vaccines protect against COVID-19. Still, if you want to be on the safer side — maybe your family members are less cautious in their day-to-day activities — there are ways to do so, Schaffner says.
Parents can tell their kids to hug grandma and grandpa around the waist when they greet them and wear masks during the visit. “And that keeps the close contact with those little rascals who can bring the virus in from their playgrounds very brief,” Schaffner says. And for overnight guests? “Just be thoughtful about it and get a clear sense of what your own risk is,” he adds.
Bottom line: Don't get rid of your mask just yet
Even if you chose not to wear your mask after getting the vaccine, don't toss it out just yet. It's unlikely the CDC will change its guidance once again, but you may want to put your mask back on during routine cold and flu seasons — especially now that they're more socially acceptable than they were before the pandemic.
"After all, we did learn that when we did the things to prevent COVID, we virtually eliminated influenza, another killer virus,” Schaffner says. “So I think there will be much more spontaneous acceptance of masking and other elements of social distancing during flu season.”
And if you prefer to wear one in the meantime, “don't make an opera out of it,” he says. “If you're a little bit concerned in certain circumstances, then you can wear your mask.”
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.
https://www.aarp.org/health/conditions-treatments/info-2021/face-masks-vaccination.html
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