The confusion caused by the Centers for Disease Control when it issued new masking guidance for those vaccinated has already been well debated. The CDC claims that vaccinated people can remove their masks indoors and out, since they pose little risk of spreading Covid-19 or becoming infected. A rather broad statement that glosses over a more nuanced reality — people vaccinated by some vaccines are well-protected against Covid-19 and some of its variants, but most likely for a finiteperiod of time.
No matter my opinion on the decision itself (which, for the record, I believe to be premature at best), the end result is that many of us — including many of my closest friends and family — have been left both confused and fearful of how to live in a world in which more and more people are maskless and all of us are unsure of who is vaccinated and who isn’t. This fear is by no means unfounded — our vaccines are not an impenetrable shield against infection and disease. Studies have shown that some vaccines protect very poorly against some variants. And even our topline vaccines, which do protect against most of the variants, are significantly weakened when faced with some of the virus’ trickier iterations, like the B.1.167 variant in India.
It’s important to remember just how violent this virus can be. To bring this home in a very real sense, let me speak a bit about my friends in India and my colleagues working there with my foundation. Some of these great people we have already lost to this latest surge. Most have family members suffering and severely ill, some luckier than others in that they’ve at least found a spare bed in a healthcare system that is completely overwhelmed. These people aren’t just the ones that are old and infirm, but the young as well. They aren’t the people who have been careless, but the ones who have been cautious in the face of the pandemic. This virus is tricky and the Indian variant may be the most transmissible version that we’ve seen yet…but it can still get worse.
When friends have asked how to navigate this new world where masks may no longer be the norm, I’ve given them an analogy that I hope may prove useful to you as well. I talk about the pandemic in terms of the weather. If it’s sunny outdoors, you can head out and enjoy the day without fear of rain. When it’s drizzling, you may pop open an umbrella. When it’s pouring, you slip on a raincoat and rainboots as well. But when there’s a hurricane warning, you head to the safest part of your home and hunker down until the danger has passed. That’s how we have to think about this pandemic and how we protect ourselves.
Let’s say you live in Vermont, the state with the highest percentage of people vaccinated with at least one dose. There were only 29 new infections reported yesterday in the state, only one person with Covid in an ICU bed, and a positive test rate of just 1.1%. Consider it then a sunny, beautiful day in Vermont, with little likelihood of rain. If you’re vaccinated, following CDC’s new mask guidance and resuming pre-pandemic activities without a mask and without social distancing is likely a fine way to approach your day. Infections around you are low, vaccination rates are high — combine that with the protection afforded you by the vaccines and you are likely very safe when unmasked.
On the other hand, if you live in Tennessee, you may already feel the drizzle. Tennessee has one of the lowest vaccination rates in the country, there were more than 1000 new infections reported yesterday, and recent reports confirm that the highly transmissible Indian variant has arrived in the region and may be circulating in the community. The positive test rate in Tennessee is also high, just above 5%. This high percentage indicates that either the virus is spreading widely or that not enough people in the community are being tested to understand the full scope of the potential outbreak.
If you’re vaccinated and heading out in Tennessee today, I would not recommend that you leave your home without your mask — just like you wouldn’t head out into the rain without your umbrella. Infections are relatively high, a variant known to weaken even our best vaccines is potentially circulating, and the likelihood that people around you are vaccinated is low. The risk of infection makes the relative inconvenience of wearing a mask worthwhile.
But, just like the weather, this too can change. If the winds shift in the right direction — vaccination rates go up, the India variant does not take root, and the number of new infections declines — Tennessee may soon be as sunny as Vermont and vaccination without masks may be sufficient. But it is just as possible that instead of shifting the winds will intensify and even darker clouds will start rolling in. Do not underestimate the power of SARS-CoV-2 and its variants.
Singapore has been one of the countries that has performed the best against Covid-19. The country started its reopening in June 2020 and has remained open ever since, all while maintaining the lowest death rate from Covid-19 in the world. And yet today, the B.1.167 variant has the country shutting down schools, indoor dining, and other large gathering places once more, as a preventative measure to stop its spread. The Singapore health minister has warned that B.1.167 appears much more virulent than previous strains and seems to attack younger children.
What we’re hearing out of Singapore is potentially the first faint echo of a hurricane warning siren that will soon start wailing on our own shores. We’ve seen what the B.1.167 variant has done in India, where the healthcare system has been completely overwhelmed. That variant took India by surprise, but here in the United States we know it’s coming and the havoc it can wreak. We should not be so foolish as to relax our restrictions too soon. The largest nursing union in the US has already called out the CDC over their new guidance, citing concerns over how long and how well vaccine protection lasts and whether they can protect against known and emerging variants that are “more transmissible, deadlier, and may already be or may become vaccine resistant.” They do not want to face what we faced in spring of 2020, when we saw into the eye of the hurricane, and nor should we.
Before heading out of your home today, check the weather — Are infections high in your community? Are there variants of concern circulating? Is the positive test rate hovering near 5% or higher? If the answer to any of those questions is yes, mask up, stay outdoors if you can, and avoid large gatherings, even if you’re vaccinated. The rule I follow, for myself and my family, is to wear masks whenever I’m with someone who I don’t know to be vaccinated — that means anyone outside my immediate bubble and close circle of friends.
We once wore masks to protect those we love around us, but today, with the confusion of CDC’s new guidance, wearing masks may now be the best thing we can do to protect ourselves as well. We are now living daily Bertrand Russel’s famous paradox, summed up so well this week in a New Yorker cartoon: A woman steps out onto her front stoop and confronts two maskless men she must pass by to move on with her day. One turns to her and asks the million dollar question, “One of us always tells the truth; the other always lies. You can ask us each one question. How do you figure out if we’re anti-maskers or vaccinated?”