POST 156. April 28, 2021. CORONAVIRUS. As CDC revises guidance on outdoor masking, Texas Governor Abbott says “the state is “very close” to herd immunity… despite acknowledging that he does not know what the herd immunity threshold is for the virus, an uncertainty echoed by the public health community.”

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“A lot has changed since early 2020, when countries around the world first realized the potential threat of a highly contagious, and still mysterious, flulike virus.

In the early days of the coronavirus pandemic, no one knew for sure how the virus spread. People were scrubbing their groceries. Governments urged people to stay home, to wash their hands frequently and to avoid touching their faces.

Masks quickly emerged as a point of confusion, as public health officials at first discouraged people from wearing them, citing shortages, and then endorsed them. Mask mandates became a flash point in the culture wars as states, counties and cities across the country adopted a patchwork of policies.

On Tuesday, the Centers for Disease Control and Prevention said that it was no longer necessary for fully vaccinated people to wear masks in small groups outdoors, bringing the public guidance in line with a growing body of research indicating that the risk of spreading the coronavirus is much greater indoors.

Here is how the public health guidance on masking in the United States has shifted since the start of the pandemic.


‘Stop buying masks,’ surgeon general pleads

“Seriously people — STOP BUYING MASKS!” the surgeon general at the time, Dr. Jerome M. Adams, wrote on Twitter in February 2020. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!”

APRIL 2020

A change in policy, with more mixed messaging

In April, officials reversed course, with the C.D.C. urging all Americans to wear a mask outside their homes to supplement other public health measures, such as social distancing and hand washing.


Health officials speak out for masks

Many officials have emphasized the public health benefits of masks. In September, Dr. Robert R. Redfield, then the C.D.C.’s director, told a Senate committee that masks were “the most important, powerful public health tool we have” for fighting the pandemic, adding that the universal use of face coverings could bring the pandemic under control in months.


President Biden imposes some masking rules

President Biden in January used his executive authority to impose mask requirements where he could — including on federal property and in interstate travel.

MARCH 2021

The C.D.C. issues its first guidelines for vaccinated people

In March, almost exactly a year since the pandemic first gripped Americans in fear, the C.D.C. said that people who had been fully vaccinated against the coronavirus could gather in small groups indoors without masks or social distancing. Vaccinated adults could begin to plan mask-free dinners with vaccinated friends, the agency said.

MARCH 2021

States begin lifting mask mandates

With vaccinations on the rise, some states began lifting mask mandates. Others, including Florida and South Dakota, never had one.

Gov. Greg Abbott of Texas, a Republican, lifted the mask mandate and capacity limits on all businesses starting March 10. The order ensured that “all businesses and families in Texas have the freedom to determine their own destiny,” Mr. Abbott said.

APRIL 2021

C.D.C. relaxes masking advice for people who gather outdoors

On April 27, the C.D.C. said that fully vaccinated people generally no longer needed to wear masks outdoors, but should continue to wear them at indoor gatherings or at crowded outdoor events. People who haven’t gotten their shots can also go without a mask in small gatherings held outside as long as they are with fully vaccinated friends and family, the agency said.

Vaccinated adults should continue to wear masks and stay at least six feet from others in large public spaces — such as at outdoor performances or sporting events, or in shopping malls and movie theaters — where the vaccination and health status of others would be unknown, the agency said. And they should still avoid medium-size and large gatherings, crowds and poorly ventilated spaces, officials said.

A growing body of research indicates that the risk of spreading the virus is far lower outdoors than indoors. Viral particles quickly disperse outdoors, public health officials have said, so the transmission risk is far lower, though not impossible.

“I think it’s pretty common sense now that outdoor risk is really, really quite low,” Dr. Fauci said Sunday on “This Week” on ABC. Particularly “if you are a vaccinated person, wearing a mask outdoors — I mean, obviously, the risk is minuscule.” “ (A)

“The Centers for Disease Control and Prevention says people who are fully vaccinated do not need to wear a mask when they’re outdoors unless they’re in a crowd, such as attending a live performance, sporting event or parade. People are considered fully vaccinated two weeks after receiving the second dose of the Pfizer or Moderna vaccines, or two weeks after the single dose of the Johnson & Johnson shot.

“If you are vaccinated, things are much safer for you,” CDC Director Rochelle Walensky said Tuesday at a White House briefing. “If you are fully vaccinated and want to attend a small outdoor gathering — with people who are vaccinated and unvaccinated — or dine at an outdoor restaurant with friends from multiple households, the science shows you can do so safely, unmasked.”

As part of the new guidance, the agency spelled out settings in which it’s OK for fully vaccinated people to be unmasked, including:

Walking, running, hiking or biking outdoors alone or with members of your household;

Attending a small outdoor gathering with fully vaccinated family and friends;

Attending a small outdoor gathering with a mixture of fully vaccinated and unvaccinated people;

Dining at an outdoor restaurant with friends from multiple households.

And, the risk is low enough that even unvaccinated people can exercise, bike and hike outside and attend small outdoor gatherings with fully vaccinated friends and family without wearing a mask.

“We continue to recommend masking in crowded outdoor settings and venues such as packed stadiums and concerts where there is decreased ability to maintain physical distance and where many unvaccinated people may also be present,” Walensky said. “We will continue to recommend this until widespread vaccination is achieved.”…

The agency lists a range of settings where masking is still recommended for people who are fully vaccinated:

Attending a crowded outdoor event such as a live performance, parade or sporting event;

Visiting a barber or hair salon;

Visiting an indoor shopping mall or museum;

Riding public transport;

Attending a small indoor gathering with a mixture of fully vaccinated and unvaccinated people;

Going to an indoor movie theater;

Attending a full capacity service at a house of worship.  (B)

Three reasons public masking is still important — no matter your vaccination status

A handful of states have lifted their mask mandates — and plenty of them never introduced them in the first place. But that doesn’t mean people shouldn’t still wear masks in public, according to infectious disease experts. Especially now, when most people are still unvaccinated and some places are seeing surging case numbers.

1) Lots of people remain vulnerable to infection who can’t get a vaccine yet — including babies and kids. Some of them also can’t wear masks…

2) New variants could put us all at higher risk…

3) When the majority still isn’t vaccinated, masks help others feel safer… (C)

Where masks are extra important, and where we might be able to ease up

As people graduate to full vaccination status — two weeks after their final dose — they can finally restart many activities, such as close gatherings with small groups of vaccinated friends. But they also don’t yet have carte blanche to do everything mask-free. “Nobody loves wearing masks, but they give us that added level of protection and you can do activities that we all want to be doing,” Guthrie says.

The types of places where it’s highest-priority for everyone to continue masking include mass transit, airports, and other venues where people from different areas are mixing; locations with vulnerable individuals such as hospitals and long-term care facilities; gyms; and stores where distancing is difficult.

The new CDC guidance notes that even with a mask on, certain indoor venues — including movie theaters, high-intensity exercise classes, and full-capacity religious services — remain among the “least safe” places for people who are unvaccinated.

In general, “indoor, crowded, unventilated spaces have always been the most unsafe,” Gandhi says — and are the most important venues to keep a mask on. “The longer people share the same air indoors, the more chance there is of spread,” Smith adds.

In areas where cases and hospitalizations are high, such as Michigan, Colorado, New Jersey, and Pennsylvania, masking indoors is especially crucial.

And, of course, public places — especially indoors — where people will not always be wearing masks remain chancy, particularly for those who are unvaccinated. These include indoor restaurants and bars, which have long been known to be frequent loci of Covid-19 transmission.” (D)

“More than a month has passed since Gov. Greg Abbott ended virtually all statewide restrictions related to the coronavirus pandemic. Nationwide, new coronavirus cases are on the rise as new variants of the virus spread. And about four-fifths of Texans are not yet fully vaccinated.

But at least for now, the most dire predictions of a new major wave of cases in Texas have not come true, prompting a mix of theories from public health experts.

Those experts caution that a major increase in cases could still come and it may still be too early to tell whether Abbott’s decisions to lift the statewide mask mandate and allow businesses to fully reopen could prompt a new wave of infections. Still, daily new cases and the positivity rate have leveled off over the past month, while deaths and hospitalization have gone down substantially.

Experts point out that vaccination is ramping up, many businesses are still requiring masks and there are unique factors impacting individual metrics — like a drop in demand for testing that is driving down raw case numbers.

They also emphasize that, especially at this point in the pandemic, a stabilization of such metrics, or even a modest decline, is not exactly cause for celebration.

“I think we could’ve been even lower at this point in time,” if not for Abbott’s latest decisions, said Dr. Luis Ostrosky, an infectious disease specialist at UTHealth’s McGovern Medical School in Houston. “The fact that we’re sort of stable is not necessarily good news — because we’re stable at a very high level. It’s like everybody saying you’re at a stable cruising speed — but at 100 miles per hour.”..

The nation’s top infectious disease expert, Dr. Anthony Fauci, was asked in a TV interview last week about Texas’ numbers and gave an uncertain response about what was driving them at the moment. Speaking with MSNBC, he said “it can be confusing because you may see a lag and a delay because often you have to wait a few weeks before you see the effect of what you’re doing right now.”

“We’ve been fooled before by situations where people begin to open up, nothing happens and then all of a sudden, several weeks later, things start exploding on you,” Fauci said. “So we’ve got to be careful we don’t prematurely judge that.”

Until recently, Abbott has been restrained in openly touting the Texas trend lines, instead focusing much of his celebratory public messaging on vaccination progress.

“We absolutely are not declaring victory at this time,” Abbott told Fox News on Sunday. “We remain very vigilant and guarded and proactive in our response, but there’s simple math behind the reason why we continue to have success,” he added, citing the combination of increasing vaccinations and the “acquired immunity” among Texans who have already had the virus and recovered from it.

However, Abbott went on to make a dubious claim: that the state is “very close” to herd immunity, or the point at which enough people have been vaccinated or have already become infected — and recovered — to protect the rest of the population. Abbott said that despite acknowledging in the same response that he does not know what the herd immunity threshold is for the virus, an uncertainty echoed by the public health community.” (E)

CDC – Interim Public Health Recommendations for Fully Vaccinated People

Underscores that immunocompromised people need to consult their healthcare provider about these recommendations, even if fully vaccinated.

Fully vaccinated people no longer need to wear a mask outdoors, except in certain crowded settings and venues.

Clarification that fully vaccinated workers no longer need to be restricted from work following an exposure as long as they are asymptomatic.

Fully vaccinated residents of non-healthcare congregate settings no longer need to quarantine following a known exposure.

Fully vaccinated asymptomatic people without an exposure may be exempted from routine screening testing, if feasible.

Key Points

This set of public health recommendations for fully vaccinated people will be updated and expanded based on the level of community spread of SARS-CoV-2, the proportion of the population that is fully vaccinated, and the rapidly evolving science on COVID-19 vaccines.

For the purposes of this guidance, people are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen).±

± This guidance applies to COVID-19 vaccines currently authorized for emergency use by the U.S. Food and Drug Administration: Pfizer-BioNTech, Moderna, and Johnson and Johnson (J&J)/Janssen COVID-19 vaccines.  This guidance can also be applied to COVID-19 vaccines that have been authorized for emergency use by the World Health Organization (e.g. AstraZeneca/Oxford).

The following recommendations apply to non-healthcare settings. For related information for healthcare settings, visit Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.

Fully vaccinated people can:

Visit with other fully vaccinated people indoors without wearing masks or physical distancing

Visit with unvaccinated people (including children) from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing

Participate in outdoor activities and recreation without a mask, except in certain crowded settings and venues

Resume domestic travel and refrain from testing before or after travel or self-quarantine after travel

Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States

Refrain from testing following a known exposure, if asymptomatic, with some exceptions for specific settings

Refrain from quarantine following a known exposure if asymptomatic

Refrain from routine screening testing if asymptomatic and feasible

For now, fully vaccinated people should continue to:

Take precautions in indoor public settings like wearing a well-fitted mask

Wear well-fitted masks when visiting indoors with unvaccinated people who are at increased risk for severe COVID-19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease

Wear well-fitted masks when visiting indoors with unvaccinated people from multiple households

Avoid indoor large-sized in-person gatherings

Get tested if experiencing COVID-19 symptoms

Follow guidance issued by individual employers

Follow CDC and health department travel requirements and recommendations (F)