Masks Off? How CDC Rules Are Playing Out in a Half-Vaccinated Country

Experts weigh in on the CDC’s new indoor mask mandates as states face decisions about verifying vaccine status.

(Barbara Leonard photo/Courthouse News)

(CN) — The metrics used to define the state of the pandemic have shifted. From discussion of hospital capacity, case and death rates only months ago to the current most-invoked parameter: how many Americans have been vaccinated. 

After a six-month push — one that was largely decentralized, with state and local governments left to create their own rollout plans as many called for more federal oversight — the United States crossed a notable halfway mark on Tuesday, fully vaccinating 50% of adults. 

The news comes on the heels of relaxed indoor mask guidelines from the Centers for Disease Control, signaling yet another shift in the state of the Covid-19 pandemic. 

Where exactly things stand, and whether the CDC was premature in allowing vaccinated people to unmask in most places, depends on who you ask. Some experts agree that it’s time to move forward, given increasing vaccination rates and the onset of summer. Others, more wary of a potential uptick in cases caused in part by patchy vaccination coverage, would prefer to see masking continue in the immediate future. 

Allowing people to drop their masks only once vaccinated also raises new questions about how businesses are supposed to confirm vaccine status, and what role governments should play in the process. 

Health law and epidemiology experts weighed in on mask mandates, vaccine passports and where we stand in the pandemic. 

Masks on the Honor System 

In an announcement that came as a surprise to many, the CDC on May 13 issued new rules saying those who are fully vaccinated can safely enter most indoor settings without a mask. 

Not everyone agrees that the country was ready to ramp things up so soon. 

“I think the CDC made a mistake,” Sharona Hoffman, a professor of health law at the Case Western Reserve University School of Law, said in a phone interview.  

“I think it’s premature to say people don’t need to wear masks indoors — which of course, predictably, caused states and localities to lift mask mandates, and to switch to an honor system.”

Indeed, nearly every state has lifted its indoor mask mandate in the wake of the CDC announcement. 

New Jersey, one of a handful of holdouts, now plans to make that move this Friday, ahead of Memorial Day weekend. Governor Phil Murphy said he stands by the decision to wait before adopting the recent CDC rules. 

“We did not act in a knee-jerk fashion,” Murphy said. “I do not for one minute regret our taking these extra two weeks.” 

California is waiting even longer; the state plans to lift indoor mask rules on June 15, when the state plans to fully reopen its economy

For now, masks are not required outdoors except at crowded events and, for unvaccinated people, when social distancing is not possible. 

“This four-week period will give Californians time to prepare for this change while we continue our relentless focus on delivering vaccines, particularly in underserved communities,” the California Department of Public Health said in a statement. “We urge all Californians to get vaccinated to ensure that infection and hospitalization rates remain low across the state and that we can all return to the activities we love.”

Even if many state governments are on the same page about mask rules, however, enforcement is a separate question. 

Rather than put its hopes on the good faith of its residents, the state of Oregon is requiring businesses to check for vaccination status. That may be easier said than done, according to restaurant owners and workers in the state. 

Jason Jugling, who owns the Ontario, Ore., restaurant Plaza Inn is still requiring masks for now. That hasn’t been an issue for the 60% to 70% of customers who come in with a mask, he told KTVB.

But the restaurant owner doesn’t plan on asking the 30% of unmasked visitors to prove they got a Covid-19 vaccine.

“I don’t have the time,” Jugling said. “I will take their word for it. I’m not going to ask to see their card.” 

Asking for proof is perfectly legal, Hoffman said. But making exceptions for those who can’t get vaccinated for religious or medical reasons — and verifying that those exceptions apply — could get tricky in terms of logistics. 

“And, of course, there are a lot of fake vaccine cards circulating,” Hoffman added. “So it’s not a foolproof system.” 

The federal government does not plan to instate a vaccine passport program, leaving the decision, like many others, up to individual states or private companies.  

Some national chains are no longer requiring masks inside: Target, Costco, Walmart, Starbucks, Trader Joe’s, Home Depot all dropped the rule, but only in states without indoor mask mandates. 

Statewide vaccine passes have not been popular so far. 

New York created an app called the Excelsior Pass to let residents keep their vaccine proof handy, should they attend a vaccination-required event — or wish to sit in the “vaccinated” section of a baseball game. 

It’s unclear whether the Empire State will be joined by any others. Hawaii Governor David Ige has said his state is considering a similar system, and Illinois Governor JB Pritzker said he was in favor of a vaccine passport. 

Elsewhere, governors are trying to get ahead of vaccine passports by blocking them before they even pick up steam. 

Texas Governor Greg Abbott in early April banned governments from creating vaccine passports. Missouri lawmakers and Florida Governor Ron DeSantis did the same, and the governors of Tennessee and Georgia each tweeted disapproval of state-run vaccine passports. 

After a year of insisting on indoor masks for all, Hoffman sees issues in relying on individuals to self-govern and only unmask starting two weeks after their final dose presents issues. 

“We’ve shown, throughout the pandemic,” she said, “that we’re not so good with honor systems.”

(Image courtesy of Pfizer via Courthouse News)

A Time of Uncertainty 

Moving too quickly away from safety precautions could put the country at risk of sliding backward, undoing the progress of the past few months. 

As vaccine distribution continues, a major benchmark ahead will be whether the country can meet President Joe Biden’s goal of vaccinating 70% of the population by July 4. 

“There’s really no magic number that we know of, for sure, that will totally protect us from another surge of infection,” said Stephen Kissler, a postdoctoral researcher who studies immunology and infectious diseases at Harvard T.H. Chan School of Public Health. 

Some states or regions are better protected than others based on vaccine distribution. And plenty of people in vulnerable communities simply have not been able to get a vaccine, for reasons like inadequate travel, language barriers, or concerns about taking time off work to get the shot and deal with side effects

That means there is work left to be done.  

“There are no guarantees in epidemiology,” Kissler said, “especially when we’re up against a virus that’s as variable and as cunning as SARS-CoV-2 is.” 

Protecting ourselves from the coronavirus can be a “moving target,” Kissler said, considering variables including new variants, immunity declining over time, and even new people being born. 

The myriad factors make this moment a precarious one in the course of the pandemic. 

“I think this is a time of uncertainty,” Hoffman said. “We see the numbers going down because of vaccines, but also because, I think, people just got used to the masks and the social distancing. And without those measures, we just don’t know what’s going to happen.” 

For kids, Hoffman noted, the lack of certainty is paired with a lack of being able to do anything about it. 

“Anyone under 12 doesn’t have access to a vaccine,” she said, noting that some variants, data suggest, affect children more than the previous coronavirus strains that have dominated in the U.S. 

A small percentage of adults say they don’t plan to get vaccinated at all, and the same goes for parents who refuse to vaccinate their children under age 18, who would need parental consent to get a shot. 

“Children just don’t have anything other than masks and social distancing as protection,” Hoffman said. “And if people feel they don’t have to wear it because we’re on the honor system, that’s problematic.” 

Kissler said issues could arise not from the timing of the CDC dropping its mask recommendations indoors but from how that message is being interpreted.  

The pandemic outlook in the United States right now is “looking reasonably good,” Kissler said, with cases, hospitalizations and deaths dropping “pretty much everywhere,” driven largely by vaccination. 

“I do think it makes sense that we can start thinking about relaxing some of these measures,” Kissler said. “That said, I think there’s good reason to do so incrementally — especially for things like the mask mandates.”

Kissler said the updated CDC guidelines are reasonable, but he fears that something was lost in translation. What some people heard, rather than an easing of previously strict mandates, was that masks are no longer needed anywhere. 

“Which is not exactly what they said — but I think that’s sort of how it’s being taken,” he said. “That’s one of my concerns.”

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