The Centers for Disease Control and Prevention reversed course Tuesday on some masking guidelines, recommending that even vaccinated people return to wearing masks indoors in parts of the U.S. where the coronavirus is surging, including most of Utah.
Citing new information about the ability of the delta variant to spread among vaccinated people, the CDC also recommended indoor masks for all teachers, staff, students and visitors to schools, regardless of vaccination status.
The delta variant “is causing dense outbreaks, more so in areas where vaccination rates are lower,” Dr. Brandon Webb, infectious diseases physician at Intermountain Healthcare, said Tuesday in an interview with The Salt Lake Tribune.
The CDC’s recommendation comes, Webb said, because “it’s becoming clear that the current level of social restrictions and outbreak mitigation is inadequate in most places. If something doesn’t change, we know how the story goes: The hospitalizations will mount, deaths will increase, and it will tax our health care systems.”
A large portion of Utah would appear to be where the CDC’s new guidance would be needed. According to the CDC’s county tracker, 22 of Utah’s 29 counties are considered in the “high” transmission level — meaning the county has had more than 100 new cases per 100,000 population in the last week.
Summit and Morgan counties are listed in the “substantial” category, with between 50 and 100 cases per 100,000. Sevier County is in the “moderate” category, which is 10 to 50 cases per 100,000. Only four rural counties — Daggett, Piute, Rich and Wayne — are in the “low” transmission category, with fewer than 10 cases per 100,000.
The new guidance follows recent decisions in Los Angeles and St. Louis to revert to indoor mask mandates amid a spike in COVID-19 cases and hospitalizations that have been especially bad in the South. The country is averaging more than 57,000 cases a day and 24,000 COVID-19 hospitalizations.
The Utah Department of Health is not changing its mask recommendations for now, spokesman Tom Hudachko said Tuesday. “We recommend unvaccinated people choose to wear masks in indoor settings,” Hudachko said, adding that the department is “always watching how the virus and the pandemic are evolving.”
Most new infections in the U.S. continue to be among unvaccinated people. But “breakthrough” infections, which generally cause milder illness, can occur in vaccinated people. When earlier strains of the virus predominated, infected vaccinated people were found to have low levels of virus and were deemed unlikely to spread the virus much, CDC Director Dr. Rochelle Walensky said.
But with the delta variant, the level of virus in infected vaccinated people is “indistinguishable” from the level of virus in the noses and throats of unvaccinated people, Walensky said.
The data emerged over the last couple of days from 100 samples. It is unpublished, and the CDC has not released it. But “it is concerning enough that we feel like we have to act,” Walensky said.
Vaccinated people “have the potential to spread that virus to others,” she said.
While the CDC’s recommendation puts the emphasis on “breakthrough” cases, Webb at Intermountain Healthcare noted that least 80% of new cases in the country, and more than 90% of hospitalizations, are among unvaccinated people.
The CDC’s announcement is a reminder “this is a pandemic of the unvaccinated,” said Dr. Angela Dunn, executive director of the Salt Lake County Health Department, “and that widespread vaccination remains our most effective defense — including against the delta variant.”
Dunn said in a statement that her “focus is on providing and encouraging vaccination, and on protecting the children in our community who are too young to be vaccinated.” With the delta variant spreading in Utah, though, “it’s important to implement multiple layers of prevention,” she said.
Dunn, who noted that she is vaccinated, said she would follow the CDC’s recommendation, and wear her own mask when indoors in public settings. “I don’t know who around me is unvaccinated,” she said.
Webb said he also eased off on mask wearing over the spring. “Our community rates were low enough that it did not seem unreasonable for individuals who are fully vaccinated and healthy, and likely to have realized the full benefit of the vaccine” to remove their masks.
Now, though, Webb said he would return to mask wearing, “because I feel a responsibility to do whatever I can in the community to help decrease pressure on the health care systems, to prevent individuals from requiring [intensive care] and from unnecessarily suffering from this disease.”
For much of the pandemic, the CDC advised Americans to wear masks outdoors if they were within 6 feet of one another.
Then in April, as vaccination rates rose sharply, the agency eased its guidelines on the wearing of masks outdoors, saying that fully vaccinated Americans no longer needed to cover their faces unless they were in a big crowd of strangers. In May, the guidance was eased further for fully vaccinated people, allowing them to stop wearing masks outdoors in crowds and in most indoor settings.
The guidance still called for wearing masks in crowded indoor settings, like buses, planes, hospitals, prisons and homeless shelters, but it cleared the way for reopening workplaces and other venues.
Subsequent CDC guidance said fully vaccinated people no longer needed to wear masks at summer camps or at schools, either.
For months COVID cases, deaths and hospitalizations were falling steadily, but those trends began to change at the beginning of the summer as the delta variant, a mutated and more transmissible version of the virus, began to spread widely, especially in areas with lower vaccination rates.
White House press secretary Jen Psaki said the delta variant has changed the nation’s COVID-19 outlook since the the CDC relaxed masking recommendations.
“That is their job. Their job is to look at evolving information, evolving data, an evolving historic pandemic and provide guidance to the American public,” Psaki said.
“What has not changed,” she added, “is the fact that people who are vaccinated have a huge deal of protection from serious illness, from hospitalization and from death.”
Some public health experts said they thought the earlier CDC decision was based on good science, which indicated that the risk of vaccinated people spreading the virus was relatively low and that the risk of them catching the virus and becoming extremely ill was even lower.
But those experts were also critical, noting that there was no call for Americans to document their vaccination status, which created an honor system. Unvaccinated people who did not want to wear masks in the first place saw it as an opportunity to do what they wanted, they said.
“If all the unvaccinated people were responsible and wore mask indoors, we would not be seeing this surge,” said Dr. Ali Khan, a former CDC disease investigator who now is dean of the University of Nebraska’s College of Public Health.
Lawrence Gostin, a public health law professor at Georgetown University, drew a similar conclusion.
“It was completely foreseeable that when they [the CDC] made their announcement, masking would no longer be the norm, and that’s exactly what’s happened,” Gostin said.
The CDC may be seen as “flip-flopping,” he said, because there’s been no widely recognized change in the science, he said. Furthermore, it’s not likely to change the behavior of the people who most need to wear masks.
“I don’t think you can effectively walk that back,” he said.
Ken Thigpen, a retired respiratory therapist who now works for a medical device manufacturer, is fully vaccinated and stopped wearing his mask in public after the CDC changed its guidance in May. But he started to reconsider in the last week after his job took him to hospitals in Mississippi, Louisiana, Alabama and Florida, where he witnessed medical centers getting inundated with COVID-19 patients.
“That delta variant is intense. It is so transmissible that we have to do something to tamp it down,” he said.
“I loved it when I could call the hospitals and they said, ‘We actually closed our COVID ward today or we are down to two COVID patients,’” he recalled. “And now we are opening the wards back up, and the numbers are going nuts.”
Tribune reporter Sean P. Means and Associated Press writers Aamer Madhani in Washington and Heather Hollingsworth in Mission, Kansas, contributed to this report.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.