Why must I still wear a mask?
Dear John,
Now that I am vaccinated, why is the government insisting that I still wear a mask? (Part 1)
Disclaimer: I received this question in March and answered part 1 in early May. Shortly after May, there was new evidence to support the removal of masks for vaccinated individuals. Complicating things even further, since the CDC guidelines permit vaccinated individuals to remove their masks indoors, the delta variant of Covid has spread throughout the US prompting scientists and officials to again re-evaluate the mask and protective provisions. This further highlights just how complicated it is to anticipate and make safe recommendations based on science and safety. New information and data is constantly coming out. I have added an updated addendum to account for this new information, which will come out next week in part 2.
Dear Covid Curious,
It’s been over a year and I’m sure you, like most of us, are worn down after the toilet paper shortages, mask wearing, sheltering in place, disruptions in our routines, and loss of freedoms. We all initially donned masks to protect ourselves and to protect each other when fear and uncertainty were both high. These were major disturbances to our daily lives and the stress of that has been wearing on us all. Covid fatigue is real, and the masks are a reminder of what we have endured.
One, just because you are vaccinated does not mean you cannot get SARS-CoV-2, commonly referred to as Covid-19 or more simply, Covid. A mask can help prevent exposure to the virus. A study from Denmark, commonly referred to as “The Danish Mask study,” is erroneously cited as finding that masks make no difference in protecting us from Covid. The British Medical Journal subsequently published a rebuttal, clarifying that the study was “inconclusive” and not “negative,” two very different conclusions. From these studies, it was highly suggestive there are strong benefits to wearing the mask, not to mention the potential benefits of reducing both the spread of droplets and diminishing the concentration of aerosolized viral particles. This is important as several studies have shown that the severity of infection correlated to 1) duration of contact and 2) concentration of exposure. In layman's terms, the longer you are exposed and the more virus you are exposed to, the greater the chance of inoculation and severity of infection.
Two, it is still unclear whether or not you can spread Covid if you are vaccinated. My thought on this is to assume you still can spread the virus rather than believing the opposite. If you are wrong, you have only inconvenienced yourself by wearing a mask. If you believe the opposite, you are potentially increasing your chances to not only get coronavirus (CV), but also spread it indiscriminately. This brings up a common discussion point, what is the individual's responsibility versus social responsibility? I will touch on this shortly.
Third, it is becoming clear that Covid is both highly contagious and mutates rapidly. This means that variants will always be emerging as the virus replicates in the human host. With the number of variants that are showing up across the globe, there is no telling when you will encounter a variant that could potentially bypass your immune system, even if you have been previously infected or vaccinated. The prevention, however, does not change, such as washing your hands, social distancing, wearing a mask, and limiting time in or avoiding large crowds and indoor spaces.
Fourth, we don’t know what we don’t know. We have experienced 3 major waves of CV since it was first reported in December 2019. We have been under quarantine recommendations or restrictions for over a year as we sought to understand this novel virus and limit its impact on the world. Globally, as of August 10th, 2021, there are over 204M cumulative cases of CV, 4.3M deaths, and a daily average of over half a million new cases with 10,000 deaths per day. We are now in our fourth wave of surging cases. By no means do we have things under control, and we are continually learning about this virus at breakneck speed. It is very clear that risk management strategies do work though, e.g. hand washing, wearing masks, social distancing, vaccinations, avoiding large crowds and prolonged time indoors, etc. Even as we look to vaccinations as our savior out of this pandemic, it is not exempt from it’s share of obstacles, such as delivery, production, storage, and distribution. Because of the degree of uncertainty and the constantly evolving nature of the virus, it makes sense to continue to wear a mask until we have truly impacted the natural history of the disease.
And finally, circling back on the point touched on earlier, what is everyone’s responsibility from an individual and social standpoint? I don’t think these two are mutually exclusive. There are many examples of individuals or groups prioritizing their individual autonomy over the greater good of society. But, the actions of a few impact many. It is important to remember the people to the left and right of us are our neighbors, our community, our friends and family. They are someone’s loved one and a person worthy of our care and consideration. When we adorn a mask, you are taking personal responsibility for your actions as well as sharing with others that you care about their well-being. We don’t know who has an underlying or possibly undiagnosed medical condition, who is vaccinated and who is not, who has a loved one at risk at home, or any of the other variables in a stranger's life. When we gather with close friends and family, we can choose and agree on the risk we are willing to take; mask or no mask, vaccinated or not, indoor or outdoor - those are the terms we get to mutually agree on. This is the very nature of informed consent, honoring everyone’s ability to manage their risk, choose for themselves, and preserve their free will and autonomy.
To bring it back full circle, why is the government insisting that you still wear a mask? Probably because it is the safest recommendation to make for yourself and the greater good of our country. Do you have to wear a mask? No, you don’t. Hopefully through education and empathy you can see why it might be best to do so for the foreseeable future.
With Love and Light,
John Moos, MD