In what felt like a fever dream at the beginning of 2020, confusion over face masks began before any mandates were in place. In March 2020, while the coronavirus was just gaining footing in the US, the Centers for Disease Control and Prevention, as well as the World Health Organization, gave the guidance that healthy people shouldn't wear masks because of limited supply -- they should be saved for sick patients and caregivers in a strained health care system short on personal protective equipment.
On April 3, 2020, the CDC flipped the script and issued the nationwide recommendation that all Americans should wear cloth masks (emphasis on the "cloth," as there was still a shortage of PPE). In the weeks and months that followed, states, cities, counties and local businesses adopted the science-backed reasoning that facial coverings slow the spread of COVID-19 by containing respiratory droplets. As mask-wearing became the norm and surgical masks became widely available, the CDC took it a step further and recommended "double masking."
We've come a long way since March 2020, thanks mostly to three highly effective COVID-19 vaccines. But on Tuesday, the CDC moved away from its May 2021 guidance that vaccinated people don't need masks in most cases, and issued a recommendation that fully vaccinated Americans should wear masks indoors if they live in an area with high rates of COVID transmission.
Between the back and forth, there's been debate about proof of vaccination, whether or not the CDC's guidance on masks is valid and confusion about local mandates. Here's where we are now.
Vaccination status and masks
According to the latest CDC guidance, fully vaccinated people living in areas of "substantial" transmission (50-100 COVID-19 cases per 100,000 people in the past seven days) or "high" transmission (100 or more cases of COVID-19 in the past seven days) should wear masks indoors.
This means that businesses in communities where there's low COVID-19 transmission (look here at the CDC's map to find your county and its transmission rate) may continue to allow vaccinated folks to go sans mask. However, the CDC points out that you might still want to wear one,even if you don't live in an area of high transmission, for example if you live with someone who's immunocompromised or otherwise at risk for severe COVID-19.
The CDC's newest guidance is meant to protect those who aren't as protected by the COVID-19 vaccines, such as immunocompromised people and kids under age 12 who can't get a shot yet. The shift in recommendations comes in light of research that shows just how dangerous the now-dominant delta variant is, and findings that people who get a symptomatic breakthrough COVID-19 infection, though rare, might be as likely as unvaccinated people to pass the infection onto someone else, CDC director Dr. Rochelle Walensky said.
Another reason for the CDC's newest mask recommendation may have been to pressure the parts of the country with low vaccination rates to get immunized. On Tuesday, Walensky said communities with low vaccination rates are experiencing a significant spread of COVID-19 cases and are also seeing "severe outcomes." In recent weeks, health experts have said that about 99% of COVID-19 deaths are now of unvaccinated people.
If you aren't fully vaccinated (being fully vaccinated means two weeks have passed since you received the second dose of a Pfizer or Moderna vaccine, or two weeks have passed since your one-dose Johnson & Johnson shot) you aren't considered protected against COVID-19 and should still wear a mask in all public places, to protect yourself and others, per the CDC guidance. Scott Gottlieb, head of the Food and Drug Administration during the Trump administration, told CBS recently that the delta variant is so contagious that most people will get COVID if they haven't been vaccinated or previously infected.
I'm vaccinated. Why am I still being asked to wear a mask some places?
All people, regardless of whether they've been vaccinated or what community they live in, need to wear a face mask on public transportation, on airplanes, in health care settings and in any local or private business that requires one.
The CDC's guidance also does not trump state, city or county mask mandates, and some areas are reinstating mask rules because of a rise in COVID-19 cases. Before the CDC's newest recommendation, Los Angeles County, for example, started requiring masks indoors again for both vaccinated and unvaccinated folks after a rise in COVID-19 cases. Seven counties in the San Francisco Bay Area stopped short of a mandate, but issued recommendations that everyone wear a mask indoors, following an uptick in COVID-19 cases caused by the highly transmissible delta variant.
Are face masks effective against the delta variant?
Delta is more transmissible and potentially leads to more severe disease, which means that masks play an even more important role in slowing the spread of coronavirus.
"Quality of mask is going to make a difference with a variant that spreads more aggressively like delta does, where people are more contagious and exude more virus," Gottlieb told CBS.
"Trying to get N95 masks into the hands of vulnerable individuals in places where this is really epidemic I think is going to be important, even in cases where they're vaccinated, if they want to add another layer of protection," Gottlieb said.
Which do I listen to -- the WHO or the CDC?
It's a little easier now that both agencies seem to agree that asking everyone to mask up is the right move while the delta variant makes its rounds in the US. A previous source of the mask confusion in the US was when officials with the World Health Organization said that vaccinated people should still continue to be cautious and wear masks. This was opposite advice from the CDC, who originally gave vaccinated individuals more slack in their return to everyday life in May when it lifted the mask recommendation for fully vaccinated people.
An important thing to keep in mind when weighing advice from the CDC against advice from the WHO is that the two agencies serve different populations. The CDC is a federal agency under the US's Department of Health and Human Services, and its mission is to guide health practices in the US. The WHO, on the other hand, is an agency with the United Nations that serves many different countries. When issuing guidance on COVID-19, the CDC focuses on the US, and the WHO has to consider the whole globe.
Is it legal to require face masks or proof of vaccination?
There is nothing in the CDC's current guidance regarding masks about proof of vaccination, and (it seems) most stores and businesses have adopted the guidance on the faith that people will be masking or not based on their personal vaccination status. If a restaurant or business asks you to wear a mask and you refuse, however, it is likely within their rights to refuse you service, as long as they are doing it in a "nondiscriminatory manner," KIRO 7 reports. (Recall "No shirt, no shoes, no service," per Healthline.)
However, there are different laws at play, and state law will take precedence over county law, for example. In states such as Texas, local governments are prohibited from enforcing mask mandates, leaving it entirely up to the employer or business.
Your employer may legally require you to wear a mask, according to guidance from the US Equal Employment Opportunity Commission, an agency that enforces civil rights laws in the workplace. In a March 2020 update, the EEOC said "the ADA and the Rehabilitation Act do not interfere with employers following advice from the CDC and other public health authorities on appropriate steps to take relating to the workplace."
As far as proof of vaccination is concerned, the Biden administration said that it will not create a vaccine passport system for the US (but you might need one to travel to other countries). That hasn't chipped away at the controversy surrounding mandated vaccines or proof of vaccination, however. Many hospitals and some universities have started requiring staff and students to be vaccinated against COVID-19. On Monday, a federal judge blocked a challenge to Indiana University's vaccine requirement for students and staff, signaling that universities have a right to require vaccination, unless there is a "religious, medical or ethical exemption."
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.