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Health Team

CDC reverses course on indoor masks in some parts of US

Posted July 27, 2021 2:49 p.m. EDT
Updated July 28, 2021 12:10 a.m. EDT

— 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.

Under the CDC's new guidance, that would include 80 of North Carolina's 100 counties. In the Triangle, only Durham, Orange, Granville, Vance, Warren and Nash counties would be exempt from the recommendation.

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.

North Carolina's statewide mask mandate in schools expires Friday, and Gov. Roy Cooper said a week ago that it's up to local school districts to enforce recommendations on who wears masks in class.

"The governor and state health officials will review changes to CDC guidance, and he strongly encourages schools and businesses to enact important safety precautions and unvaccinated people to wear masks until they get their shots," Cooper spokeswoman Mary Scott Winstead said in a statement.

But that guidance has changed.

Kira Kroboth welcomes the new guidance. As the parent of a child who is immunocompromised, she says recommending staff and K-12 students to wear masks gives her peace of mind.

"This is fantastic and that's exactly what the majority of parents are wanting," Kroboth said.

Thales Academy parent Jenny Potter doesn't agree.

"I don't feel like there should be any mandates or requirements for that," she said.

Potter is the mother of three children attending Thales Academy. She says the private school notified her about requiring masks for unvaccinated people on campus.

"[I'm] not against a mask, [I] just feel like if you can choose that for your family, that's great. I choose not for my family," she said.

The frequency and percentage of COVID-19 cases in children 12 and under appears to have dropped. Data from state health officials shows this age range made up more than 1,600 cases this month.

The same four weeks around this time last year, it was more than 3,000 cases.

Dr. Gavin Yamey with the Duke Global Health Institute said the CDC is making the right call.

"I was very pleased to see the CDC change it's guidance on masks," he said.

Yamey noted many students remain vulnerable to the Delta variant, with children under 12 not yet eligible for the vaccine. With strong opposition to a mask mandate, he said wearing one is the best safeguard in schools.

"Public health should change when conditions change," Yamey said. "They are being responsive to the new reality."

Cooper has scheduled a 2:30 p.m. Thursday briefing to provide updated guidance.

The new CDC 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.

In North Carolina, an average of 1,754 people have been infected each day over the last week, up 79 percent from a week ago. Also, 10.4 percent of all virus tests statewide are coming back positive, the highest rate in almost six months.

More than 1,000 people are hospitalized in North Carolina with COVID-19, the first time the state has topped 1,000 since early May.

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.

Rita Williams, who was vaccinated months ago, said she tested positive for the virus two weeks ago and was briefly hospitalized. She's among more than 4,600 breakthrough cases North Carolina health officials have recorded.

"The combination of having the vaccine onboard [along] with doing everything right that I was supposed to be doing, like limiting my activity, my traveling, wearing gloves, wearing a mask, I was very surprised that I still contracted COVID in spite of all those things," Williams said.

She agrees with the new call to put the masks back on.

"It is unfortunate, but if this is what we have to do to make sure the community remains safe, then I’m all for it," she said.

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.

"Wearing masks, even if vaccinated, in areas that have substantial community transmission makes perfect sense," said Dr. David Weber, an infectious disease expert at UNC Health.

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.

Weber disagreed, saying, "If we've learned anything about COVID in the last 18 months, it's one needs to be flexible and adaptable and alter guidelines and mitigation efforts depending on what's actually transpiring with the virus."

Yamey concurs with Weber.

"Sound pandemic management requires tailoring measures to the local situation on the ground," Yamey said. "The right public health response to control these surges is to use a range of science-based approaches ... until vaccination rates increase."

But U.S. Sen. Thom Tillis said changing the mask guidance sends the wrong message.

"I am deeply concerned that the Biden administration’s contradictory decision will cause even more vaccine hesitancy, giving many Americans the false impression that the vaccines are not as effective as they were originally told," Tillis, a North Carolina Republican, said in a statement.

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. "Now, we are opening the wards back up, and the numbers are going nuts.”

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Associated Press writers Aamer Madhani in Washington and Heather Hollingsworth in Mission, Kansas, and WRAL reporters Amanda Lamb and Aaron Thomas contributed to this report.

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