As infections rise, CDC urges some vaccinated Americans to wear masks again

Revising a decision made just two months ago, the Centers for Disease Control and Prevention said on Tuesday that people vaccinated against the coronavirus should resume wearing masks in indoor public spaces in areas of the country where the virus is on the rise.

CDC officials also recommended universal masking for teachers, staff, students and visitors to schools, regardless of vaccination status and community transmission of the virus. With extra precautions, however, schools should resume in-person learning in the fall, agency officials said.

The recommendations are another grim twist during the US pandemic, a war-weary concession that the virus outstrips vaccination efforts. The agency’s decision follows rising cases in states like Florida and Missouri, as well as growing reports of breakthrough infections of the Delta variant, which is more contagious in fully immune people.

“The Delta variant shows its willingness to outdo us every day,” CDC director Dr Rochelle Walensky said at a press conference on Tuesday.

Data from several states and other countries shows that the variant behaves differently from previous versions of the coronavirus, she added: “This new science is worrying and unfortunately deserves an update of our recommendation. “

Jen Psaki, the White House press secretary, told a press conference on Tuesday that the change in guidelines was crucial to “combat an ever-evolving virus” and that the Biden administration has backed the effort .

“Their job is to look at changing information, changing data, an evolving historic pandemic, and providing advice to the American public,” Ms. Psaki said.

Vaccines remain remarkably effective against the worst consequences of infection with any form of coronavirus, including hospitalization and death. But the new guidelines explicitly apply to both unvaccinated and vaccinated people, a radical departure from the agency’s stance since May that vaccinated people do not need to wear masks in most settings. interior spaces.

These recommendations, which appeared to signal a slowing of the pandemic, were based on previous data suggesting that vaccinated people are rarely infected and almost never transmit the virus, making masking unnecessary.

But that was before the arrival of the Delta variant, which now accounts for the bulk of infections in the United States. CDC officials have been convinced by new scientific evidence showing that even vaccinated people can be infected and carry the virus in large quantities, according to three federal officials familiar with the discussions.

Some public health experts have welcomed the agency’s decision to revise its guidelines. From what scientists are learning about the ability of the Delta variant to cause breakthrough infections, “it’s a step in the right direction,” said Dr. Celine Gounder, infectious disease specialist at Bellevue Hospital Center in New York.

The American Federation of Teachers and the National Education Association, the two main teachers’ unions, strongly supported the CDC’s decision to use universal masking in schools.

“Masking inside schools, regardless of vaccination status, is necessary as an important way to deal with the changing realities of virus transmission,” said Randi Weingarten, AFT president. precaution needed until children under 12 can receive a Covid vaccine and more Americans over 12 get vaccinated.

It is far from certain that national and local health authorities are willing to follow the agency’s guidelines. And there will certainly be resistance from Americans tired by the pandemic, especially in areas of the country where vaccination rates are low and concerns about the virus are alleviated.

Some jurisdictions, like Los Angeles County and St. Louis County, Missouri, have already reinstated mask warrants in response to the increase in cases. But Arkansas, one of the states with the highest numbers, has maintained the ban on mandatory masks even though vaccination rates have lagged.

As recently as last week, a spokesperson for the CDC said the agency has no plans to change its direction unless there is a significant shift in science. Researchers have started to find disturbing new data.

The Delta variant is believed to be about twice as contagious as the original version of the virus. Some research now suggests that people infected with the variant carry about a thousand times more viruses than those infected with other variants, and may remain infected longer.

CDC officials have been influenced by new research showing that even people vaccinated can carry large amounts of the variant virus in their nose and throat, suggesting they can also pass it on to others, according to three officials. federal officials close to the case.

Large viral loads, especially in the nose and throat, may help explain reports of breakthrough infections in groups of people who have been vaccinated. For example, an outbreak that began in Provincetown, Massachusetts after the July 4 festivities has increased to include at least 765 cases, according to Steve Katsurinis, chairman of the Provincetown Board of Health.

Of the 469 reported cases among Massachusetts residents, 74% were in people who were fully immune, Katsurinis said.

Smaller clusters of breakthrough infections have been reported after weddings, family reunions and dinner parties. Some of those infected were showing symptoms, but the vast majority were not seriously ill, suggesting that the immunity produced by the vaccines is quickly slowing the virus.

Vaccines “are not a force field,” said Jennifer Nuzzo, an epidemiologist at the Bloomberg School of Public Health at Johns Hopkins University. Instead, vaccination trains the immune system to recognize cells infected with the virus.

“The term breakthrough infection is probably a bit misleading,” she said. “It’s probably more realistic that we’re talking about a revolutionary disease and the scale of it. “

Dr Walensky again urged people to get vaccinated on Tuesday, noting that the increase in cases and hospitalizations is greatest in places with low vaccination rates and among unvaccinated people.

She acknowledged that some vaccinated people can be infected with the Delta variant and can be contagious, but maintained that this was a rare event. But the CDC only tracks breakthrough infections that lead to hospitalization or death in vaccinated Americans. Authorities previously said those vaccinated accounted for just 3% of hospitalizations.

Dr Gounder and other experts said it’s not clear how often vaccinated people pass the virus on to others, but it may be more common than scientists predicted as the original virus spreads.

“We have seen a growing number of groundbreaking infections, and it seems most of them can occur in places where people are exposed to a lot of Covid,” said medical specialist Dr Scott Dryden-Peterson infectious disease and epidemiologist in Brigham. & Women’s Hospital in Boston, which looked at breakthrough infections in Massachusetts.

People vaccinated – especially people with weakened immune systems or at high risk – should consider wearing masks even in areas of low transmission, he said: “Masks can effectively reduce the amount of virus. that we breathe and keep us from getting sick, and therefore they increase the impact of our vaccine. Almost everywhere in the United States, this is a good idea.

Infections have increased rapidly in the United States, reaching more than 56,000 daily cases on average Tuesday, more than four times the number of four weeks ago. Hospitalizations have also increased in almost all states, and deaths have risen to an average of 275 per day.

“Given what we’re seeing, it’s absolutely necessary right now to slow down and curb transmission,” said Dr Robby Sikka, a doctor who has worked with the NBA’s Minnesota Timberwolves, of the new guidelines. masking.

“Not everyone who has a breakthrough infection will be at risk of transmission, but it is imperative to note that there is a risk of transmission,” he said.

But Dr Sikka noted that relying on states or localities to establish masking rules will require more testing than is currently done to identify people with mild or asymptomatic infections. “This is something that we are probably not quite ready to do,” he said.

Since the virus appears likely to become endemic, permanently entrenched in American life, federal officials must articulate an even clearer plan for long-term masking, Dr Nuzzo said.

“The question is, what are the exit ramps for masking? It is really important for us to define that, ”she said. “If we’re going to keep asking people to step in, we need to give them a vision of what we’re working towards. “