Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at email@example.com.
Dear Dr. Hamblin,
I’m still confused about what our lives will be like after we are vaccinated. As I understand it, it will still be possible to get the virus, but hopefully the course won’t be as severe or life-threatening. And we are going to have people who won’t even get the vaccine. Do you foresee us still wearing masks for the next year or two? I hate to even type this question.
New London, New Hampshire
I can’t wait to stop wearing masks. I want to go out without a mask so badly that I’ve been dreaming about it. That’s how far the pandemic has lowered the ambitions of my dreams.
Last month, Joe Biden said he will urge Americans to wear masks for the first 100 days of his presidency. “Just 100 days to mask,” he said, “not forever.” That sounds manageable even for those of us who can’t wait to go out maskless: I’m absolutely sick of this, but I can do 100 more days.
Setting this sort of short-term goal can be helpful in making a seemingly endless challenge like this pandemic more manageable. But, to be blunt, 100 days is not a realistic end point. On our current trajectory of illness and infection, masks will be part of most Americans’ lives for at least the rest of the year, and possibly longer. My hope is that it will soon be possible to say, as a general rule, that once you’ve been vaccinated, you don’t have to wear a mask. But that depends on two key variables.
The first is that a vaccinated person could theoretically still transmit the virus. This isn’t typically an issue after vaccination against respiratory viruses, once your body develops antibodies and other means of immune memory. If you inhale the virus again, these defenses should identify and eradicate it before it multiplies in large numbers. But that doesn’t mean viral particles can’t briefly cling to your nasal cavity and replicate before your body’s alarms go off, creating a brief window in which you could transmit the virus to someone else. This coronavirus warrants special caution because we know that it can be transmitted by people who have no symptoms and low levels of virus in their bodies. That means it is especially adept at lingering in people’s noses without quickly triggering an immune response (which is the source of most symptoms, such as cough, muscle aches, and fever).
The vaccines that have been rolled out in the U.S. do seem to be extremely, surprisingly effective at preventing people from falling sick with COVID-19, but the clinical trials did not monitor the mechanisms through which this protection is conferred. People were not tested to see when and how reliably they developed antibodies, nor screened to see whether they ever carried the virus. Additional research is under way to address these questions in coming months. Although I would be surprised to learn that vaccinated people are spreading the virus to any significant degree, it’s reasonable to have everyone continue wearing masks until we know more.
The second variable in the countdown to mask-free life is how quickly entire communities get vaccinated. When the virus is spreading widely and very few people are vaccinated, the chance that a vaccinated person might carry the virus (and possibly even get sick, since no vaccine is 100 percent effective) is simply too high to suggest that anyone forgo masking. But as more and more people get vaccinated, the potency of each vaccine grows. Even if vaccinated people do prove to have the potential to carry and spread the virus in small amounts, for brief periods, that risk can be rendered moot if almost everyone gets vaccinated.
All of this is contingent on the assumption that immunity generated by vaccines is reliable and long-lasting (which it seems to be, so far) and that the virus does not evolve to become resistant to this immune protection in the near term. Eventually, it likely will. But by that point, hopefully, the rates of transmission will be low enough that we can quickly identify new variants and modify vaccines accordingly, to stay ahead of any new surges.
The bottom line is that the less the virus is circulating in the U.S., the more confident we can be about transitioning away from masks. Unfortunately, we haven’t collectively actually started wearing them. More than 3,000 people are dying every day in the U.S. alone, and hundreds of thousands more are being infected. This wouldn’t be happening if we were all wearing masks effectively. Before we truly begin to think about the end of masks, we need to think much more seriously about how to use them better.
I’d love to stop wearing masks. They erase the subtleties of communication that tether us to humanity, the cues that give context and nuance to everyday interactions. They make people feel two-dimensional. But we are far from done with them. I hope that if we can accept this reality soon, we can focus more on building public support and distribution channels for quality masks. There’s room for someone to win a Nobel Prize for figuring out how to get Americans to wear their mask over their nose.
It’s easy to become numb to the numbers of people who are getting sick and dying every day, and let the annoyance of masks feel somehow more comparably urgent than it is. But even if the mortality rate were cut in half, and then cut in half again, we’d still be losing hundreds of people every day. For the foreseeable future, even among the vaccinated, masks will at the very least be symbols of solidarity and empathy. That symbolism may have real consequences. The clearest, most urgent challenge of the pandemic remains simply getting people to wear masks (and wear them correctly). The message would be made more complicated by creating two classes of people, some who have to wear masks and others who don’t. However long we have until the end of masks, we’ll get there far faster if we act together.
“Ask Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.