How Did It Come to This?

The Delta variant is winning, for the moment, and the CDC’s coronavirus map shows that we’re failing to fight it.

a map of the country's coronavirus status on July 27, 2021
Centers for Disease Control and Prevention, July 27, 2021 / The Atlantic

The CDC’s color-coded coronavirus case map, if you can find it, is easy enough to read. It’s a county-by-county snapshot of viral transmission—the agency’s new fallback for advising fully vaccinated people on whether they need to don a mask indoors. The parts painted in those scary shades of orange or red are areas of substantial or high transmission, respectively; they’re the places where you should be shielding your face indoors, regardless of how shot-fortified your immune system is. According to the agency, not everyone has to mask up again, so the map is, in theory, something inoculated Americans could check like a weather forecast to decide their face’s fate. Use the map, CDC Director Rochelle Walensky advised in a press briefing this week. It’s updated daily.

Today, the CDC is expected to publish data, leaked last night and reported by The Washington Post, hinting at the increased dangers of the Delta variant—a version of the coronavirus that can accumulate in high amounts in the airways of even fully vaccinated people, potentially poising them to spread it to others around them. And while Delta is still less likely to set up shop in someone who’s been immunized, it might be better equipped than other variants to cause severe symptoms when it does. Delta is clearly a far more formidable foe than its predecessors, which makes a map like this seem an even more necessary tool.

And that’s one way to think about the American pandemic now: If you’re immunized, just take a quick glance at the map before heading out the door, and decide whether to nab a mask from the mudroom, like an umbrella on a cloudy day. (Unvaccinated people should be covering up in public indoor spaces wherever they are; that recommendation hasn’t changed.)

But this check the weather forecast strategy belies the full national pandemic portrait: Nearly half of Americans are still unvaccinated, and the super-contagious Delta variant is flooding every corner of the country. The CDC’s internal document suggests that Delta could be as contagious as the chickenpox virus, a transmissibility trait that potentially outstrips that of other known human coronaviruses, including the original SARS virus, and flu viruses (though statements like this are very difficult to confirm without more data). Vaccinated people, in other words, pose more of a threat to those around them than the CDC had hoped in May, when it said they could shed their masks in most situations. That’s why that same document explicitly calls for universal masking to halt Delta’s rampage, The Washington Post reported. In public, however, the agency’s call for map-based masking sends a different message. During a time of public crisis, when so many are looking for guidance from a central authority, the CDC has punted decision making to local governments and individuals. “We’re clearly not thinking bigger picture,” Krutika Kuppalli, an infectious-disease physician at the Medical University of South Carolina, told me. (The CDC did not respond to repeated requests for comment.)

I spoke with several researchers who agree: Masking up again is warranted, and the CDC’s map is well intended, even useful for some purposes. But as a personal risk-assessment tool, it’s frustrating and confusing—and symbolizes how muddled the messaging on masking while vaccinated has become. Once again, people are being asked to take a “choose your own adventure” approach to public health. With Delta cases rising quickly, we might choose, without the best of intentions, to dig our collective COVID hole deeper.

The map itself, after weeks of pulsing in a nearly uniform shade of comforting blue, now highlights in fiery hues how dire the nationwide situation has become. Case rates will inevitably vary geographically; they’ve risen, quite reliably, in places where vaccination rates are low. “There is legitimately higher risk in some places than others,” Whitney Robinson, an epidemiologist at UNC’s Gillings School of Global Public Health, told me. The map does ask people to consider the circumstances around them, which is a step in the right direction. But that sentiment might not go far enough. Neither viruses nor humans are easy to pen in with county lines; risk won’t obey those borders either. People who work and live in different counties with discordant transmission profiles might struggle to adjust; those in low-risk islands, swathed by seas of orange and red, might mask more laxly than they should. “Too often we only focus on the county we live in,” Saskia Popescu, an epidemiologist and infection-prevention expert at George Mason University, told me. “Consider where you work, the general state, and region.”

The color-coding system, too, draws some false boundaries. To qualify for “substantial” transmission, a county must record 50 new coronavirus cases per 100,000 people within a seven-day period, or report that more than 8 percent of tests for the virus are positive in that same window. The “high” category kicks it up a notch: 100 new cases, or 10 percent test positivity. Those aren’t unreasonable cutoffs to set, experts told me, and cutoffs have to be set somewhere. But those thresholds still end up turning a spectrum into a binary—above 50 new cases is bad, below that is fine—and obscures when one county is on the verge of ascending to a higher-risk class. “What’s safe? What’s not? How you put a number on that is really hard,” Robinson said. Those numbers also change, frequently and without warning. They offer a glimpse into the past week, but don’t forecast the future, making them harder to parse than weather forecasts. (The way to get a yellow county to morph into an orange one is, of course, by allowing the virus to spread.)

“At this point, I’m telling folks in most of the country to mask up indoors,” Megan Ranney, an emergency-medicine physician at Brown, told me. “If you’re not in high or substantial transmission today, you probably will be tomorrow or the next day, given the rate of spread of this Delta variant.”

Several experts, including Kuppalli, think the CDC’s new masking guidance should have gone a step further, skipped the geographical contingencies, and asked all vaccinated people to resume covering up indoors—as the agency’s internal document called for. That would’ve generated some whiplash, too, Kuppalli told me, but it would have at least been more straightforward, and might have felt less wishy-washy; it might have signaled a more collective movement, toward a common goal. As it stands, the agency’s new guidance is murky and riddled with contingencies: Even vaccinated Americans in low- and moderate-transmission areas, it states, should consider masking up indoors if they or someone in their household is immunocompromised, at risk for severe disease, or unvaccinated. That last category includes all kids under 12—roughly 50 million Americans who haven’t yet been green-lit for their shots. The CDC’s Tuesday announcement also included a call for universal masking in schools nationwide.

“This continues to be exhausting,” Ariangela Kozik, a microbiologist at the University of Michigan, told me. Kozik’s 5-year-old remains unvaccinated, and she said she’s struggling to navigate a community where attitudes toward vaccination and masking are extremely split.

Communities are, after all, where many people will acquire their cues on risk, certainly more than from a color-coded map. People will look to their neighbors, their families, their friends, the strangers they see weaving in and out of grocery stores, Ranney said. Mask wearing will encourage more masking—and vice versa. The country’s approach to the pandemic has been, for the past year and a half, a patchwork of attitudes, and by now, it’s fairly easy to see the loophole this creates. Vaccines have been buffering communities against Delta; where immunization rates are high, transmission has been low. But the places where people have been reluctant to line up for their shots are also some of the spots where masks frequently get snubbed. Incentive can also bottom out when people feel like they’re missing out on perks others get to enjoy. If fully vaccinated people in other parts of the country can still eschew masks indoors, shouldn’t everyone who’s gotten their shots, and even some who haven’t, be exempt? At the other extreme, a misconstrued map might signal to vaccinated people in low-risk areas that they’re free to opt out of everyone else’s crisis. A virus travels best when people forget to be considerate of one another.

The general messaging on masks, Robinson and others pointed out, oversimplifies in other ways, too. Calls for more vaccination—still our best long-term solution to combat the coronavirus—have been drowned out by debates over personal freedom. Little attention is being paid to the quality of masks, and the high-filtration types that more effectively block inbound virus. Discussions about ventilation, testing access, contact tracing, and other preventive measures have similarly fallen to the wayside. Even people who are ready and willing to mask up again indoors are struggling to figure out what counts as “public” and what groups are “small.”

The map is a single tool and, to me, better suited to assessing the national than the hyperlocal. Most of New England, where I’m based, is still yellow. But those regions are in a dwindling minority. Some 70 percent of American counties are, according to the map, currently on fire; that percentage will probably tick up before it drops again. For now, I am tracking my pandemic circumstances. But my boundaries for my “community” are bigger than what the map says they are. They don’t stop at my county line, or my state line. They go as far as the virus treads—everywhere. Right now, I’m masking for as many people as I can.