Masks Are Back, Maybe for the Long Term
Some people can’t help but feel that masking while vaccinated is a regression—especially because this time, there’s no obvious off-ramp.
It certainly feels like we’ve been here before. Nationally, coronavirus case numbers are the highest they’ve been since the start of 2021. Hospitalization rates are on a roaring upswing in nearly every state. Young kids—many of them still ineligible for immunization—are gearing up for another pandemic school year. And even while SARS-CoV-2 continues to shape-shift, we’re struggling to get more shots into arms. The summer is starting to feel a lot like the long, hard winter many people were sure they’d left behind.
Last week, the CDC played what probably seemed like one of the most obvious cards left in its hand: asking fully vaccinated people to once again mask in public indoor spaces, in places where the virus is surging. This recommendation echoed one the agency had controversially dispensed with in May—and has clearly saddled immunized Americans with a serious case of masking déjà vu. “It’s been an abrupt 180,” Helen Chu, an infectious-disease physician and epidemiologist at the University of Washington, told me, and for many people, “that’s made it difficult.”
In the past week and a half, I’ve spoken with, texted, emailed, messaged, and tweeted dozens of sources, readers, friends, family members, and total strangers about the CDC’s announcement. My correspondences have been a mix of emotions. Some are relieved that the CDC has officially reunited vaccines and masks, a scientifically powerful pairing that many experts think never should have been broken up. But I also heard frustration, confusion, even betrayal. There was a sense that we’re in a morose backslide, a worry we’ll never be rid of pandemic behaviors initially pitched to us as “temporary.” In America’s version of the pandemic, flimsy masks have already been forced to carry so much symbolic heft. Now they’ve taken on yet another weight: the sense that the precautionary limits we’ve put on our lives might never, ever end.
“So much of the previous messaging was ‘Wear a mask until we have a vaccine developed’ or ‘until we have people vaccinated,’” says Gretchen Chapman, a psychologist who studies decision-making behavior around vaccines at Carnegie Mellon University. Masks were a stopgap, and shedding them was a reward for rolling up our sleeves. “Now,” Chapman told me, “it seems to some people like that reward is getting taken back.”
To be clear, we aren’t exactly where we were during previous surges. Nearly 60 percent of the country is at least partially immunized, and the shots are still holding their own against all known forms of SARS-CoV-2. Vaccinated people are still less likely than the uninoculated to contract the pathogen, pass it on, or, especially, come down with disease.
A variant like Delta does somewhat muddy the odds—it is perhaps the wiliest version of the virus to date, and can dodge certain immune defenses. It accumulates stubbornly in an infected person’s airway, poising itself to spread more efficiently, and growing evidence suggests that it might also be likelier to land people in the hospital. And a truly staggering amount of this variant is flitting around. Even excellent defenses can take a beating when they’re repeatedly called to the fore.
By limiting the virus’s access to human airways, masks can set vaccinated immune systems up for success. And they help protect vulnerable people in the vicinity, by corralling the problem and curbing its spread. “I’ve always thought the real strength of vaccines is keeping you from getting severely ill,” Chu told me. “Masks work on the other end of the spectrum.” Their return to the pandemic front lines makes logical sense.
Still, some vaccinated people can’t help but feel a bit like “suckers,” Chapman said. Many people covered up dutifully while awaiting their shots, then tossed their masks aside because the government said they could—only to reel from the whiplash of last week’s switcheroo. The guidelines for the unvaccinated (that is, keep masking) haven’t changed, while the immunized are once again being called upon to act. “Asking people to mask up again is triggering a lot of emotional stuff,” Lindsey Leininger, a public-health-policy expert at Dartmouth, told me. “You can’t tell people that those feelings are invalid.”
Masking, at least at pandemic levels, also doesn’t feel sustainable in the long term. Although vaccines confer protection against disease that’s expected to last for many months, if not years, with one or two brief jabs, masks require constant reinvestment and vigilance. They falter when we wear them incorrectly; they vary immensely in quality; they can tear or fall apart or fall off; they can be forgotten at home. “It’s on you to do it right every time,” Chapman told me. “People love the set-it-and-forget-it approach, where you only have to intervene once. Enduring behavior change is often a very thorny problem.”
“Keep on masking” also feels like a pretty sharp departure from the initial selling points for face coverings. These accessories were meant to be deployed until something better came along, and the most unpalatable aspect of the CDC’s new mask ask might be the uncertainty it comes with. This time, there’s no well-signed off-ramp. The vaccines are already here; they’ve already been made available to most Americans. We hit the milestones we laid out and still feel stuck.
I asked nearly a dozen infectious-disease experts this week if they had set a new benchmark—the next bellwether to signal to the vaccinated that they can divorce themselves from pandemic-level masking. Everyone agreed on only one thing: There isn’t a clear-cut answer, not yet.
At this stage of the pandemic, the goal isn’t to stop all infections but to prevent as many cases as possible from turning into life-threatening or chronic illnesses. “The outcome here is to prevent people from dying in large numbers, and figure out who those [highest-risk] people are, and to keep our health-care systems ready,” Yvonne Maldonado, a pediatric-infectious-disease physician and vaccine expert at Stanford, told me. Meeting that goal might mean reaching a “low” transmission rate, such as 10 new coronavirus cases for every 100,000 people over a seven-day period, as the CDC stipulates. Or it could mean sky-high vaccine uptake—a percentage well into the 80s or even 90s, to account for Delta’s eagerness to spread. (That last option is contingent on expanding immunization eligibility to the 50 million Americans younger than age 12.)
But too much remains in flux to pin down those statistics. Immunity is neither uniform across people nor static in individuals. Even though vaccine efficacy seems to have taken a bit of a hit since Delta’s rise, experts still don’t know how often immunized people are catching the virus and passing it on. It’s also unclear when, or how quickly, our immune cells’ memory of the virus will start to fade. If people are slipping back toward vulnerability, the threshold for “high enough” vaccination will be hard to define. The virus, too, will keep changing, and could one day bamboozle even bodies whose immune safeguards remain intact. As bad as Delta is, “it’s not the scariest thing you could imagine,” John Moore, a virologist at Cornell, told me.
Humans could sharpen their weapons too. Some experts, including Kanta Subbarao, a virologist and infectious-disease expert at the Doherty Institute in Melbourne, are hopeful for a next-generation vaccine that could be delivered not as a shot to the arm but as, say, a nasal spray. That could better marshal local, airway-specific immune defenses to head the virus off at its point of entry, potentially making infection and transmission even less likely.
But we don’t need a perfect vaccine to bring the pandemic to a close. We already have all the supplementary tools we need: masks, ventilation, tests, and more—strategies whose effects are additive when used together. Recent modeling work backs this logic up. To quash outbreaks, we’ll need not only vaccines but measures to stave off the exposures that strain our bodies to begin with.
Some of these tactics—masks included—have proved themselves so effective that many people might never drop them. The off-ramp that many people imagined may simply not exist. Although pandemic-caliber masking won’t be universally embraced long-term, Maldonado, the Stanford vaccine expert, thinks we’re headed toward a “soft stop” on masking and a societal rethink on face coverings. “I think people are going to be feeling uncomfortable without masks for some time,” she told me. Masks might slip on socially or seasonally, as people move in and out of public spaces, or when the temperature drops in winter. Public-health officials could also recommend face coverings intermittently in lockstep with outbreaks, or as a method to tide people over between boosters. “If people are smart, they will continue to mask if they’re in high-risk situations,” at least for a while, Maldonado told me, and perhaps not just for SARS-CoV-2 but for other airway viruses as well. Those practices have long been commonplace elsewhere, and if the United States and many other Western countries haven’t hopped on board before, maybe they will now. Australians have “really come full circle on masks,” Subbarao, the Melbourne vaccine expert, told me. “I don’t see a lot of pushback on it.”
Instead of thinking of masks as a pandemic Band-Aid, maybe we can consider them an obvious fixture of our future, even beyond SARS-CoV-2’s global reign. The end of this crisis, after all, isn’t really about an end to prevention behaviors such as masking or distancing, but an end to the worst phases of our relationship with this virus. Adopting new strategies isn’t admitting defeat, nor is dusting old ones off. We can, and should, expect masking to wax and wane as risk waxes and wanes. “We have to learn as we go and adapt our strategies as needed,” Subbarao told me. “This is just one more example of that.”