Perspective: Relaxing Mask Guidance Must Be Done 'Carefully'

The Centers for Disease Control and Prevention (CDC) relaxed mask guidelines on indoor mask requirements Friday. Reports indicate the new guidelines are now based, at least in part, on hospitalizations and hospital capacity. There is no doubt that cases are plummeting in the United States and projections look excellent. However, there is still reason for concern. 

Kevin Kavanagh, MD

(Credit: Worldometer)

First, the metric for hospitalizations is a lagging indicator, and basing action on increasing hospitalizations will make our actions reactive and not proactive. Second, there are data that indicate we may not yet be in an endemic phase of the pandemic. Some epidemiologists are predicting another Omicron wave. For example, the BA.2, or "stealth Omicron," variant has been all but discounted as not having a significant impact on the course of disease in the United States. One recently posted research preprint (not yet peer-reviewed) from South Africa concluded that BA.2 has a similar clinical profile as BA.1. Thus, deaths and hospitalizations were not increased. However, the data acquisition for the study stopped at January 20, 2022. During the month of February, deaths spiked in South Africa (see figure).

(Credit: Worldometer)

Viral levels are certainly too high for the nearly 1 in 30 Americans who have an immunodeficiency. For them, community levels are far too high. It must be remembered that the wearing of masks not only adds a layer of protection for the wearer, but masks also protect others and decrease community spread. 

Similar data was also seen in Denmark, a country whose cases are almost totally comprised of the BA.2 variant. Deaths are at an all-time high.

Both native and vaccine immunity in the United States is waning. A recent report published in the CDC’s Morbidity and Mortality Weekly Report observed that immunity produced by boosters to Omicron is waning for emergency room and urgent treatment visits after 4 months. Another study found that natural immunity’s ability to prevent infections from the Delta variant wanes after 1 year, with only a 69% protection against reinfection. We are now more than 2 years into the pandemic. 
 
Thus, relaxing public health guidance at this point needs to be done carefully. We are not talking about having an invasive procedure. For many, helping to protect oneself and others means just wearing an N95 mask for a short time while you visit a store. For me, this is reason enough to continue masking.