But we have to sort through that confusion: Masks continue to be a useful tool, especially because coronavirus infection rates in much of the country are still elevated. But as more people get vaccinated and infection rates fall even further, we are going to have to start thinking about when we can loosen indoor mask restrictions, too.
Another issue is that most settings don’t require proof of vaccination. So, until systems are in place to identify those with natural or vaccine-acquired immunity, or enough of the country has been vaccinated, the CDC is likely to continue to recommend masking in indoor situations.
The vaccine piece of the puzzle
But evidence is beginning to trickle in showing that these vaccines, especially Pfizer/BioNTech and Moderna, are very effective at not only reducing asymptomatic infection but also reducing viral load if a vaccinated person does get infected. For example, recently published real-world studies on the Pfizer/BioNTech vaccine suggests it reduced asymptomatic infection by as much as 92%.
Here is the critical point: The possibility of being a vaccinated silent carrier is becoming lower and lower. It’s not zero, but it’s pretty low. So how much should we continue to worry? And what will the threshold be when we can finally, collectively, breathe an unmasked sigh of relief?
Unmasking indoors vs. outdoors
While it is not easy, there are objective ways to figure this out. To start, you can ask yourself, what is the likelihood that I’m going to breathe in someone else’s air and that air will have enough of the virus in it for me to get infected?
One of the biggest factors is the environment. Where are you? If outdoors, the likelihood of you breathing in someone else’s air with enough virus to give you an infection is very small.
What about indoors?
The CDC has said it will continue to update the guidelines as the situation in the country evolves, although an agency official told CNN in an email Tuesday they were unaware of any current plans to update it.
In my background conversations with senior officials at the CDC, I often ask not just about the recommendations, but also how they work and think through these recommendations. What’s become increasingly clear to me is that the recommendations of indoor mask-wearing will probably be among the last public health measures the agency will loosen.
Let me explain. Remember that public health recommendations fundamentally balance risk and reward. In this case, how much of a sacrifice is the individual being asked, balanced against the potential benefit?
With indoor mask wearing, CDC officials have told me they believe it’s easy to wear one (not a big sacrifice) and the public health rewards are still quite high, given the amount of persistent viral spread.
That is not the way all organizations appear to view the risk-reward proposition. Starting Monday, the New York Stock Exchange will allow fully vaccinated people on the trading floor to go unmasked when socially distanced, according to an internal memo obtained by CNN.
It will be a provocative way to do things, and many in the public health community will find it irresponsible. How will they ensure people do in fact have immunity? Will there be adequate ventilation? And isn’t a trading floor a very crowded environment in which to try to maintain physical distance?
Linsey Marr, a professor and an expert on the airborne transmission of viruses at Virginia Tech, told CNN in an email she isn’t especially troubled by the NYSE’s actions.
“If everyone in the room is vaccinated, then I do not think any precautions are needed. If unvaccinated people are present, then it comes down to the vaccinated person’s own risk tolerance. We know the vaccines are very good, that they protect against severe illness and death, but breakthrough infections do occur,” Marr said, noting that from the photos she’s seen, the high ceilings help dilute exhaled breath and reduce the risk of transmission.
She added that good ventilation and filtration, avoiding crowded parts of the floor and avoiding people who are yelling and shouting will reduce risk further, if that’s even possible on the trading room floor.
“The risk to yourself and others is low,” he wrote.
“Social science tells us something different. In this interim phase, as vaccinations go up and cases come down, the right thing to do is wear masks indoors in public spaces until every adult has had a fair and equitable chance to be vaccinated — likely around June 1. It takes about 30 days for people to be fully vaccinated and for full protection to kick in. That means it’s reasonable to expect that we will be able to ditch indoor mask mandates by July 4. Independence Day. Seems fitting.”
Our brains have been trained
Maybe, their tolerance for risk is lower. But neuroscience would probably add in another reason. After a year of wearing masks, our brains have simply been trained to do it. It’s become a habit.
Each time we engage in regular new behaviors, like mask-wearing, our brains actually change — they slightly rewire to accommodate that new experience. Specifically, that experience causes the formation of new dendrites — which are segments of brain cells that receive electrical impulses. With repeated behavior and learning, existing dendrites strengthen, they make more connections which then become the normal pattern of transmission in our brains. It’s called neuroplasticity.
And much of that is good: Increased public health behavior will probably better protect us against other pathogens, like flu. That rewiring, though, may also make it more challenging to shift our habits again as Covid-19 restrictions are eased.
Science tells us we may go maskless more frequently and see each other’s faces again for the first time in over a year. For some of us, however, it may take our brains a little longer to catch up — which is also OK, because in truth, there is no mandate, no CDC guidance, telling us not to mask.
CNN Health’s Andrea Kane contributed to this report.