Friday's change in masking guidance from the Centers for Disease Control and Prevention comes as several states and cities across the US are starting - or already - relaxing on mask mandates.
According to new CDC metrics, nearly 70% of the US population lives in a place where they no longer need to wear a mask to protect themselves and others. Their calculations are based on three variables: the rate of new cases, new hospital admissions, and hospital capacity.
But infectious disease experts surveyed by NPR say they are not taking off their masks just yet. Many people still plan to wear them because they live in a part of the country where the coronavirus is still spreading widely - at least for the time being.
When will they feel comfortable eating, teaching and grocery shopping without masks? He shared his personal risk calculation with NPR.
Seek Less Community Transmission – But How Low?
The CDC's new emphasis on hospitalization rates is warranted, but this metric is not necessarily the best guide when considering your individual risk, says Dr. David Downey, an epidemiologist at Johns Hopkins University. He and other experts still look at local infection rates when they weigh their individual precautions.
Dowdy says he has been vaccinated and extended and feels well protected from being hospitalized, but he is still trying to avoid catching COVID.
"I just don't want to be out of work. I don't want to spread it to my family and they have to miss work and school," he says. "And so from that point of view, cases really matter more than hospitalizations"
Dr. Robert Wachter says he is waiting for the daily case rate in his community to drop to 10 cases per 100,000 people per day.
"There's nothing magic about Number 10," says Wachter, MD, chair of the department of medicine at the University of California, San Francisco. "If someone else likes 15 or 20, that's fine." He is looking for a number that "reflects the low amount of virus in the community."
In California, where Wachter lives, rates are currently about 24 per 100,000 people per day and are falling. And when there's a big enough profit, he starts making exceptions for masking that involves eating at a restaurant indoors for him.
The number of new cases per capita is also guiding Dr. Ali Khan, dean of the School of Public Health at the University of Nebraska, in deciding whether or not to wear a mask.
Khan would like to see about 5 to 10 cases per 100,000 people per day before going mask-free. “My wish was never to have individuals wear masks forever – it was really to reduce the level of transmission in the community enough so that we could be safe,” he says. "I don't have a high-risk condition, so I'll take my mask off in about two to three weeks when cases are low in my community."
Dr. Lisa Margakis, senior director of infection prevention at the Johns Hopkins Health System, agrees that she would like to see the case rate "in the single digits" before getting comfortable without a mask. She is seeing a daily case rate of 1 to 5 per 100,000 in a rolling 7- to 14-day average.
The daily COVID case rate is not an ideal guideline for taking precautions (or skipping), Wachter acknowledged, especially as more people use home tests that do not report in national numbers. Still, he says, decreased levels of community transmission are a good sign that "the system isn't getting super-stressed; that hospitals aren't overwhelmed; that I'll have access to a test and that I can have access to treatments." [if need be]."
Remained a trend over time
It's not just how many cases are being reported.
Dr. Abrar Karan, an infectious disease physician at Stanford University, looks at how many tests are coming back positive, which is known as the test positivity rate.
If a sustained test positivity rate is less than 1% — without any increase — the chances of a revival or community outbreak are very slim, says Karan. Test positivity for several counties can be found in the government's community profile dataset or on the state health department's COVID-19 dashboard.
Karan from his community says, "With so many community events happening at this point of time, I would not have been going inside the house and removing my mask."
Cases are falling where Karan lives in California, as they are in much of the US. If people start taking off their masks in response and the number of cases remains low, he says it is an encouraging sign: " We could very well buy ourselves a nice spring."
Other health mavens don't have strict numbers in mind. "There will come a time when the transmission rate [reaches the plateau] and it doesn't budge. At that point, I'll just make a decision," says Arkansas State Health Secretary Dr. Jose Romero. Factors he will consider at that point include how well the vaccines work and whether COVID treatments are widely available.
A permanent adjunct – as part of a layered risk strategy
There should be either an all or nothing option for masking.
Even when Romero from Arkansas feels comfortable grocery shopping without a mask, "I'm not sure I'm going to give it up completely," he says. Like a bottle of hand sanitizer in his backpack, he sees a mask as just another way to protect himself, especially at a time when the risks are high.
The mask has become a permanent assistant for Seema Lakdawala, a virologist at the University of Pittsburgh. "It's a really good complement to vaccines," he reasoned: "If I'm wearing a mask and someone else in my environment is infected, I'm going to be breathing in less virus. Even more so." that if I do become infected, the infectious dose will probably be low enough that my immunity from vaccination can provide a strong enough barrier and help me recover."
Practically speaking, "if the cases are few, I'll probably go to the store without a mask," she says, "but I'll keep a mask in my car or in my jacket pocket. And if I want to, I I'll just take it out and keep it."
Considerations for people at high risk and their families
Of course, decisions about masking are personal. They will be different for certain groups, including those at high risk of severe COVID, unable to be vaccinated, or living with someone who falls into either of those two previous categories.
Although her youngest child is now six years old and has been vaccinated, Lakdawala says it makes sense for families with young children to remain more conservative about COVID risks. “I think even if I had kids under the age of 5, I would have worried about some of the environments we would visit,” says Lakdawala.
For those who are equally vigilant during this transitional period, a high quality, properly fitted N95 or KN95 mask can provide a substantial amount of protection to the wearer, even if other people in public settings wear the mask. Have not worn Still, there are places where Margakis thinks the mask requirements for everyone should remain in place.
"We need to understand and care for those who are most vulnerable among us, not forcing everyone into situations where they should be in close contact with masked people,"
Maragakis says that for the time being the need for masks will make sense in some settings, including on public transport.
from my perspective, face mask is still necessary to protect ourselves from covid-19. Although now the vaccine injections have been in high rate, the covid 19 still affects those who had injected enough doses and even bonus one.
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