Dr. Leana Wen
Title: Emergency physician and public health professor at George Washington University; former Baltimore City Health Commissioner
On Thursday, May 13, the Centers for Disease Control and Prevention announced that people who are fully vaccinated against the novel coronavirus can stop wearing masks and social distancing — whether outdoors or indoors — except in some cases. The guidance has been met with optimism, confusion and controversy. Here, Dr. Leana Wen, a prominent public health expert whom U.S. News profiled last year, digests the news.
As told to Lindsay Lyon as part of U.S. News & World Report’s “One Pandemic Question” series. Responses have been edited for length and clarity.
Q: What ran through your mind when the Centers for Disease Control and Prevention issued its new mask guidance last week?
I can’t tell you how shocked I was by their announcement because the CDC went from 0 to 100.
They went from this overly cautious, nonsensical approach to another nonsensical approach — but one that is dangerous, one that throws caution out the window.
Ironically, I was on CNN just before the announcement and was asked to speculate on what I wished the CDC would do. Previously, I had been very critical of the CDC and their overly cautious approach. Before last week, the agency was saying the vaccines are very effective, but you can’t change your behaviors very much after getting vaccinated. It didn’t make sense and was actually serving as a disincentive to people getting vaccinated.
I explained that I thought it was too soon to be lifting indoor mask mandates overall, but that the CDC could say that fully vaccinated people could be around one another without restriction, including in workplaces and large, public venues like theaters. Also, the CDC could have defined metrics for vaccination that are then tied to lifting remaining mandates. So if a particular region had 70% of its population fully vaccinated — whatever the range is, defined on a region-by-region, community-by-community basis — it could determine when remaining restrictions would be removed.
But now, there’s a substantial portion of the country that heard the CDC announcement and understood it to mean the pandemic is over. They can take their masks off — and nobody will be checking for proof of vaccination. Yet still, only 37% of the country is fully vaccinated. That’s not nearly high enough. There are also regions of the country where that rate is far lower — and it’s just not appropriate with that level of vaccination to say, ‘If you’re unvaccinated, that’s on you.’
First, there are a number of people who can’t be vaccinated. Children under age 12 — like my own young kids — are not yet able to be vaccinated.
Second, there are also people who are vaccinated but are immunosuppressed and therefore can’t mount a high enough immune response to be fully protected: for example, cancer patients on chemotherapy or transplant patients on immunosuppressants. Even patients on dialysis. We have just made life much riskier for them.
What’s more, there are a lot of people who have not yet been vaccinated — not because they’re anti-vaxxers, but in large part because they haven’t had time to get the vaccine. These individuals worry about taking time off work. There are also structural barriers tied to rampant disparities that have gotten in the way of people getting vaccinated — people unable to get time off from work, or lacking transportation. It’s premature to be lifting these restrictions, and it could worsen inequities
I think what I am extremely frustrated by is: Why the abrupt change overnight? What was the impetus? Why couldn’t the CDC have engaged in a thoughtful, weeklong process where they telegraphed their intentions and then had various stakeholders come and inform them about any unintended consequences they might not have thought about?
For example, any local and state health official, as I was in Baltimore, would have told them about how difficult things will be going forward without the cover of the CDC to enforce mask mandates, which were quite unpopular in many parts of the country. Such officials might have articulated how the burden of responsibility will now be on local businesses and local health departments. If the CDC had consulted unions, I think unions representing retail and food workers would have told them about the difficulty of verifying vaccine status and that a blanket masking policy might still be necessary to safeguard the most vulnerable. The lack of coordination is astounding.
The CDC has tried to walk back its new guidance in interviews by saying things like, ‘We at the CDC are not making this policy decision; that decision is made by state and local governments and businesses.’ Essentially, the CDC is trying to wash their hands of their responsibility and culpability here. They can’t do that. You can’t be expecting businesses and local and state health departments to go against what it sounded like the CDC was saying.
Let’s look at what happened in Maryland, where I live. Previously, our governor had announced that he would be lifting indoor mask mandates when 70% of adults had received their first dose of the vaccine. Well, the day after the CDC announcement, the governor announced that effective the next day, mask mandates would be ending. That occurred directly because of the CDC’s guidance.
Multiple states have followed suit, as have many big stores like Walmart and Costco.
As a result, there will almost certainly be people getting infected who would otherwise not have been infected. We are likely to see, in many communities that have not even come close to anything resembling herd immunity, a rise in infections once again. We know that new variants occur when the virus is allowed to spread, so I am very concerned about that potential.
If the CDC had said , ‘Here’s what the science shows: Vaccinated people are so well-protected that they can take off their masks in public indoor settings — but this has to be tied to proof of vaccination in some way, because it’s difficult for businesses to enforce the honor code, and therefore mask mandates must be in place until a certain level of vaccination occurs,’ that would have been great. But they did not add that caveat. We just removed the strongest incentive that we have: that vaccination will allow you to go back to your pre-pandemic normal activities. Now, if you can do that anyway, I worry we’ll actually see a fall-off of vaccination rates.
Yes, we all want masks to go, but I think we can do this in a way that’s graduated. What the CDC should have done is to offer a road map for going forward, rather than this abrupt change that could really have lasting consequences on people’s health. It will potentially endanger those who are the most vulnerable and it could set back progress on the pandemic — which is a real shame given how much great work the Biden team has done. Long term, I think it damages the credibility of both the CDC and of public health on the whole.
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