Face masks and vaccines: 3 reasons why indoor public masking is still important

Spring is here, and with 1 in 3 adults in the US fully vaccinated against Covid-19, it feels like it might finally be time to start breathing easier. Maybe even without a mask on. Indeed, many are calling for outdoor masking mandates to be lifted in places where they still exist.

But it’s not time to drop our masks altogether. Maybe soon. But not yet.

“Especially in public spaces where you’re around a lot of people, it is going to be important that folks keep wearing masks, even if they are vaccinated,” says Brandon Guthrie, an epidemiologist at the University of Washington.

Really? Yes.

We know the vaccines authorized in the US are extremely effective and safe — but not perfect — at preventing Covid-19 illness. Newer data suggests they are also very good (though also not perfect) at keeping people from getting infected, thus likely drastically reducing the chances they could spread it to others.

Even with the small risks of these “breakthrough infections,” there are much more pressing reasons to keep masking in public — especially indoors in places like gyms, stores, and airports. And masking is still one of the least intrusive interventions we can take to keep putting the brakes on Covid-19 spread.

From variant wildcards to protecting unvaccinated kids, the reasons we should keep masking in crowded public spaces at least into the summer are strong. We talked to experts to better understand them and to get a glimpse of when we might finally be able to leave our masks at home.

Three reasons why public masking is still important — no matter your vaccination status

A handful of states have lifted their mask mandates — and plenty of them never introduced them in the first place. But that doesn’t mean people shouldn’t still wear masks in public, according to infectious disease experts. Especially now, when most people are still unvaccinated and some places are seeing surging case numbers.

1. Lots of people remain vulnerable to infection — including babies and kids — who can’t get a vaccine yet. Some of them also can’t wear their own masks.

The majority of people in the US are still susceptible to infection from Covid-19. “There are folks around us who will not or cannot get the vaccine, and we have to keep thinking, as a community, of ways to protect them, too,” says Kumi Smith, an epidemiologist and public health expert at the University of Minnesota.

Many of these folks might line up to get vaccinated soon, now that everyone 16 and older is eligible and supply is high. But polling data also suggests more than one-third might not, at least not immediately. And even millions who are eager to get vaccinated — and have been eligible to do so for some time — have still been unable to get a shot due to issues with access and equity.

There are also tens of millions of people in the country who simply aren’t allowed to get a vaccine: everyone younger than 16. As more kids go back to school and to other in-person activities, widespread public masking — in the community and in schools — will help keep virus numbers down and kids and teachers safer, Guthrie notes. From that standpoint, he says, masking is really “a public responsibility to make sure that those activities can keep going on.”

Additionally, a subset of people — roughly 3 percent in the US — have compromised immune systems that might do a poor job of mounting a robust response to the vaccine, leaving them vulnerable to infection even after getting shots.

There are also some people who aren’t able to wear masks to protect themselves in public. This includes some adults and children with disabilities or rare health conditions, as well as babies and toddlers, who also don’t yet have the benefit of vaccine coverage.

Masks, Guthrie notes, are one reliable and easy way of putting as much protection around these more vulnerable people as possible.

2. New variants could put us all at higher risk

Although the vaccines authorized for use in the US appear to be very effective against the variants that are circulating, it is possible future strains will be better at evading vaccine protection (as the B.1351 variant, first detected in South Africa, is against the AstraZeneca/Oxford vaccine). Vaccine companies are working to keep pace with variants, testing their vaccines against them and formulating potential boosters. But, says Guthrie, “it may be a bit of a game of whack-a-mole as new variants come up.”

We also have been somewhat slow at detecting new variants here in the US, since finding them requires a different and much more involved method of testing than a typical Covid-19 test. So although the Biden administration has promised to ramp up this sort of genomic screening, it is possible new, more dangerous variants could crop up and start infecting people before we know about them.

“These variants — especially ones that have mutations that make them more transmissible — can pop up and then spread quite quickly,” Guthrie says. “If you combine that with a variant that could evade the current vaccines, you’re not going to get a lot of advance warning.” Which means a widespread outbreak, including some people who had already gotten their shots, could get going before we were able to contain it.

Masking can not only prevent a new variant from spreading, but it could also help prevent new variants from emerging, as the more people the virus infects, the greater the opportunity it has to mutate.

3. When the majority still isn’t vaccinated, masks help others feel safer

As Monica Gandhi, an infectious disease doctor and researcher at the University of California San Francisco, points out, it’s not like the vaccines turn our foreheads a different color.

“There’s no way to go into a grocery store and make an announcement that: ‘I’m vaccinated, so I’m not going to wear a mask,’” she said. So for now, wearing a mask — even if you’re vaccinated — can help those around you who don’t know your status feel safer.

Wearing a mask in public is especially thoughtful to essential workers, such as grocery store clerks, restaurant servers, and others who have public-facing jobs, and have been facing — and continue to face — elevated Covid-19 exposure and risk day after day for more than a year. Many have been traumatized by the experience. Guthrie urges people to continue “thinking about the folks who don’t necessarily have the choice to be providing services, who have a higher level of exposure. … That, to me, is common courtesy,” he says.

If everyone, regardless of their vaccine status, can keep wearing masks in public spaces for now, things also stay a lot simpler. “The beauty of these generic mask mandates is there’s no ambiguity,” Smith says. “As things get more granular than that, people are just going to get more confused and frustrated.”

Where masks are extra important, and where we might be able to ease up

As people graduate to full vaccination status — two weeks after their final dose — they can finally restart many activities, such as close gatherings with small groups of vaccinated friends. But they also don’t yet have carte blanche to do everything mask-free. “Nobody loves wearing masks, but they give us that added level of protection and you can do activities that we all want to be doing,” Guthrie says.

The types of places where it’s highest-priority for everyone to continue masking include mass transit, airports, and other venues where people from different areas are mixing; locations with vulnerable individuals such as hospitals and long-term care facilities; gyms; and stores where distancing is difficult. In general, “indoor, crowded, unventilated spaces have always been the most unsafe,” Gandhi says — and are the most important venues to keep a mask on. “The longer people share the same air indoors, the more chance there is of spread,” Smith adds.

In areas where cases and hospitalizations are high, such as Michigan, Colorado, New Jersey, and Pennsylvania, masking indoors is especially crucial.

And of course, public places — especially indoors — where people will not always be wearing masks remain chancy, particularly for the unvaccinated. These include indoor restaurants and bars, which have long been known to be frequent loci of Covid-19 transmission.

That being said, if everyone in your group is vaccinated and no one lives in a household with someone who is unvaccinated and high-risk for severe Covid-19, these settings are likely pretty safe. Gandhi, who is vaccinated, reports that she took her fully vaccinated 87-year-old parents to eat at an indoor restaurant in San Francisco, where virus prevalence is also quite low. Even so, she recommends vaccinated people still mask inside when not eating. And, she says, “I would not go to indoor dining if I wasn’t vaccinated.”

Even if we can’t drop our masks indoors for a little while longer, outdoors is a different story. The rates of public outdoor transmission of Covid-19 are incredibly low, and most known cases of outdoor infection spread have occurred from long conversations, yelling, or exercising together.

Some areas are planning to lift outdoor mask mandates; a handful of Colorado counties already did so earlier this month, and Rhode Island announced it would next month. Some countries have been following this early easing step as well, including Israel, which lifted outdoor mask mandates on April 18. Although at certain outdoor events, with prolonged close contact among people from different households — especially if there is sustained talking, singing, or yelling — the risk of transmission could still linger if people are unmasked, particularly with more transmissible variants like B.1.1.7 circulating. Israel, for example, has fully vaccinated more than half its adult population and still recommends masks at large outdoor gatherings.

When might we be able to finally drop our masks?

The short answer is, of course, that we don’t know yet.

One potential endpoint is herd immunity. This is reached when so many people are immune to the virus that it simply hits too many roadblocks and stops spreading without us having to erect other barriers, like masking and distancing.

We just don’t know when we’ll hit that point because there are at least a few key pieces of information we’re missing:

  • How many people need to be immune to SARS-CoV-2 to reach herd immunity (it’s a different percentage of people for different viruses)
  • How long it will take to get that particular percentage of the population immune (due largely to unknown vaccination uptake)
  • How long we have before our vaccine-dosed immunity starts to wane
  • What the variant landscape will look like in months to come

Smith also cautions that herd immunity as we might be picturing it is not likely to arrive suddenly, to the entire country, after which point we’ll all be able to throw a ticker-tape parade, toss our masks into the air, and blissfully forget about all Covid-19 risk.

“It’s not like we reach some magical number and then we can magically throw the doors open,” Smith says. “We will have to keep monitoring the epidemic.” That means continuing to track the virus, especially in communities and areas with lower vaccination rates.

Ideally, she says, we would get to the point where outbreaks would be rare and when they happened, they could be rapidly spotted and contained, as they are in Australia and Vietnam. “That’s where we want to get, and that’s the point where we could stop wearing masks all the time,” Smith says.

She doesn’t see that point coming in the US any time soon, especially as we are already seeing a drop in daily vaccination rates.

The other issue in predicting the end of masking is the variant wildcard. The modeling for Covid-19 transmission rates and projections for herd immunity have been based on standard strains. So the rise of new variants, with different dynamics (such as being more transmissible, more deadly, and/or better able to evade distributed vaccines) mean that all those projections would change.

Guthrie says that for him to feel comfortable dropping indoor public masking, not only would he want to see very widespread vaccination and very low case numbers, but also to not see new variants emerge — or to have a very strong track record of our vaccines being effective against all new variants.

Gandhi says we should stop stressing about projections over herd immunity, and adopt a more radical plan: Lift all mask mandates as soon as everyone 16 and older has had a chance to get fully vaccinated if they want to.

By this simple heuristic, and if vaccine rollout continues on the federal government’s proposed timeline, it would be possible that “by July you can throw away your mask if you like,” Gandhi says. People could keep masking if they wanted, and there could even be mask recommendations for certain instances, but the broad mandates would be gone.

Having such a clear endpoint, she suggests, could also help people better adhere to responsible masking for the next crucial few months. “Everything is doable when it’s temporary,” Gandhi says.

But what about kids? Or the presumably tens of millions of people who will have chosen to not get vaccinated? And how about those variants? Gandhi offers some answers.

For those who will remain unvaccinated, she has been heartened by recent data from Israel. A March preprint paper that has not yet been peer-reviewed found that with each 20 percent of the population 16 and older that was vaccinated, the rate of infections in people younger than 16 (who cannot yet get the shot) dropped by half. “As cases go down in a population, children are simply not exposed to it,” Gandhi says. Others in the population who have not gotten vaccinated yet would be similarly protected, she notes.

As for variants, she points to the authorized vaccines being effective against any of the major variants we have seen in the US so far. So if we can get vaccines to everyone in the US who can and will take them by this summer, Gandhi is not terribly concerned about the current variants posing a significant risk, even if many people choose to forgo masks at that point.

Of course, whenever masking mandates are dropped, people can still wear one (perhaps to protect against other viruses, too). And many people should, including those who have been unable or unwilling to get vaccinated and those with compromised immune systems.

In the meantime, as the pandemic drags on, so too does the burden of having to constantly make our own calculations of risk. And that doesn’t stop with half of the population getting their first vaccine dose, or even their second one.

All of the studies, trials, and public health recommendations focus, by necessity, on the broader population level. “But when it comes to an individual making their own decision, there’s still a huge amount of circumstance and chance at play,” Smith says. For now, “masks are just so cheap and safe and effective, I feel like it’s a reasonable thing to ask us to bear with a little while longer,” says Smith.

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