After Vaccination, Should We Take Off Our Masks?

Virtually everyone was vaccinated at the joint session of Congress this week. Yet it still looked like a pandemic scene as President Biden addressed masked and distanced lawmakers in the House chamber.

The approach frustrated a number of public health experts, who are starting to question the Biden administration’s conservative approach to public health guidance despite highly effective — and now widely distributed — coronavirus vaccines. “Everyone could have been in that room,” said Monica Gandhi, professor of medicine at the University of California at San Francisco. “If we’re all fully vaccinated, we could all be unmasked and distanced in that room.”

For the vaccinated, the risk of serious illness from the coronavirus — and spreading the virus to others — is vanishingly low.

There have been some cases of breakthrough infections even among those who have received the shot. But based on data posted on the Centers for Disease Control and Prevention website, the risk is tiny — well below 1 percent. Consider the numbers:

• Out of 87 million people vaccinated, 7,157 experienced breakthrough infections.
• Of those, 498 were hospitalized and 88 died.
• So, vaccinated people have a 0.0005 percent chance of hospitalization and a 0.0001 percent chance of dying from the coronavirus.

Those percentages are far lower than the risk of being hospitalized with or dying of the seasonal flu, some experts note. They also represent much less risk than people are willing to take on every day when they drive in their car or engage in a sport.

“There is nothing that’s 100 percent safe,” said Leana Wen, a professor of health policy at George Washington University. “I think we need to be living with the concept of living with risk and reducing risk.”

Earlier this week, the CDC rolled out revised masking guidance. The agency did relax rules around outdoor activities — although some felt the guidance was late, given evidence that the virus doesn’t easily transmit outside has been around for nearly a year. Yet the agency is still recommending some strict distancing and masking measures for the fully vaccinated. This population should continue wearing masks at indoor public places and should still avoid crowded, indoor venues, officials say.

“Is the CDC guidance a little too conservative? I think so,” said Carlos del Rio, a professor of medicine at Emory University.

In explaining its guidance, federal officials have noted the potential for breakthrough infections, without clearly explaining just how rare this is. They’ve also pointed to the possibility that fully vaccinated people could still spread the virus to others, even though there’s mounting evidence to the contrary, both from the coronavirus vaccine trials and how other vaccines typically work. “We do believe that vaccinated people are much safer when they’re wearing those masks indoors,” CDC Director Rochelle Walensky said. “It’s not just to protect themselves, but largely to protect others, and really to protect the unvaccinated.”

Not only do multiple studies point to negligible risk that the vaccinated might spread the disease, but the spread of the coronavirus in the United States also has fallen dramatically. The number of new cases being detected per day — about 52,000 — is below that of a mild flu season, said Marty Makary, a surgeon and professor at the Johns Hopkins School of Public Health.

Add it together, and the risk of getting or transmitting the coronavirus is tiny for the fully vaccinated.

Makary echoed a concern expressed by Wen and Gandhi: that by insisting that vaccinated Americans continue to distance, the agency is feeding into a distorted perception of risk among the public and causing some people to question why they should get the shots at all. “We’ve got the CDC moving toward a culture of absolute risk intolerance,” Makary said. “As a physician, I can tell you, if you’re out of step with where people are and don’t have good answers to their very logical questions — such as don’t these restrictions contradict the messaging on vaccine safety — you lose credibility,” he said.

The president wore his mask to the podium, only taking it off to speak. Behind him sat Vice President Harris and House Speaker Nancy Pelosi (D-Calif.), also wearing masks. All three have been fully vaccinated for months. Del Rio envisioned an alternate scenario, in which Biden might have turned around and told Harris and Pelosi they should take off their masks because of being vaccinated. “He could have done a theatrical point that would have been effective,” del Rio said. Wen said the approach could have been to require all attendees to show proof of vaccination — and then allow people to enter the House chamber without masks and without restrictions on where they could sit.

She’s been hammering this point for weeks — that people need a clear answer on when life can go back to normal.

“We should tell people the end of the tunnel is when you are fully vaccinated,” Wen said. “Not some mythical number we can never actually get to.”