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In what felt like a fever dream at the beginning of 2020, confusion over face masks began before any mandates were in place. In March 2020, while the coronavirus was just gaining footing in the US, guidance from the Centers for Disease Control and Prevention, as well as the World Health Organization, was that healthy people shouldn’t wear masks — they should be saved for sick patients and caregivers in a strained health care system short on personal protective equipment.
On April 3, 2020, the CDC flipped the script and issued the nationwide recommendation that all Americans should wear cloth masks (emphasis on the “cloth,” as there was still a shortage of PPE). In the weeks and months that followed, states, cities, counties and local businesses adopted the science-backed reasoning that facial coverings will slow the spread of COVID-19 by containing respiratory droplets. As mask-wearing became the norm and surgical masks became widely available, the CDC took it a step further and recommended “double masking.”
We’ve come a long way since March 2020, thanks, mostly, to three highly effective COVID vaccines. On May 13, the CDC announced that vaccinated people are safe to go without masks in most cases. Since then, there’s been debate about proof of vaccination, whether or not the CDC’s guidance on masks is valid and confusion about local mandates. Here’s where we are now.
Vaccination status and masks
According to the CDC guidance, fully vaccinated people can safely be indoors or outdoors in any type of group setting without a mask, because they are protected against severe disease caused by COVID-19, and much less likely to transmit disease to anyone else. Being fully vaccinated in the US means two weeks have passed since you received the second dose of a Pfizer or Moderna vaccine, or two weeks have passed since your one-dose Johnson & Johnson shot. (An important note to add is that immunocompromised people are not nearly as protected from COVID-19 after vaccination, and you should consider your personal risk and the risk of your household. The CDC recently updated its guidance to reflect this.)
This guidance means that people who have not been fully vaccinated are not safe to go without a mask, and are still at risk for COVID-19. In fact, over 97% of all hospitalizations caused by COVID-19 are in unvaccinated people, and over 99% of COVID-19 deaths are now in unvaccinated people, according to CDC director Dr. Rochelle Walensky and US Surgeon General Dr. Vivek Murthy, respectively. In a White House press briefing Friday, Walensky said the coronavirus pandemic was becoming a “pandemic of the unvaccinated.”
Face masks, and social distancing, were our main arsenal against COVID before the vaccines. Now, it’s hard to sort through conflicting advice on who should wear one and when.
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I’m vaccinated. Why am I still being asked to wear one some places?
All people, regardless of whether they’ve been vaccinated, need to wear a face mask on public transportation, on airplanes, in health care settings and in any local or private business that requires one.
The CDC’s guidance also does not trump state, city or county mask mandates, and some areas are reinstating mask rules because of a rise in COVID-19 cases. Los Angeles County, for example, started requiring masks indoors again for both vaccinated and unvaccinated folks after a rise in COVID cases. Seven counties in the San Francisco Bay Area stopped short of a mandate, but issued recommendations that everyone wear a mask indoors, following an uptick in COVID cases caused by the highly transmissible delta variant.
Are face masks effective against the delta variant?
Delta is more transmissible, and potentially leads to more severe disease, which means that masks play an even more important role in slowing the spread of coronavirus.
“Quality of mask is going to make a difference with a variant that spreads more aggressively like delta does, where people are more contagious and exude more virus,” Scott Gottlieb, former head of the Food and Drug Administration told CBS.
“Trying to get N95 masks into the hands of vulnerable individuals in places where this is really epidemic I think is going to be important, even in cases where they’re vaccinated, if they want to add another layer of protection,” Gottlieb said.
Who do I listen to — the WHO or the CDC?
A main act of the mask confusion in the US was when WHO officials said that vaccinated people should still continue to be cautious and wear masks. This is opposite advice from the CDC, who gave vaccinated individuals some rope in their return to everyday life with the lift of the mask recommendation (with the aforementioned exceptions).
An important thing to keep in mind when weighing advice from the CDC against advice from the WHO is that the two agencies serve different populations. The CDC is a federal agency under the US’s Department of Health and Human Services, and its mission is to guide health practices in the US. The WHO, on the other hand, is an agency with the United Nations that serves many different countries. When issuing guidance on COVID-19, the CDC focuses on the US, and the WHO has to consider the whole globe.
For more details on the WHO vs. CDC issue, check out CNET’s explainer.
HIPAA has been brought into the mask debate because it protects people from questions about their health. But HIPAA works to protect patient health information from being shared by certain agencies or providers, such as doctors, and won’t apply to a person asking another person why they aren’t wearing a mask.
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Is it legal to require face masks or proof of vaccination?
There is nothing in the CDC’s current guidance regarding masks about proof of vaccination, and (it seems) most stores and businesses have adopted the guidance on the faith that people will be masking or not based on their personal vaccination status. If a restaurant or business asks you to wear a mask and you refuse, however, it is likely within their rights to refuse you service, as long as they are doing it in a “nondiscriminatory manner,” KIRO 7 reports. (Recall “No shirt, no shoes, no service,” per Healthline.)
However, there are different laws at play, and state law will take precedence over county law, for example. In states such as Texas, local governments are prohibited from enforcing mask mandates, leaving it entirely up to the employer or business.
Your employer may legally require you to wear a mask, according to guidance from the US Equal Employment Opportunity Commission, an agency that enforces civil rights laws in the workplace. In a March 2020 update, the EEOC said “the ADA and the Rehabilitation Act do not interfere with employers following advice from the CDC and other public health authorities on appropriate steps to take relating to the workplace.”
As far as proof of vaccination is concerned, the Biden administration said that it will not create a vaccine passport system for the US (but you might need one to travel to other countries). That hasn’t chipped away at the controversy surrounding mandated vaccines or proof of vaccination, however. Many hospitals and some universities have started requiring staff and students to be vaccinated against COVID-19. On Monday, a federal judge blocked a challenge to Indiana University’s vaccine requirement for students and staff, signaling that universities have a right to do so, unless there is a “religious, medical or ethical exemption.”
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.