CDC’s new COVID-19 metrics indicate most Americans can go maskless
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New COVID-19 guidance released by the CDC on Friday indicates that most Americans now live in areas where they can go maskless.
The guidance is based on metrics that rely on local measures of hospital capacity, including a county’s level of COVID-19 hospitalizations and percentage of hospital beds occupied by patients with COVID-19. It also factors in COVID-19 cases per 100,000 people.
A color-coded system that identifies counties’ level of risk — from low (green) to medium (yellow) to high (orange) — can be used to determine if a mask is necessary.
According to the CDC, around 70% of people live in the low and medium risk areas and can go without a mask, although the guidance says that people in medium risk areas who are at high risk for severe illness should talk to their health care provider about masks and other precautions.
“In a time of decreasing infections, and high vaccination coverage in many communities, I’d feel comfortable lifting the mask mandate as we strive to return to a ‘new normal’ in this next phase of the pandemic,” Infectious Disease News Editorial Board Member Jeanne M. Marrazzo, MD, MPH, director of the division of infectious diseases at the University of Alabama at Birmingham School of Medicine, told Healio.
CDC epidemiologist Greta Massetti, PhD, MPH, of CDC’s COVID-19 Response Incident Management Team, clarified in a call with reporters that people in medium risk areas “may choose to wear a mask,” and CDC Director Rochelle P. Walensky, MD, MPH, encouraged anyone who wants to wear a mask to do so, no matter where they live.
In areas of high risk, the CDC recommends that everyone wear a mask indoors and in public settings, including schools.
“This new framework moves beyond just looking at cases and test positivity to evaluate factors that reflect the severity of disease, including hospitalizations and hospital capacity, and helps to determine whether the level of COVID-19 and severe disease are low, medium or high in a community,” Walensky said.
According to Massetti, at the low level, there is limited impact on the health care setting and low amounts of severe disease in the community. In the medium level, more people are experiencing severe disease in the community, impacting the health care system more. At the high level, there is a high amount of severe disease in the community and a potential for health care strain.
“These categories help individuals assess what impacts COVID-19 is having on their community, so that they can decide if they need to take extra precautions, including masking, based on their location, their health status and their risk tolerance,” Massetti said.
The more than 70% of Americans who are currently residing in areas with low or medium COVID-19 risk in their communities is an increase from about one-third of total counties last week, Massetti said.
The CDC recommends that schools adhere to masking policies only if they are located in an area deemed at high risk. Walensky said mask mandates for public transportation would remain in place until at least next month.
Prior to Friday, the CDC recommended that anyone aged 2 years or older who is not fully vaccinated wear a mask indoors in public settings.
The CDC said people do not need to wear a mask outdoors but should consider wearing a mask if they are in close contact with others in areas of high transmission.
People who have a weakened immune system should take all precautions recommended for unvaccinated individuals, including wearing a mask at all times, the CDC said.
Last month, the CDC said said for the first time that people can wear N95 or KN95 respirators, which were previously recommended only for health care settings.
Perspective
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When it comes to public health guidance from the CDC, it is really important for it to be tied to metrics that are meaningful. If almost the entire country has significant and high levels of spread, but very different conditions inside hospitals, then the metric of exclusively using cases is not warranted when it comes to guidance. Focusing on hospital capacity is a much better metric and has always been the overriding concern.
Perspective
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I think that as the epidemic has evolved — and after omicron when so many got infected — we now have a reasonable level of immunity in most of the U.S., between vaccinated and previously infected persons, to move in this direction.
We also have clear evidence that vaccines are powerful against severe disease and death from COVID-19, and we have more access to testing and better therapies. All those things make it reasonable to develop revised parameters for nonpharmaceutical interventions like masking.
COVID-19 hospitalizations are now added as a parameter, which makes sense. The revised guidance should be used to inform local decision making. This doesn’t mean masking is gone forever, it simply means that it can be removed as mandatory in a significant portion of the country without much risk at the moment.
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CDC. COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html. Accessed Feb. 25, 2022.
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