Q&A: PCPs should instill confidence in COVID-19 vaccines amid change in CDC guidance
The CDC recently updated its guidance to say that even vaccinated individuals should wear masks indoors when in areas with high or substantial COVID-19 transmission.
According to The Washington Post, the CDC updated its guidance after reviewing data from outbreak investigations and studies that showed vaccinated individuals who become infected with the delta variant may be able to transmit the virus as easily as unvaccinated individuals.
In light of the change in guidance, Elisa Choi, MD, FACP, FIDSA, an internal medicine and infectious disease specialist in clinical practice in Massachusetts, said it is critical for primary care physicians to emphasize the importance of vaccination to their patients.
“We are working hard to try and encourage those who have reservations about moving forward with the COVID-19 vaccine. These patients may ask, ‘Why should I bother now? Even if I get vaccinated, I’m going to have to mask.’ That is not the message that I would want the public to take away,” Choi told Healio Primary Care.
The vaccines, she added, have substantially reduced COVID-19-related deaths.
“Even if someone has a breakthrough infection and they’re fully vaccinated, they are unlikely to need hospitalization, and they are extraordinarily unlikely to die from COVID-19,” Choi said. “That means the COVID-19 vaccinations are working.”
However, the rapid spread of the highly contagious delta variant warrants additional prevention measures.
“This is not signifying failure of the vaccines — it is just the opposite,” she said. “This is a new stage in the pandemic, so we need to use all our tools.”
We spoke with Choi about the CDC’s new masking guidance, what PCPs should be telling their patients about COVID-19 prevention measures, and more.
Healio Primary Care: Do you agree with the CDC’s new masking guidance?
Choi: I do very much agree with the CDC masking guidance. Vaccinations are working, and we have made remarkable strides in reducing severe disease and deaths related to COVID-19. But what we are seeing now is that the COVID-19 variants are more contagious and more transmissible, and we’re experiencing another surge in cases pretty much across the U.S. at this time. Worldwide, there are certainly big surges of COVID-19 cases. So, this is the right time to amplify our efforts to prevent infection: vaccinations plus heightened infection control and infection prevention measures.
We know that masking works, and tying in masking guidance to local transmission rates of COVID-19 is appropriate at this stage in the pandemic. We also know that risk of infection can vary. For example, COVID-19 exposure in indoor, poorly ventilated environments will present greater risk of infection than COVID-19 exposure in the outdoors or in a well-ventilated space. There could be greater risk of COVID-19 exposure if you come in contact with more people or with people who are unvaccinated. There is also greater risk if there are greater background rates of COVID-19 infection in your geographic area. CDC’s masking guidance is acknowledging those different nuances in transmission, and it does makes sense as part of an overall, comprehensive infection prevention strategy in light of where we are right now in the pandemic.
Healio Primary Care: How are patients supposed to know whether they live in a high-transmission area?
Choi: The CDC provided a fairly helpful site: the COVID Data Tracker. The CDC’s new masking guidance recommends masking in either a substantial- or high-transmission area. At this link, one can determine if one’s local geography falls into either of those categories.
Healio Primary Care: Misinformation has been an issue throughout this pandemic. How can the CDC and HHS better communicate their messages to the public?
Choi: Misinformation has been such a significant barrier for our patients and has presented substantial challenges for physicians, as we are needing to actively rebut inaccurate information about COVID-19 vaccines, transmission, and clinical manifestations. The CDC and HHS have been doing a very admirable job, particularly in light of how rapidly the information has been changing and the complexity of information that has been emerging.
There could be opportunities to provide even more enhanced patient-facing information such as infographics. I know the CDC has some, but it never hurts to have more. The infographics can be a very easy visual that can contain the take-home points. Patients really need to know the bottom line. Having as much of a supply of that kind of information as possible, and having it easily accessible for patients, is only going to be beneficial.
Physicians can be messengers and ambassadors of medically accurate information. There are opportunities for the CDC to continue some of its partnerships, and perhaps even increase partnerships, with physicians, health care organizations, and various physician groups to provide talking points or scripts for how physicians can talk to their patients. I personally think that it will be important, with this changed masking guidance right now, to emphasize that this is not a vaccination failure. Vaccinations are really working — they are good vaccines — but this is part of the evolution of the COVID-19 pandemic. We know this virus can mutate and develop variants; that is what is happening. The guidance is not changing because vaccination failure is happening, but rather because of the need to have a heightened and amplified level of infection prevention as SARS-CoV2 has become more infectious and contagious. This new guidance for masking plus continued successful vaccines, in combination, will heighten protection against COVID-19. Reinforcing messages that vaccines are working but we also need masking as additional infection prevention will help allay some patients’ fears and the general public’s concerns.
Healio Primary Care: What is the role of PCPs in all this?
Choi: Primary care physicians are one of the most trusted sources of information for patients. Patients trust their primary care physicians for information about COVID-19 vaccinations. Similarly, patients trust their primary care physicians for guidance and information about COVID-19 in general, particularly because there is so much information that is coming out on such a frequent basis, and the information can often change.
Primary care physicians, in my opinion, can and should be a major source of information about the new CDC masking guidance. There will undoubtedly be confusion amongst the lay public about why the guidance changed. Primary care physicians can help provide the more nuanced context that the guidance changed not because of vaccination failure, but because this variant — the delta variant — happens to be more contagious, and we want to be sure that we protect our patients, including those who are not vaccinated. Primary care physicians can help discuss the importance of adhering to this new masking guidance given the current situation with the pandemic, and also instill confidence in those who have been vaccinated that their vaccines are working. The masking guidance is not being changed out of a fear that vaccinated patients are likely to succumb to COVID-19 disease, to become severely ill, or to be hospitalized and die. The data show that is not so much the concern. What primary care physicians can explain to their patients is that the masking guidance is changing in an effort to help protect those in our communities who are not fully vaccinated against COVID-19, for whatever reason. For those who are COVID-19 unvaccinated, maybe they did not have a chance to get vaccinated yet, or maybe they can’t get vaccinated because of various other medical issues, or maybe their medical conditions (for example, immunosuppression) may create increased risk of COVID-19 disease. The masking guidance change is part of a layered approach to heightened infection prevention efforts against COVID-19, recognizing different risk levels for transmission of infection. It is really more for the greater good of the community and an attempt to push back a little bit on the current increasing number of cases in a way that we know helps prevent infection.
The bottom line is that the primary care physician has such an important role as a trusted voice of medically accurate information for their patients, and also as a medical professional who can help explain the rationale for why some of these different measures have changed and may continue to change. For a person who is not a medical professional, it must be really overwhelming to know where to go and find accurate and trusted information. Even though the primary care physician can direct the patient to the CDC website, which is a valuable resource, there may still be a lot of information that is over the head of someone who is not medically trained. The primary care physician’s role can be to distill that medically complex information into much more manageable, everyday language that the patient can then understand and feel confident that they are getting the most up-to-date, accurate information.
*Editor’s note: The opinions expressed by Choi in this interview represent her own, and are not necessarily policies or positions of any organization with which she is affiliated.
References:
Christie A, et al. MMWR Morb Mortal Wkly Rep. 2021;doi:10.15585/mmwr.mm7030e2.
The Washington Post. ‘The war has changed’: Internal CDC document urges new messaging, warns delta infections likely more severe. https://www.washingtonpost.com/health/2021/07/29/cdc-mask-guidance/. Accessed July 29, 2021.