Future Tense

New Mask Guidelines Don’t Take a Huge Number of Americans Into Account

Masks hang on an outdoor clothesline.
Chris Delmas/Getty Images

When the Centers for Disease Control and Prevention recently announced new guidelines that fully vaccinated individuals could now go unmasked indoors, I wanted to rejoice. After 14 months of masking, following rules, and waiting for a vaccine, it’s understandable that so many people would be happy about this news. I’m happy for my friends back in the U.S. (Although I’m a U.S. citizen and hope to visit home sooner rather than later, I currently live in Germany.) But I can’t allow myself to get too excited, because I have chronic cancer.

Advertisement

In 2017, I was diagnosed with chronic lymphocytic leukemia. I was shocked—this was a disease that largely affects the elderly, and I was in my mid-30s and healthy. But I quickly learned that, to stay healthy, I would need to take extra precautions. I started wiping down my seat on airplanes and wearing a mask in crowded spaces long before it was cool. With those precautions, I continued to live a normal life until COVID-19 came along.

Advertisement
Advertisement
Advertisement

When the pandemic hit, I was terrified. For the first two months, I stayed home, only stepping outside with a neighbor and her dog. But eventually I had to traverse the city for a blood test. And the results were what I expected: I was due for treatment. And so, last summer, I spent three days a week taking public transit for treatment and follow-up blood tests. My oncologist encouraged me to wear a KN95 mask, and I did so diligently. But when it came to making other decisions about my safety, I was left to assess my own risk.

Advertisement

This is because the messaging around the virus in most countries has catered to the healthy among us. Those of us with chronic illness, and particularly cancer, have been told to simply stay at home, even during periods when transmission rates were low. The underlying message? Our lives don’t count. Even now, there are few statistics to guide us in our decision-making, because we are not included in most research.

As my treatment began working and I started to feel well again, I was stuck in a constant state of fear and limbo. While in the “before times” I might have jumped on a plane with a week’s worth of medication, now I was left to perform complex risk assessments: Would it be safe to spend a couple of days in a friend’s apartment for the holidays if we both got tested? If I needed to go back home to the U.S. to visit my mother, would there be a safer way to do so? Should I yell at the guy on the train who removed his mask to make a phone call? Honestly, it’s been exhausting.

Advertisement
Advertisement

And so, for people like me, the CDC’s latest announcement is bittersweet. The risks of COVID-19 for us are just so much higher: Not only are we more likely to catch the virus, because of our weakened immune systems, we’re also more likely to get seriously ill, be hospitalized, or die. Unfortunately, some of us are also less likely to mount a robust response to the vaccine, leaving us less or completely unprotected if we go without masks.

Advertisement

As I’ve been tweeting about my concerns, some fully vaccinated people have been asking why they should have to continue masking, when they’re unlikely to pose a threat to my health. After all, the latest data shows that those vaccinated with the Pfizer/BioNTech or Moderna vaccine—the two most common shots in the United States—are unlikely to transmit the virus to others. While that’s great news, it’s not the whole picture.

Advertisement

First of all, we know that in the United States (and elsewhere), a large number of people have scoffed at mask mandates, with some even acting violently toward others. There are also plenty of individuals who refuse to get vaccinated. Together, those behaviors suggest that there are some unvaccinated people who will take the CDC’s guidelines as a free pass to stop masking, putting the health of immune-compromised people (and children) at direct risk.

Advertisement

So, the logic goes, I should simply wear a mask myself. I plan to, but there are a couple of flaws with this line of thinking: We know that masks don’t confer 100 percent protection, particularly to the wearer. Furthermore, with most businesses and workplaces not requiring proof of vaccination, this argument would mean that I would have to mask indefinitely.

Advertisement

Notably, a large number of epidemiologists seem to disagree with the CDC, with many expressing that they had expected masking to continue until herd immunity was reached. I worry that the CDC’s decision was prompted by political and economic concerns, which have been at the forefront of the U.S. strategy to “return to normal.”

Here in Germany, where things are progressing a bit more slowly, we’re still required to wear masks indoors, and more specifically, we must wear KN95 or medical masks—not those cute but often useless cloth ones. I feel a bit safer here than I would in the U.S., and yet I worry that the CDC’s global reach will have undue influence elsewhere, where other vaccines—which may not confer the same level of protection as the mRNA vaccines—are in common use or vaccine supplies are too low to reach herd immunity.

Advertisement
Advertisement

So what should be done? I believe that public health authorities should consider the potential effect of behavioral guidance on vulnerable populations from the start. For one thing, we don’t have statistics on how many people in the U.S. are actually immune-compromised, but given the fact that roughly 39.5 percent of Americans will be diagnosed with cancer in their lifetimes and that there are plenty of other conditions that affect the immune system, we very well might be the majority. At the very least, the unhealthy make up a healthy minority.

A strong democratic society should seek to protect its most vulnerable. And that protection shouldn’t mean relegating us to our homes forever or forcing us to live our lives inside a bubble. Many people with cancer and other chronic conditions can increasingly lead full and fulfilling lives—but not if they’re constantly left to dodge unvaccinated anti-maskers. That’s why a strong public health strategy should operate on the principle of solidarity and recommend—or better yet require—that masks be worn until herd immunity is reached.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.

Advertisement