Medical Examiner

“I Never Quit Masking”

Three public health experts on how they are thinking about masks in their own lives, and yours.

A shopper with a cart enters a store where it says, "Mask required" outside the doors.
People shop at a grocery store enforcing the wearing of masks in Los Angeles on Friday. Chris Delmas/Getty Images

Knowing when, or when not, to wear a mask has involved a series of perplexing risk calculations since the lifting of mandates for vaccinated people earlier this spring. New mask guidance from the Centers for Disease Control and Prevention released on Tuesday clarified the situation for people living in areas with high COVID-19 transmission rates by recommending they start masking indoors regardless of vaccination status. The CDC also shifted its mask guidance for schools, saying that kids and staff should mask up as well.

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Even before the CDC’s most recent shift in guidance, we wanted to know how public health experts in different circumstances were thinking about masking in their own lives, with the delta variant ascendent and vaccination rates lagging. We recently spoke to Stanford-based doctor and journalist Seema Yasmin, Louisiana health official Martha Whyte, and Jessie Abbate, an infectious disease doctor in Montpellier, France, where the COVID-19 rates are the highest in the country. All three noted that, ultimately, the solution is to vaccinate as many people as possible, but in the interim, masks are still vitally important. These interviews have been edited and condensed for clarity.

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Julia Craven: When are they masking in their own lives?

Seema Yasmin: Had there not been a delta variant, I probably would not be masking in a lot of places where I am currently masking. However, my decision-making goes back to context. Where am I? What kind of situation am I in? Am I indoors? Outdoors? Are there people around? Are there no people around? If I’m indoors around other people who I know for sure are fully vaccinated, I don’t wear a mask because I think the chances of becoming infected are so low.

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That’s what factors in, and it’s the same as what was happening this time last year when I was trying to calculate: “How many times am I willing to go to the grocery store a week?” “Oh, cases have dropped a lot in my county and in my city in the last week? I might pop to the store one more time.”

One of the most tiring things about the last 18 months has been those mental calculations that we are constantly making.

Martha Whyte: In the last couple of weeks, we have seen Louisiana enter a fourth surge. Our case rates have gone from around 200 a week in the state to days of 5,000 cases a day. We’re averaging now about 3,500 cases a day. Our hospitalizations have climbed as well as the number of people who are vaccinated having breakthrough cases. Now, by far, the number of people hospitalized is significantly greater in unvaccinated people. About 94 percent of the people who get sick are unvaccinated and about 97 to 98 percent of people hospitalized are unvaccinated. It is still very, very important to get vaccinated, but we are in a surge.

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I never quit masking despite finishing my vaccination series primarily because I was very aware of the number of people who were not vaccinated. And I felt like I should be an example more so than to protect myself or protect them. If I’m in a meeting with five people and we’re closing a door in a small room, I think we need to mask. If I’m going into a large box store and there’s a lot of people in there, I’m going to wear my mask. If I’m around a group of people who are all vaccinated and we can keep a pretty decent social distance, then we don’t mask. On my floor, where I work, we’re 100 percent vaccinated. So unless we’re closing the door with a few of us in a room, we don’t necessarily mask.

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Jessie Abbate: I don’t mask as much outside because we’ve seen that transmission is much more of a risk indoors, but if I’m inside, absolutely. And even outdoors, if I’m around a lot of people that I don’t know and I’m having sustained contact, I’ll wear a mask. A lot of people aren’t vaccinated and vaccines are not 100 percent effective. So everyone should be masking whether you’re vaccinated or not.

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Are mask mandates a good idea?

Yasmin: I really worry about how failures in communication and potential universal mask mandates might undermine the way that people think about vaccines. The mandates require really, really careful messaging, because if you already have division, if you already have people who don’t know who to trust when it comes to messaging around COVID and science, then it’s fueling that confusion and that mistrust more.

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There needs to be even clearer communication that this has to do with the more transmissible delta variant, and the fact that in the last four weeks in the U.S. we’ve seen an increase in the number of daily COVID cases. It sounds obvious, but we’re not always making those points obvious in terms of whether a mask mandate may be necessary in some areas. You have to repeat that messaging about the delta variant and saying if you got vaccinated, the vaccine is still highly protective against the delta variant, but it’s a bit less.

Abbate: I’m not sure what the idea behind the Biden administration saying [previously] that if you’re vaccinated you can stop masking might’ve been because until we’re all protected no one’s protected. Maybe they did that to give an incentive to people to get vaccinated saying, you know, if you get vaccinated, we can get back to your daily lives and you don’t have to wear a mask. But, I just don’t think that was very wise. Everyone should be made to wear a mask until enough people have been immunized and the spread of variants is diminished.

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Does indoor dining still make sense, since you have to take your mask off to eat?

Whyte: Indoor dining is difficult. I do believe that if you are waiting in line and if you’re coming into the restaurant greeting that sweet host who’s going to seat you, that they deserve you to wear a mask. Whenever my server comes, I put my mask on to speak to them just out of respect for them, because we know that they have been in a high-risk situation. And we have had outbreaks among servers—not so much that we’ve seen spread to other people who had eaten at the restaurant. And I just think they deserve to be protected. They wear their masks to help protect you. You should wear your mask when they approach your table.

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When you’re sitting and eating, you should request table room so that you have enough space to take your mask off and still be pretty protected from each other. Then, enjoy your meal. And when it’s time to leave, or the server comes back over, put your mask on and take care of business. It’s very simple. It’s not a lot to ask of someone and it does go a long way to protect the people who are taking care of you.

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What about kids in school? 

Whyte: It’s funny, superintendents were concerned that children would have a hard time with masking and our children just did not. It’s a little shocking to adults to see all these little children running around with masks on, but it didn’t bother them.They like picking out the different colors and having their pink mask today. My good friend that works with me, her little niece had a whole little set and she picked what she wanted. She would not leave the house without her mask. It was not a big deal to them. So, yes, I do firmly believe that masking should happen in schools, along with social distancing and then good contact tracing. That’s how we really were successful in limiting outbreaks in our schools here, despite being in school throughout the pandemic.

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Will we need to stock up on N95s to travel? 

Whyte: The CDC never went as far as recommending N95s for the general public. And I still think that it’s true.

Yasmin: I keep thinking about when these conversations were happening last year. And because I used to work at CDC, I had to get fit tested. So I know that the regular off-the-counter N95 actually won’t fit my face, and I wouldn’t have known that otherwise. When you see people with beards wearing N95s, you just know that it’s not offering them a seal.

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We often have conversations about masks or about the masks themselves—and that’s totally legit. What kind of mask is it? Does it fit properly? Do you know how to put it on or not? But we neglect to discuss all of the things that are not about the material and the straps that also go into someone’s decision making about the mask. So much of that has to do with things that are not really associated directly. It’s people’s personal beliefs; it’s how they feel about government. It’s what people in their circle are saying to them. It’s complicated.

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How do you feel about the new CDC guidance? And what’s the biggest challenge to getting people where you live to follow it? 

Whyte: Vaccinated or unvaccinated, people need to wear masks in situations indoors when they cannot socially distance. Unvaccinated people need to get vaccinated, but until they are fully vaccinated they need to wear masks outside of their home—unless outdoors and socially distanced, or alone in an office, for example. The issue is no one has been wearing masks, unvaccinated or vaccinated. It was never OK for unvaccinated [people] to not mask, but they have been. Now, we are asking people, who did the right thing, to mask. They are not happy about giving up that freedom.

It is important, not just to protect those who have not been vaccinated, but to protect us all from the development of variants.

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