Mask On? Mask Off?

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S1: Quick heads up here, there’s a bit of spicy language in this episode, you’ve been warned. There’s an old episode of the TV show Candid Camera I kept thinking about this weekend, your dad came in, an unsuspecting person gets onto an elevator with a bunch of people who work for the show. Here’s the candid subject. Here comes the Candid Camera stance, three of them at least, and the Candid Camera people, they start doing weird stuff in unison. They all turned to face the back of the elevator, they take off their hats, then they put their hats back on, they take off their hats. Now, do you think we could reverse the procedure watch and every time these folks do something, the person who is stuck in the elevator with them, they end up doing whatever the group around them is doing, no matter how absurd. For me this weekend, it was just like that Candid Camera episode, only with masks. At the park at my kid’s bus stop at Roll-Up, much of the time without a mask and I’d wait, I was following this new guidance from the CDC released last week. They say vaccinated people can go without masks almost everywhere, especially outside. But one by one, the people all around me would stay masked or they’d find a mask and put it on and I’d wonder, hold it. Am I the asshole?

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S2: You know, I’ve been saying that this decision was based on sound biological science, but the behavioral science behind it is the part that’s pretty confusing.

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S1: I called up Dr. Megan Ranee, an E.R. doctor who teaches at Brown University, to see if she could help me figure this out. It turns out things were pretty confusing at her hospital this weekend, too.

S2: I worked the last two evenings in the emergency department and this was a major topic of conversation both between me and my fellow physicians and nurses and physician assistants.

S1: What were folks saying?

S2: You know, the health care providers are all awfully confused. It feels premature to most of us. We’re certainly not going to take our masks off in health care. And CDC says we shouldn’t. But we know that most of our population isn’t vaccinated for the patients. There was some confusion. Some patients, those who were not yet vaccinated in particular, felt very excited that they thought that they were not going to have to wear masks anymore.

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S1: The people who are not vaccinated.

S2: Mm hmm. Exactly right. That’s the confusion.

S1: The majority of Americans are just like the patient Megan’s describing. They haven’t gotten their shots yet. Even if they are fully vaccinated, there’s no good way to tell without demanding to see their little paper card. Given all that, these new guidelines, they’re enough to make anyone suspicious of the person standing next to them at their kid’s bus stop.

S2: I expected some shift in guidelines like this, but I thought that it would wait until 50 or 60 percent of adult Americans had been fully vaccinated.

S1: I can’t tell if you’re worried or not.

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S2: I can’t tell if I’m worried either, to be honest, Mary. We can’t protect everyone forever, and at some point we have to let people put themselves at risk. The question to me is, was this too soon?

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S1: Today on the show, what these new guidelines really mean for you, your family and that pile of masks you’ve accumulated over the last year, a Mary Harris you’re listening to, what next? Stick around. Before we get into the details of this new guidance from the CDC, I want to talk about how Dr. Megan Ranney thinks about where we are when it comes to the coronavirus in this country. She calls it the ninth inning. The pandemic seems to be nearly over in the U.S. at least, but the game is still going on. It reminds me of something her dad used to say to her when she was younger.

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S2: So when I was a kid and we used to come back from vacation and night before going back to regular life, you’d always be a little bit of anxiety and sadness and butterflies about going back to school or whatever it was the next day. And my dad talked about that moment as being the heat of reentry. So, you know, when a space shuttle is flying up in space and it comes back down into the atmosphere as it enters the atmosphere, it gets really heated up that the heat of reentry as it goes from space back to earth. I think it’s also the moment that we’re in right now as a country, we’re in the heat of reentry from pandemic world to endemic world where covid is going to be around. But it’s not going to be overwhelming us. It’s not going to be dominating the news headlines and it’s not going to be killing thousands of people a day. This is a tremendously uncomfortable moment and there’s no perfect answers right now. That anxiety, that fear is normal. We have to push through it. We will get back to Earth. It’s just a question of how hot that re-entry is going to be,

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S1: can we go back in time? Because I think part of the reason that people may have struggled with this new guidance from the CDC is that it’s been such a quick turnaround. Like I remember back in March, Rochelle Walensky was talking about impending doom from covid like a creeping sense of dread. I’m going to pause here. I’m going to lose the script and I’m going to reflect on the recurring feeling I have of impending doom. We have so much to look forward to, so much promise and potential of where we are

S2: and so much reason for hope. But right now I’m scared,

S1: which is like a complete turnaround from what was being said last week.

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S2: So I think the difference between March and today is the rate of vaccine delivery. We have done it better than expected job in the US of getting vaccines and arms and our case rates have dropped accordingly. And the amazing thing is, is that these vaccines have proven in some ways more effective, honestly, than we had hoped. Many of us suspected that, as with most medications, when they got out into the real world, they would work a little less well than they had in the trial. But they’ve actually worked just as well as they did during the studies. And they’ve seemed to maintain efficacy against most of these variants. And I think that’s the reason for the shift in the tone that you’ve heard, not just from the CDC, but also from most of us in public health, that we’ve seen the vaccines get into arms. And as people get vaccinated, those numbers are just dropping so quickly. It’s marvelous. But the question is, are we over that hump where this is the part of the pandemic where we can take our masks off? Because masks, if we’re incorrectly and it’s a good mask, are really just about as effective as some vaccines. The JMJ and vaccine and universal masking have about equivalent efficacy. So that’s that balance and that shift. That’s a difficult one. And only only in retrospect will we know whether this was the right choice at this time.

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S1: Can we lay out exactly what the new rules and guidelines say and what they don’t? Because I think it’s really important to be clear that the new rules from the CDC are about vaccinated people and they’re about specific situations where you can go without a mask.

S2: Yeah, I love that. Thank you for asking. It is really important to be clear that this is only for people who are fully vaccinated, meaning more than two weeks after your second shot, if it’s been during our Fizer or two weeks after your single shot, if it’s Johnson and Johnson and it says that for those folks, you don’t have to wear a mask just about ever, except in health care facilities, in kongregate care settings like jails or shelters or on public transport.

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S1: For the people who heard the CDC’s announcement and got nervous, Megan says, just know you can still do what makes you comfortable.

S2: One of the things I tell those folks is that they are not obligated to take their mask off just because the CDC says it’s safe for most vaccinated people. Again, not 100 percent, but for the majority of us, that doesn’t mean you’re forced to take the mask off. So if you want to keep your mask on, you can. And Mary, I’m going to keep my mask on in public indoor settings for now until vaccination rates go higher. But here’s the other side. We also have to manage that anxiety of getting back towards normal. Yes, we have all been staying home and wearing masks for the past year. But the truth is these vaccines are excellent and we are going to move back towards what life used to look like. And it is OK to take those masks off if you are fully vaccinated outside or indoors, if you’re with other fully vaccinated people with a trusted group, or if rates are really low in your community at that point. Also, it will be safe to be unmasked indoors if you’re vaccinated.

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S1: You said that after this guidance, you’re not going to change much in your own life. And I wonder if you can talk a little bit about why.

S2: Yeah, so first, obviously, I work in the E.R., so I’m wearing a mask when I’m at work, no matter what. Second, not everyone in my family is vaccinated and my husband is one of those who just got his second shot. He wasn’t eligible till mid April and my kids obviously are not fully vaccinated. One got her first shot this week. And the other, we don’t know when he’s going to be have the option. I also have parents who are high risk. I feel like I’ve made it this far. And although the vaccines are stellar, again, they’re not 100 percent. I don’t want to take that small risk, four percent, 10 percent of catching covid at work or out at a social gathering when I’ve been lucky so far the last. Part is, is that, you know, I live in Rhode Island, which has been tremendously successful at getting vaccines and arms, but even in my state, over half of adults are not fully vaccinated yet. The rate of vaccine uptake is just not high enough yet for me to trust that I’m not going to be exposed to more than one person with covid, I’m going to wait a little bit longer. I’m expecting I’ll start taking masks off indoors probably in the summer.

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S1: So can I do a bit of a lightning round with you about what your choices might look like right now at this moment? Yeah, like, OK, you’re going for a walk in an urban environment are going to be passing a bunch of people mask or no mask, no mask.

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S2: Outdoors is tremendously safe

S1: if you’re having dinner outdoors or a picnic in the park. It’s crowded park. Lots of people, dogs, you know, you can’t really control who to mask or no mask.

S2: No mask. Outdoors is lovely

S1: kids. Birthday party happy. So lots of people who are not vaccinated outdoors, indoors, either one masks or no masks,

S2: so outdoors kids, birthday party, no masks depends a little bit on the density of folks, but most likely no masks.

S1: Should the kids be in masks?

S2: It depends on how many kids are there simply because of the likelihood of someone having covid outdoors is pretty low risk, though. And so I’ll be honest, I don’t make my kids wear masks for outdoor playdates.

S1: OK, so let’s say you’re going to a mall, you’re going to go shopping. Are you wearing a mask? Are you not? And it’s a pretty big space, probably pretty well ventilated, but it’s definitely indoors and you do not know who you’re next to.

S2: For now, I’m still masking transportation.

S1: Like let’s say you are going on a trip. Maybe you’re renting a rental car or maybe you’re taking a train, maybe you’re taking a plane. What are the rules for those kinds of situations?

S2: Any public transportation right now? We should all be masked rental car if it’s me and my family, no mask. If it’s me and some friends who are vaccinated, no mask.

S1: If you’re picking up a hitchhiker mask and don’t pick up your SICHER. When we come back, whether these updated guidelines are going to influence how safe you are. One thing the CDC didn’t do before announcing these guidelines was apparently warned the states they were going to do this or even really the Biden administration, there’s a report that they just really gave them 24 hours notice that they were going to be saying, you know, masks are basically optional for those who are vaccinated. And you could see that in the way local health officials responded to the news, like the mayor in Kansas City, Missouri, apparently went from saying he wouldn’t change his mask mandate to saying he’d consider changing it to saying he’d get rid of it in the space of seven hours, which is just mind boggling. Do you think the CDC acting so quickly and decisively without warning people? Do you think that was a mistake?

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S2: So I think a big part of public health is communication, right? There’s the science and then there’s the behavioral side. It would have been lovely for the CDC to communicate about the science and to give folks some lead time, and I think an ideal world would have been to clarify the science around vaccinated people, but to give people some clear metrics around when it was safe for communities because there’s a difference between a risk to an individual into a community. So to provide some metrics for communities around that mask, mandate lifting because remember, mayors and business leaders are not public health professionals. They’re saying, well, CDC says it’s safe. So I guess I can’t require masks anymore. And I don’t know that that was fair to some of our non public health leaders.

S1: It was interesting to me to see how quickly after these guidelines came out, things began to change, especially when it came to the private sector like Wal-Mart, Costco, public, Starbucks, all of them. It was like flipping a light switch. They went from mask requirements to no masks, but they didn’t say they would be checking vaccine cards at the door or anything. When you heard that, did you think, oh, that was fast?

S2: That was exactly my reaction, huh? I think the businesses were left without a leg to stand on. You know, once the CDC says everyone who’s vaccinated can take a mask off, businesses don’t really have a choice. They’re getting a lot of pressure from clients and customers to allow them to go masks in the stores. Again, most of that pressure is from folks who are unvaccinated, but it makes it really tough for them to maintain the mandate when there’s no longer this sense of community or collective responsibility.

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S1: I think most people who are worried about this new guidance are worried about one of two things, or maybe both of these things, what unvaccinated people will do and in particular, what kids will or should do. So I’m wondering if we can break those two things up and talk about them individually, like if we start with kids. What does having kids mean for mask wearing decision making? Like, do you think parents should still be modeling mask wearing for their kids in certain settings where they may not need a mask anymore because maybe they’re vaccinated?

S2: Absolutely. You know, as a parent, it’s do what I say, not what I do. Right. We know that that doesn’t work. I have to show my kids how to behave. And I’m telling them to do something. I have to do the same thing. So if I want my kids to continue to mask and endure public settings, which is the appropriate thing right now, when rates of covid are not yet close to zero, I need to mask also now the risk to kids. The younger you get, the lower your risk of getting severely ill. But it’s not, again, a zero risk and our 12 to 15 year olds have just become eligible for vaccines. It is still critically important for our kids to mask at school and at other indoor settings right now until the rates drop. And really this is the really difficult thing is that it is not a black and white distinction. There will be a point over the next couple of months where I and others will start to say it’s OK for kids to be massless indoors if covid rates in the community are low, if vaccine rates are high because the kids are going to be protected by the rest of us. But we’re not there yet. Hmm.

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S1: OK, so let’s talk about the unvaccinated and how this new guidance may or may not impact them. I think the worry is that this guidance becomes a get out of Marzook free card for unvaccinated people, since we can never know someone’s vaccination status, at least not easily when we’re passing them on the street or going into a mall where they are. What do you say about that?

S2: I think that’s totally true. I guess my question is, how much were those folks asking to begin with? Right, and then the other part is they are mostly putting themselves at risk, the part that bums me out is that they’re potentially putting the rest of us at risk as well, again, because our vaccination rates aren’t high enough yet and they’re going to create little surges in parts of the country where vaccine rates are still low by going unmasked.

S1: Should we be asking people to show, like, their vaccine card at the door if we’re letting them into an indoor public space?

S2: Honestly, I would love that. Huh? You know, people have said to me, will you take a cruise or will you go to a movie theater without a mask? If there were a way to ensure that everyone there were vaccinated? I would be thrilled. I would even be willing to pay a little extra for something if I knew that everyone were vaccinated around me.

S1: I’d be willing to do that, too. I hadn’t even thought about that I’d pay a premium for the fully vaccinated movie. I mean, I think the real question is whether this guidance becomes an incentive for some people to get vaccinated or an incentive for them to lie. And I don’t know if we know an answer to that. I don’t know if there’s previous research about how people think of themselves in these kinds of situations and think of others and how this might go.

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S2: So back when we first mandated Universal asking, one of the concerns was that people would take other risks because they thought they were protected by masks their them.

S1: Right. And they were like everybody, masp then everyone to be really close to each other. And that won’t be great.

S2: Exactly. And that turned out to totally not be true. And in fact, there’s a lot of research showing that when you get people to take one risk reduction behavior, they actually tend to increase the full suite of risk reduction behaviors. There’s also research talking about community good, that sense of collectivism from a universal or near universal strategy. So even if you’re in an area where mass minutes have not been in place, the fact that Wal-Mart mandated masks, you knew that when you were in there, it was an expectation that everyone would be masked. It’s tough to imagine that part of the reason for making this announcement today instead of a month from now was not also because they want to try to motivate people to get vaccinated, that they think that by telling people that you can take your mask off if you’re vaccinated, that it will drive more people to get the vaccine. And erm, I’m just not sure that’s going to be true.

S1: So you’re basically telling me. The thing that I fear, which is being in a room full of unvaccinated people without masks, yeah, that’s real.

S2: That’s real. And then the question becomes, how much do you trust the vaccine and how worried are you about a small chance of catching covid yourself? The science is clear that the vaccines are amazing. And if covid cases are low in your area, well, being in a room of unvaccinated people may not be that dangerous because the chance of one of them having covered is low. The chance of you catching it is low and you’re probably going to be OK. And this is where that tradeoff comes in. If rates of covid in your community are high or if you’re higher risk and don’t want to take that small chance of catching covid yourself, then sadly you are going to continue to need to mask up even if you’re fully vaccinated.

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S1: It feels like a very American decision it’s interested in. Getting us to feel better individually and maybe not collectively,

S2: that’s the struggle of public health in the United States. It is this constant tension between the collectivist and the individualist. And I’ll be honest, the individualist almost always wins its people’s individual right rather than a sense of community belonging and owing something to each other.

S1: I wonder a little bit if this decision was made because we’re at this point where enough people are vaccinated, not for herd immunity, but so that if there’s a spike in covid cases in an individual area, what you’re saying will happen. It’s not going to overwhelm the hospitals in the way that it did last spring or even in the winter. And so that sort of structural issue is relieved a bit. And people are going to make their choices, which sounds a little harsh, but it is a little bit what we do each year with, say, the flu, we offer a shot, you can get it or not. We know that there will be a surge in people going to the hospitals, but we sort of accept it. And we know that it’s at a point where it won’t overwhelm the hospitals. I wonder if you agree with that.

S2: I think that that’s exactly right. We have reached the point in the pandemic where as a society, it is not going to overwhelm us anymore. And so, again, it goes back to this individual factor of tough cookies for you. If you happen to be someone who’s not been vaccinated or for whom the vaccine hasn’t fully worked, as a society, we’re more or less going to be OK again, assuming no new horrible variance. And it’s what we do for a lot of things. You know, we know that motorcycles are riskier than cars, but there’s a lot of folks that choose to ride motorcycles because they’re fun. My E.R. was full of motorcycle crashes this weekend because it’s a gorgeous weekend in Rhode Island and there were a lot of folks out. That’s a risk that we as a society take. We can’t wrap everybody in a bubble forever. And I don’t think anyone expected that or wants that again. The question is, was this the moment? To allow folks to go unasked and only time will tell, it may turn out to be OK or it may turn out to have been a little premature.

S1: Dr. Megan Ranny, thank you so much for joining me.

S2: Thank you.

S1: Dr. Megan Ranney is an E.R. physician at the Rhode Island Hospital. She’s also an associate professor of emergency medicine at Brown University. And that’s the show. What Next is produced by Davis Land. Kamal Dilshad, Daniel Hewett, Elena Schwartz and Mary Wilson were led by Allison Benedict and Alicia Montgomery. And I’m Mary Harris. I will cut you back in this feed tomorrow.