Are You Suffering from Mask Guidance Whiplash?

May 26, 2021

If you are experiencing confusion, frustration, and neck pain resulting from the CDC’s about-face on masking, you are not alone. Here is what you need to know to stay safe and keep you and your family COVID-free.

FAQs

1. Q: If I am fully vaccinated*, do I need to wear a mask?

No, but with a few exceptions.
- According to the CDC, if you are fully vaccinated, you can participate in all indoor and outdoor activities, large and small, without a mask or practicing social distancing. The CDC wants you to start doing all of the things you did pre-pandemic, and you should!
  - However, the CDC is not providing any guidance on vaccine verification, and thus, America is now on the ultimate honor system.
    - What does that mean?
      - Essentially the CDC has made every American responsible for their own health, meaning that it will not take on the challenge of verifying if an unmasked individual is, in fact, fully vaccinated*
      - Specifically, “you can resume activities without wearing a mask or staying six feet apart, except when required by federal, state, local, or tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.”
    - Masks are required on public transit and in hospitals, nursing homes, and prisons.
    - Bottom line: You do not have to wear a mask unless…
      - Your local jurisdiction requires it based on community COVID-19 infection and vaccination rates.
      - A public or private entity that you do not own and operate requires a mask.
      - You take public transportation.
      - You visit a hospital, nursing home, or prison.
  - Note: Over 4% of Americans have been told by their healthcare professional that they are immunocompromised. American children under twelve have no vaccine, so please do your part to keep your neighbors safe.

2. Q: If I am fully vaccinated*, but I have children under twelve who are not vaccinated, do I need to wear a mask?

No and yes.
- While the quick, easy answer appears to be no because you are fully vaccinated*, you are also your unvaccinated children’s strongest role model, and modeling mask-wearing behavior for them is critical!
  - Dr. Yvonne Maldonado, Chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and Division Chief of Pediatric Infectious Disease at Stanford University, recommends the following.
    - Model mask-wearing behavior when you are out with your children, i.e., everyone can wear masks for a trip to the grocery store.
    - If some siblings are vaccinated while others are not, to prevent the feelings of unfairness when friends of the vaccinated children come over, ask everyone to wear a mask, including you
    - Make a Family Plan
      - Set expectations for everyone in the household
      - “Include your children in family discussions about the best way to protect everyone inside and outside of your home.”
      - Solicit your children and teen’s opinions on mask-wearing and vaccination, they have learned a lot about considering others during the pandemic, and they “will probably provide some pearls of wisdom to include in your family plan!”
    - Remind your children under twelve that “normal” is coming and that research trials are underway right now for children six months and older, and their turn will come as soon as it is safe

3. Q: If I am fully vaccinated*, but have children under twelve who are not vaccinated, do they need to wear a mask?

Yes!
There is no COVID-19 vaccine for children under twelve, so their strongest line of defense is wearing a mask.
Current CDC Guidelines
- Outdoors
  - No Mask
    - Walk, run, or bike with members of your household
    - Attending small, outdoor gathering with fully vaccinated* family and friends
    - Water sports
      - Swimming
      - Diving
    - Sports where masks could pose a safety risk
      - Gymnastics
      - Cheer stunts
      - Tumbling
      - Wrestling
    - Sports where children can keep a safe distance
      - Golf
      - Singles Tennis
      - Skiing
    - Children under two
  - Mask Up
    - All other outdoor activities
  - Indoors
    - No Mask
      - Home with immediate household
    - Mask Up
      - Home with anyone outside of the immediate household
      - School
      - Carpool, school bus, all public and private transportation provided outside of the household
      - After School and daycare programs
      - Any enclosed space, large or small, where there are members outside of your household

4. Q: Summer is almost here, what are the rules for my kids at camp or summer school?

Since there is no vaccine for children under twelve, camp, summer school, and daycare, even if mixed with older vaccinated adolescents, will require the same precautions that have been in place for months.
- Mask-Wearing
- Social Distancing
- Hand Washing
- Limited Object Sharing
- Keeping Activities Outdoors or Indoors with Proper Ventilation
These guidelines will likely extend to in-person schooling in the fall
- Pfizer and Moderna are currently conducting two-dose, age de-escalation, vaccine trials on children ages six months to eleven years in the US and Europe
  - A two-dose vaccine may be available to children as young as two in September
  - A two-dose vaccine for children under two years of age will likely not be available until early 2022
- According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH, “It is likely and almost certain that by the time we get to the end of this calendar year and the first quarter of 2022 that we will have enough information regarding safety and immunogenicity to be able to vaccinate children of any age.”
Important: Please review the specific mask-wearing and COVID-19 prevention guidelines with your child’s school, camp, or daycare and then review them with your child

5. Q: If I am fully vaccinated* and immunocompromised, can I take off my mask?

Consult your physician.
- The CDC does not currently have a single recommendation for fully vaccinated* immunocompromised Americans.
  - The CDC’s “When You’ve been Fully Vaccinated” web page outlines what every fully vaccinated* American can do, and in the last section of the page, “What We’re Still Learning,” it states, “How well the vaccines protect people with weakened immune systems, including people who take immunosuppressive medications.”
  - Dr. Rochelle Walensky, Director of the CDC, stated in interviews following the May 13th press conference.
    - For certain underlying conditions, the vaccine works very well, as shown in long-term healthcare facilities.
    - However, science is emerging that the vaccine may not be as protective for the immunosuppressed, specifically.
      - Transplant patients on immunosuppressive medication
      - Cancer patients
        
        Undergoing chemotherapy
        
        Due to the disease itself
      - Dialysis patients
  - Candida Moss, author of the New York Times essay, “I’m a Vaccinated Transplant Recipient. I Don’t Have Antibodies. Now What?,” highlights how the 4% of Americans, who have been told by their healthcare professional that they are immunocompromised, have essentially been left behind by CDC and their fellow Americans.
  - Dr. Leana Wen, author of the Washington Post opinion, “The CDC shouldn’t have removed restrictions without requiring proof of vaccination,” argues that the CDC should revise their guidance to protect the immunocompromised and children under twelve by
    - Stating that fully vaccinated* people have no restrictions on their public activities if their vaccination status can be verified
      - “Stores, theaters, and restaurants can be full capacity, without masks, if they check vaccination status.”
    - Setting a level of community vaccination, i.e., “If 70% of the community is vaccinated, everyone can take off their masks, vaccinated or not.”
    - Wen is a staunch advocate for both a change in CDC masking guidelines and for “those who do not yet have immunity.”
  - As every one of the over thirteen million immunocompromised Americans knows, the spectrum of type and severity of immunosuppression varies greatly, and thus Cancer Sherpa recommends that you consult the healthcare professional who prescribes your immunosuppressive medication or treats the condition or disease that causes your immunosuppression. UNTIL THEN FOLLOW THE CDC GUIDELINES FOR UNVACCINATED AMERICANS TWELVE AND OVER. (See question 9)
  - Note: Immunocompromised children under twelve years of age are at the highest risk and should mask and follow all precautions recommended by their pediatrician.
  - Contact us if you need assistance!

6. Q: If I am fully vaccinated* and pregnant, do I need to wear a mask?

Individual Choice
- According to Dr. Rochelle Walensky, Director of the CDC, the decision to wear a mask during pregnancy after being fully vaccinated* is an individual one. She states that each fully vaccinated* pregnant woman should ask three questions:
  - How much risk are you willing to tolerate?
  - How hard is it for you to continue to wear a mask?
  - How much disease is in your community?
    - To find your local infection and vaccination rates visit the CDC’s COVID Data Tracker
- Pregnancy is considered an underlying condition that increases the risk of contracting COVID-19. Thus Cancer Sherpa recommends you wear a mask as much as possible, especially when indoors with potentially unmasked, unvaccinated people outside of your household.
- Contact us if you need assistance!

7. Q: If I am fully vaccinated*, is it safe for me to travel? Do I need a mask?

Yes, and here is what you need to know.
- Domestic Travel
  - Mask that completely covers the nose and mouth is required when awaiting, boarding, disembarking, or traveling on
    - Airplanes
    - Ships
    - Ferries
    - Trains
    - Subways
    - Buses
    - Taxis
    - Ride-shares
  - Mask that completely covers the nose and mouth is required in transportation hubs, including
    - Airports
    - Ferry and Bus Terminal
    - Train and Subway Stations
    - Seaports
    - U.S. Ports of Entry
    - All other locations where people board public transportation in the U.S. and U.S. Territories
  - No COVID-19 testing required before or after domestic travel
  - No self-quarantine after domestic travel
- International Travel
  - Departures
    - Mask requirements same as above
    - Need to pay close attention to the situation at your international destination before travel
    - Do NOT need to get tested for COVID-19 before departure UNLESS your destination requires it.
    - Need to show
      - Negative COVID-19 test result
      - Documentation of recovery from COVID-19 before boarding an international flight in the U.S.
    - Should still get tested 3-5 days AFTER international travel
    - Do NOT need to self-quarantine after arriving in the U.S.

8. Q: If I have only had the first dose of a two-dose vaccine, do I have to wear a mask?

Yes, and here is why:
- The two-dose COVID-19 vaccines create immunological memory of the virus’s spike proteins by priming immunological memory with the first dose and solidifying it with the second.
- According to Thomas Denny, Chief Operating Officer of the Duke Human Vaccine Institute and a Professor of Medicine at Duke University, says “You can think of it as a gradient.”
  - One dose of the Pfizer vaccine reduces the risk of symptomatic infection by ~50%
  - One dose of the Moderna vaccine reduces the risk of symptomatic infection by ~80%
  - Two doses (same brand) of either vaccine lowers the risk of symptomatic infection to ~95%
- It is unclear from current research how long and at what level immunity lasts only after receiving the first dose of a two-dose vaccine, thus it is important to follow mask guidelines for unvaccinated Americans twelve and over. (See Question 9)

9. Q: If I am not vaccinated, do I have to wear a mask?

Yes! Your risk for contracting COVID-19 has not changed.
- Outdoors
  - No Mask
    - Walk, run, or bike with members of your household
    - Attending small, outdoor gathering with fully vaccinated* family and friends
  - Mask-Up
    - Attend small, outdoor gathering with fully vaccinated* and unvaccinated people
    - Dine at an outdoor restaurant with friends from multiple households
    - Attend a crowded outdoor event
    - Live Concert or Performance
    - Festival
    - Parade
    - Sporting Event
  - Indoors
    - Mask-up for ALL indoor activities including a small, indoor gathering in your home with people outside of your household
    - Public and private transportation provided outside of the household

10. Q: Why do all the guidelines around masks keep changing?

The short answer is that the way the American school system teaches science gives the impression that science is static when, in fact, it is anything but…What we all accepted as finite back in our high school biology, chemistry, and physics classes was simply strong scientific theories that have yet to be disproven. Gravity is just a really solid guess, known as a hypothesis, made by Sir Isaac Newton at the turn of the eighteenth century that has yet to be disproven. Since the early 1700s, brilliant men and women of science have attempted to disprove Newton’s Law of Gravity through empirical experimentation. They failed to do so.

What does gravity have to do with masks, you ask? Well, because we were all led astray in school, we have come to believe that science, and in this case, specifically, medicine has all the answers and that they too are finite. That is not true. COVID-19 is a novel coronavirus (nCoV) because it is a new strain of the coronavirus that was not previously found in humans. Humans have encountered and contracted other coronaviruses for centuries, most recently, SARS and MERS. The research conducted and data collected on all of those previous coronaviruses allowed the scientific, medical, and pharmaceutical industries to act quickly and provide sound scientific guidance and develop vaccines to counter COVID-19 in under a year. The inactivated polio vaccine (IPV), developed by virologist Joseph Salk, took over twenty years to develop.

While the COVID-19 vaccine is hailed as a miracle of modern science, it is really the result of millions of research, trial, and treatment hours given by countless scientists, healthcare professionals, and patients. This community of people suffered innumerous setbacks, many that resulted in severe illness or death, but the world was not watching as closely as it is now. Science and medicine are as alive and evolving as the humans they seek to treat. Healthcare professionals and officials are continually striving to message all that they are learning as fast as they are learning it. What they learn today may not be true tomorrow, but we all need to be as informed as possible and do the best we can based on what we know.

*Fully Vaccinated – 2 weeks out from the second does in a 2-dose series (Pfizer and Moderna), or 2 weeks out from a single-dose vaccine (Johnson & Johnson)

The information contained in this post was sourced from the following:

05/13/21: Press Briefing by White House COVID-19 Response Team and Public Health Officials

America Dissected: Talking Science with Dr. Sanjay Gupta, Podcast 5/18/21

Concert Packing Guide: What to Bring To your First Music Festival Post-COVID, Rolling Stone 5/18/21

CNN: State of the Union: Interview with Dr. Rochelle Walensky, Transcript, Aired 5/16/21

Does my unvaccinated child still have to wear a mask when the rest of the family doesn’t?, American Academy of Pediatrics at healthychildren.org 5/21/21

I’m a Vaccinated Transplant Recipient. I Don’t Have Antibodies. Now What?, New York Times, 5/24/21

Is It Safe to Delay a Second COVID Vaccine Dose?, Scientific American, 2/10/21

Meet The Press with Chuck Todd, Aired 5/16/21

Opinion: The CDC shouldn’t have removed restrictions without requiring proof of vaccination, Washington Post, 5/13/21

PBS Newshour, Aired 5/13/21

Requirement for Face Masks on Public Transportation Conveyances and at Transportation Hubs, CDC Website Updated 5/23/21