Is it time for the vaccinated to mask up again?

Man, I’ve really enjoyed largely mask-free living for the past bit.  But, damnit, I’m really starting to think that Delta and dramatically-rising case counts should probably put an end to that.  Why?  Because I still really don’t want to get Covid and it seems that pretty soon here, there’s going to be a non-trivial amount of Covid circulating around here and the vaccines, awesome as they are, are certainly not perfect.  Delta’s transmissibility seems to be so high because people are shedding just ridiculous amounts of virus.  Again, usually, the vaccines still work great, but I think I’d rather not count on usually when there’s still so many infected, unvaccinated people running around spreading disease.  There was a really good Slate article on these breakthrough cases:

The most important thing to realize is that breakthrough cases are going to continue to surface in our lives. “The goal was never to eradicate COVID from being annoying—it was to eradicate it from being a killer,” said Dara Kass, an emergency medicine physician in New York. (She emphasized, again, that the vaccines are very good at doing the latter.) And so even while you have likely heard that breakthrough cases are “rare,” that’s a subjective assessment that is probably worth adjusting upward. There hasn’t been a firm percentage available beyond these vague characterizations—and the CDC is only tracking breakthrough cases that result in hospitalization or death, a decision a Harvard doctor called “disappointing” on the medical school’s blog. But medical professionals are starting to think about this more and more, and the suspicion is that they will happen with increasing frequency—and we shouldn’t be surprised when we do…

Another disconnect is what we think of as “severe illness” and what is actually severe illness. My colleague said he could not imagine describing the illness he had experienced as anything other than “severe”—he was unable to do anything for 36 hours and said it was on par with having debilitating food poisoning. But when I asked a couple doctors about this, they disagreed with his ranking. “Technically, it sounds like he had a mild bout of COVID-19, by strict case definitions,” emergency physician and sometime Slate contributor Jeremy Samuel Faust wrote to me. “Mild does not mean pleasant. In fact, you can have fever, chills, body aches, and feel downright terrible for a week or more and still be categorized as ‘mild.’ ”

To approach even a moderate (or severe) case of COVID, “there must be significant lung involvement as evidenced by low oxygen levels, for example,” Faust said. “It really can be miserable. But you’re at home, not in the ICU.”

Hanage told me that a vaccinated friend of his had just had a mild case that lasted fourdays. And that still means the vaccines are doing what scientists like him believed they would. “Vaccination effectively removes the threat of nationally overburdened healthcare—even though locally serious outbreaks remain not only possible but likely,” he said.

Yeah, so, on a population level, the vaccines are doing great and saving lives, but I still don’t want to be laid up with a nasty disease circulating around if avoiding it can be much more likely just by wearing a mask when around potentially unvaccinated people.  Katherine Wu had a really, really good piece on this, “4 Reasons I’m Wearing a Mask Again
Our vaccines are extraordinary, but right now they need all the help they can get.”

Most post-vaccination infections, or breakthroughs, appear to be asymptomatic or mild, a sign that the vaccines are doing their job. But mild illness still isn’t desirable illness, especially given the threat of long COVID, which reportedly can happen in vaccinated people, though researchers aren’t yet sure how widely.

Masks slash the risks of all these outcomes. Breakthroughs are more common when the immune system faces a ton of inbound virus—when there’s an ongoing outbreak, or when the people around me aren’t immune. A mask reduces my exposure every time I wear one. Some variants, including Delta, might be more transmissible, but they’re still thwarted by physical barriers such as cloth…

3. I trust the vaccines, but I understand their limits.

My pivot back to masks says nothing about my continued confidence in the vaccines and what they’re capable of. But although vaccines are an excellent tool, they are also an imperfect one, and they’ll perform differently depending on the context in which they’re used.

Consider, for example, the effectiveness of sunscreen, another stellar yet flawed preventive. Certain brands, including those with higher SPF, will be better than others at blocking burns and cancer. Mileage may vary even with the same tube of sunscreen, depending on who’s using it (how much melanin is in their skin?), how they’re behaving (are they dipping in and out of the shade, or spending all day soaking up rays?), and local conditions (is it a cloudy day in a wooded park, or a sunny day on a snow-speckled hill?). Vaccines are similar. Breakthroughs are more likely in people with a weakened immune system and those who mingle frequently with the virus; they may happen more often with certain variants.

Asking a vaccine to shoulder the entire burden of protection felt all right a month ago, when case rates were plunging. Now they’re ticking back up. The vaccines don’t feel different, but the conditions they’re working in do. Maybe now’s not the best time to rely on them alone. “That’s putting a lot of pressure on the vaccines,” Jason Kindrachuk, a virologist at the University of Manitoba, told me. The virus has upped the ante, and I feel the urge to match it. When it’s extra sunny out, I’m probably going to reach for sunscreen and a hat…

4. Wearing an accessory on my head doesn’t feel like a huge cost to me.

Don’t get me wrong. I don’t enjoy wearing a mask, and all else equal, I’d still prefer to keep it off. But for me, it’s not a big sacrifice to make for a bit more security: I’ll mainly be using one indoors when I’m around strangers, a situation in which the risk of spread is high. And I’ll keep checking pandemic conditions like I would a weather forecast—hospitalizations, variants, immunization rates, and the behaviors of people around me—and adjust as needed. The idea is that this state of affairs will be short-lived, until vaccinations climb and the virus retreats again.

That all strikes me as a very well-reasoned and sensible take.  Here’s in NC, we’ve got from a 2% positive test rate to around 7% in just 4 weeks.  That’s not great.  Wake County is still at 3%, so I’m not exactly freaked out here, but I do agree with Wu that it’s probably time to adjust mask-wearing to the Covid conditions around. 

About Steve Greene
Professor of Political Science at NC State

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