The CDC’s new mask guidelines finally got it right

The CDC’s new mask guidelines finally got it right

Leana S. Wen — Read time: 4 minutes

A customer waiting to enter a restaurant in San Francisco on Feb. 15. (David Paul Morris/Bloomberg News)

February 25, 2022 at 6:57 p.m. EST

The CDC finally got masking right. After months of pleading from governors, local officials, educators and health experts, their new recommendations make clear that masks are no longer required in much of the United States — including in most schools.

Previously, the Centers for Disease Control and Prevention’s sole determining factor for whether a community needed to implement masking was case counts. This made sense in 2020 and early 2021, when surges in infections invariably led to overwhelmed hospitals and deaths. But vaccines have rendered covid-19 far less severe. In areas with high levels of immunity from vaccination or prior infection, cases can be high, but hospitalizations remain low. The risk to society now correlates with severe infection, not positive tests, so it’s reasonable to shift the threshold for government-imposed restrictions.

The CDC’s new metrics are predominantly based on covid-19 hospitalizations as well as hospital capacity. Because severe illness lags infection by one to two weeks, the CDC also takes into account community infection rates. For example, there is a lower threshold of hospitalizations needed to trigger masking if the overall infection rates are more than 200 cases per 100,000 people in the past seven days.

Importantly, the guidelines leave open the possibility that these metrics might need to change in the future should a new variant arise that escapes vaccine immunity. Instead of viewing masking as an on-off switch, the CDC makes the case that mitigation measures are more like a dial. Depending on changing circumstances, restrictions can be turned up or down.

Beyond the rationale for the revision, the CDC deserves recognition for its newfound clarity of messaging. I appreciated the easily understood orange, yellow and green categorizations: When concern for severe illness is very high (orange), everyone should mask; when they are low (green), everyone could unmask; in between (yellow), people can decide whether to mask depending on their medical circumstances and risk tolerance.

I especially applaud the CDC for its bold — albeit overdue — stance on masking in schools. It was poor policy for some states to drop virtually all indoor mask mandates but continue imposing them in schools, when children are at far lower risk from the virus and, unlike adults, could experience harm from prolonged masking. The CDC isn’t going so far as to say that schools should end masking, but is recommending that mask requirements in schools align with the rest of the communities they are in.

At current rates, about 70 percent of Americans live in green or yellow zones. That means about 70 percent of students are in schools that could end mandatory school masking now. This is a dramatic change from the CDC’s prior guidance, which — when based only on case counts — would have required masking in more than 96 percent of the country and virtually all schools.

The revised guidance will surely anger people on both sides. Some will argue that the CDC should have ended mandatory masking altogether and that masks should be a matter of individual choice everywhere. I don’t think this is a responsible stance, because masks — especially high-quality N95, KN95 or KF94 masks — remain an important tool to prevent disease transmission and ensuring that hospitals are not overwhelmed. More dangerous variants might emerge, and federal health officials need to set the expectations that masks might be needed in the future.

Others will be upset that the changes go too far and leave behind the immunocompromised and children under 5. I understand the frustration; it is unfair that many will get to move on to reclaim normalcy while some cannot. But there is a cost to keeping blanket restrictions in place.

Plus, there are other ways to protect vulnerable populations. The Biden administration must commit to doing far more to make antiviral treatments and preventive antibodies available to them. The federal government should make N95s or their equivalent widely accessible and free of charge to all who want to keep masking. Businesses can also do their part, for example, by designating specific hours for shoppers during which everyone must don high-quality masks.

No matter what guidance the CDC released, it would been accused of going too far or not far enough. This time, I think it has it about right. Of course, I wish this guidance arrived a few weeks earlier, before governors took it upon themselves to remove mandates in nearly all states. Still, it’s better late than never, and I’m relieved that the CDC has finally signaled that we need to live with covid-19 and remove restrictions while we can, with the understanding that they might need to return in the future.