We’re now getting more information about what new data was behind the CDC’s revised guidance on COVID-era masking. An internal power-point presentation was shared with The Washington Post and the CDC will apparently be making a public presentation today. One key datapoint seems to be an apparent super-spreading event on July 4th in Provincetown, Massachusetts which suggests very efficient spread of COVID among vaccinated people. As you know, I have followed the emerging data very closely. There’s so much conflicting data on transmissibility and even what constitutes transmission and infection (more on that later) that it’s really, really hard to know what’s happening. I would say the more you dig into the data the more confusing it gets, not less. With all that said though it’s clear that Delta COVID is much more transmissible than earlier versions and that available vaccines, while still very effective, are not as effective as they appeared to be and likely were even a couple months ago.
That sucks. But here we are.
But I wanted to flag another article in the Post to your attention. It’s an opinion piece by Leana S. Wen, a physician and former Public Health Commissioner for the City of Baltimore, who’s been a prominent public voice during COVID. Wen’s argument is essentially this: Yes, there seems to be new data that vaccinated people can transmit the virus. But the vast majority of transmission is still being done by the unvaccinated. So why are the vaccinated being asked to mask up again when they are clearly not the main problem?
Let me quote Wen …
The CDC is also trying to urge localities and businesses to reimplement indoor mask requirements given surging coronavirus infections. That’s the right policy, but it’s using the wrong explanation. The vaccinated are not a major source of spread. Even if every vaccinated person puts on a mask, that’s not going to solve things when the vast majority of transmission is by the unvaccinated.
And that is the actual problem that the CDC is trying to solve: It wants to get the unvaccinated to put on masks in indoor spaces. Without proof of vaccination, the only way to reliably to do this is to ask the vaccinated to also don our masks. Relying on the honor system was a big fail, and the best way to curb the current surge is to get everyone to mask up again.
That’s what the CDC should have announced: We need a return to indoor mask mandates not because the vaccinated are suddenly a problem, but because we don’t trust the unvaccinated to voluntarily do the right thing. It’s not a commentary about the effectiveness of the vaccine, or even the trickiness of the delta variant, but rather about the failure of unvaccinated Americans to fulfill their societal obligation to act in the interest of everyone’s health.
I don’t know what the people at the CDC ‘mean’ or ‘want’. And I think Wen may be understating at least a bit how much Delta is a genuinely new factor. But Wen is certainly right about about the big picture. We are continuing to rely on the responsible to pick up the pieces for the irresponsible. We haven’t been able to count on the voluntarily unvaccinated to get vaccinated. We can’t rely on them to wear masks to limit the impact of their irresponsibility on others. We can’t even rely on them to be honest enough to abide by a masking policy only for the unvaccinated. So we’re left with arguably over-broad guidance and continued unclarity about why all of this is happening.
As I’ve been saying for some time, the problem with our policy is that we are not doing enough to place the burden of non-vaccination squarely on the voluntarily unvaccinated. That is both the most equitable and the most effective approach. Here though we can see that public authorities’ effort to work around the problem of the irresponsibility of the unvaccinated actually manages to bring them into a sort of public contempt. The science clearly has changed with the Delta variant. It’s much more transmissible. But the problem remains that Delta is spreading like wildfire among the unvaccinated and it’s lapping up onto the shores on vaccinated America.
So just as we’ve gotten the balance off by having the vaccinated shoulder the burden created by the unvaccinated, we now have public health authorities bringing their own authority into contempt because of too aggressive coddling of the unvaccinated. So now they’re picking up the burden for the unvaccinated too – not at the cost of daily inconveniences but at the cost of their public authority. We all suffer for that.
We need to be placing the burdens on non-vaccination on the unvaccinated. And we need to be clear with the public that the problem is the non-vaccinated. They’re at fault. They’re to blame. And even more, the public influencers, celebrities and political actors who’ve driven resistance to vaccination are to blame.