I see you stayed clear of J&J Vs Pfizer/Moderna. I am sure that was by design given that the main point you are trying to make is that Vaccines work. However, wouldn’t it be good to map the breakthroughs to vaccines to maybe arrive at a booster decision sooner . I am hoping someone smarter than me already has a plan for the same!
You’ve been critical of early attempts at messaging that were intended to (for lack of a better word) manipulate people (for example, saying masks don’t work in order to preserve supplies for healthcare workers). To me this latest CDC guidance shows they’ve learned that lesson a bit. As it’s become clear how effective the vaccines are, it’s become less and less defensible to mandate masks for the vaccinated, so I think the CDC is building credibility here by saying that openly, instead of yielding to the pressure to maintain mandates that no longer make much epidemiological sense.
Something the new CDC mask guidelines brought up by way of one of their exceptions, which I have seen relatively little discussion about, is mass transit.
I understand the health-care exceptions, hospitals and care facilities are full of vulnerable people, and presumably also higher densities of infectious people in their COVID wards, in the case of hospitals.
I am less clear on the mass-transit exception. From the beginning of the pandemic, I have occasionally seen articles explaining that subway cars in particular fully exchange their air in relatively short periods of time. I saw one about Boston "T" cars that I think said 90 seconds to fully exchange the air, and I have a bookmarked link to one from the Washington Metropolitan Area Transit Authority explaining that Metro cars fully refresh their air every three minutes.
This makes transit train cars seem to me similar to a well-ventilated indoor space, so the safety angle would then depend on how crowded it is, which for the Washington Metro in particular these days, is "not crowded at all".
There's all kinds of "buts" to this though.
I don't actually know if "fully refreshing air every three minutes" is impressive or not. How often does a well-ventilated building fully refresh its air? Metro cars are currently not crowded at all, but presumably there's some level of crowding that creates an infection danger greater than can be remediated by the ventilation system?
Also, there are secondary effects. While underground, metro cars exchange their air with the air in the tunnel, and the following train exchanges its air with exhaust from the leading train, so maybe air-exchange isn't a good metric at all?
I'm a fan of transit, when full-time on-site work resumes I will want to resume my metro commute, but I'm not finding a lot of hard data on transit safety vs. airborne contagion.
This makes sense that the vaccine is doing precisely what it is supposed to do to protect the vaccinated Yankees, but I'm unclear what the implications are for the unvaccinated (children, hard to reach communities, etc.) and immunocompromised in light of the relaxation on masking. Let's hypothetically say the coach, who is presumed to be the the source, had gone to Costco unmasked (per the new guidelines) either right before he had symptoms or thinking he just had his seasonal allergies. Since he managed to pass on the virus to 7 others (the team members, who stomped it out due to vaccination), should we presume he would have been able to pass it on to more vulnerable citizens at Costco who would not have fared as well? Or is that the wrong way to think about it?
How do you think about the risk of a vaccinated individual with covid eventually experiencing long haul covid symptoms like persistent fatigue or brain fog? I've heard this can follow even asymptomatic infections. Is this simply very unlikely, such that it isn't worth worrying about for most vaccinated people?
The CDC has been totally non-transparent about all their advice and decisions. I can imagine a good explanation: it now estimates that the difference between the likelihood of a masked vaccinated person transmitting the disease compared to the likelihood of an unmasked person transmitting the disease is so miniscule, that the benefits do not outweigh the also miniscule costs of wearing a mask. [I assume a mask protects the mask wearer far less (essentially zero) than it protect other FROM the wearer.]
Instead, we are left wondering what kind of cost benefit analysis they did to come up with this decision like so many other questionable decisions: not promoting screening of asymptomatic people, not delaying the second shot, the J&J "pause," not approving the Astra Zeneca vaccine on the basis of UK tests and experience.
So I feel torn about masking up. I advocated masks before the CDC recommended them. I urged my friends to follow the science, mask up, and practice social distancing. I offended some family members because I refused to attend an indoor gathering while COVID was raging. Now the CDC tells me to unmask. On the one hand, I believe I should to keep my messaging consistent. On the other hand, I live in an area where vaccination resistance is really high. I am fine with unmasking outdoors. I feel uncomfortable unmasking indoors. I also do not feel like going to a large family gathering indoors where most of the people are not vaccinated. I want to demonstrate that I trust the vaccine, and I want to follow the science. What is the science here?
I am concerned that this sudden change of CDC policy 1- is unenforceable as we have no vaccine passports ; 2- occurred w/o much apparent consultation/notification of states, unions, industry, etc; 3- was done in such a sudden manner that states, businesses, etc had no time to prepare 4- could well end up backfiring in that people who never really wanted to get the vaccines but were thinking about it will now feel it unnecessary; 5- could result in our downward curve to start going up again.
In such an incautious sudden policy change, if it turns out to have been a mistake, how can the CDC recover from it? In terms of both its credibility and also in terms of new, more cautious guidance?
This is a great vaccine but I fear that this new policy will backfire- on the CDC and all of us.
Wait, I missed the basic argument for the CDC to continue recommending masking? That there are some demographics that somehow can't find a vaccine despite doses being free and easily available at several locations in most towns? Doesn't seem like reason enough to ask everyone to perform the charade of wearing a mask when the chance they will contract and/or transmit the virus is very small.
Or is it that anti-vaxxers will also feel more free to remove their masks? I honestly don't know how many anti-vaxxers were masking to begin with, and I have no idea what messaging is best to reach them. I don't think the CDC knows, either. I think they've chosen the reasonable path of just telling the truth and offering reasonable guidance. If unvaccinated people chose not to follow the guidance and also unmask, is that a problem with the guidance or a problem with those people?
I think the reason the announcement was abrupt is that the CDC messed up the first announcement. They shouldn't have made it so complicated and made vaccination seem useless. They realized they were overly conservative and reversed course.
But why do the vaxed need a mask? Even if they are around the unvaxed, what risk do they face? Maybe they shouldn't be in a mixed choir, but otherwise?
And about vaxing kids: the way I read it, the mortality risk to an unvaxed healthy child is less than that of a vaxed senior. Shouldn't we be sending those doses to places with lots of unvaxed seniors?
Just out of curiosity. Are the drug companies still following the original participants of the drug trials? I hope so as one of the unknowns is how long the vaccine will remain effective. At what point might it be determined that an additional booster is needed? What recommendations does the CDC have for fully vaccinated people who get COVID? Get a booster? Do nothing? Go hang gliding? We still have a little over 40,000 new cases each day. What do we know about those new cases? What are the demographics? If you have been vaccinated but are living in a hot spot, do the new recommendations still apply?
This morning, as I go about normal errands, I see that there remains a lot of confusion about what’s acceptable and what’s not. Many people, inside and out, continue masking. Not sure what’s peer pressure or force of habit, and what’s inability to tell if “this is an OK place.”
I’m going masked if for no other reason than not to stand out. State-level guidance is definitely well behind the CDC.
I see you stayed clear of J&J Vs Pfizer/Moderna. I am sure that was by design given that the main point you are trying to make is that Vaccines work. However, wouldn’t it be good to map the breakthroughs to vaccines to maybe arrive at a booster decision sooner . I am hoping someone smarter than me already has a plan for the same!
You’ve been critical of early attempts at messaging that were intended to (for lack of a better word) manipulate people (for example, saying masks don’t work in order to preserve supplies for healthcare workers). To me this latest CDC guidance shows they’ve learned that lesson a bit. As it’s become clear how effective the vaccines are, it’s become less and less defensible to mandate masks for the vaccinated, so I think the CDC is building credibility here by saying that openly, instead of yielding to the pressure to maintain mandates that no longer make much epidemiological sense.
Something the new CDC mask guidelines brought up by way of one of their exceptions, which I have seen relatively little discussion about, is mass transit.
I understand the health-care exceptions, hospitals and care facilities are full of vulnerable people, and presumably also higher densities of infectious people in their COVID wards, in the case of hospitals.
I am less clear on the mass-transit exception. From the beginning of the pandemic, I have occasionally seen articles explaining that subway cars in particular fully exchange their air in relatively short periods of time. I saw one about Boston "T" cars that I think said 90 seconds to fully exchange the air, and I have a bookmarked link to one from the Washington Metropolitan Area Transit Authority explaining that Metro cars fully refresh their air every three minutes.
(Link:https://twitter.com/wmata/status/1393291680896458757)
This makes transit train cars seem to me similar to a well-ventilated indoor space, so the safety angle would then depend on how crowded it is, which for the Washington Metro in particular these days, is "not crowded at all".
There's all kinds of "buts" to this though.
I don't actually know if "fully refreshing air every three minutes" is impressive or not. How often does a well-ventilated building fully refresh its air? Metro cars are currently not crowded at all, but presumably there's some level of crowding that creates an infection danger greater than can be remediated by the ventilation system?
Also, there are secondary effects. While underground, metro cars exchange their air with the air in the tunnel, and the following train exchanges its air with exhaust from the leading train, so maybe air-exchange isn't a good metric at all?
I'm a fan of transit, when full-time on-site work resumes I will want to resume my metro commute, but I'm not finding a lot of hard data on transit safety vs. airborne contagion.
This makes sense that the vaccine is doing precisely what it is supposed to do to protect the vaccinated Yankees, but I'm unclear what the implications are for the unvaccinated (children, hard to reach communities, etc.) and immunocompromised in light of the relaxation on masking. Let's hypothetically say the coach, who is presumed to be the the source, had gone to Costco unmasked (per the new guidelines) either right before he had symptoms or thinking he just had his seasonal allergies. Since he managed to pass on the virus to 7 others (the team members, who stomped it out due to vaccination), should we presume he would have been able to pass it on to more vulnerable citizens at Costco who would not have fared as well? Or is that the wrong way to think about it?
Hi Zeynep, thanks as always for a great article.
How do you think about the risk of a vaccinated individual with covid eventually experiencing long haul covid symptoms like persistent fatigue or brain fog? I've heard this can follow even asymptomatic infections. Is this simply very unlikely, such that it isn't worth worrying about for most vaccinated people?
The CDC has been totally non-transparent about all their advice and decisions. I can imagine a good explanation: it now estimates that the difference between the likelihood of a masked vaccinated person transmitting the disease compared to the likelihood of an unmasked person transmitting the disease is so miniscule, that the benefits do not outweigh the also miniscule costs of wearing a mask. [I assume a mask protects the mask wearer far less (essentially zero) than it protect other FROM the wearer.]
Instead, we are left wondering what kind of cost benefit analysis they did to come up with this decision like so many other questionable decisions: not promoting screening of asymptomatic people, not delaying the second shot, the J&J "pause," not approving the Astra Zeneca vaccine on the basis of UK tests and experience.
So I feel torn about masking up. I advocated masks before the CDC recommended them. I urged my friends to follow the science, mask up, and practice social distancing. I offended some family members because I refused to attend an indoor gathering while COVID was raging. Now the CDC tells me to unmask. On the one hand, I believe I should to keep my messaging consistent. On the other hand, I live in an area where vaccination resistance is really high. I am fine with unmasking outdoors. I feel uncomfortable unmasking indoors. I also do not feel like going to a large family gathering indoors where most of the people are not vaccinated. I want to demonstrate that I trust the vaccine, and I want to follow the science. What is the science here?
I am concerned that this sudden change of CDC policy 1- is unenforceable as we have no vaccine passports ; 2- occurred w/o much apparent consultation/notification of states, unions, industry, etc; 3- was done in such a sudden manner that states, businesses, etc had no time to prepare 4- could well end up backfiring in that people who never really wanted to get the vaccines but were thinking about it will now feel it unnecessary; 5- could result in our downward curve to start going up again.
In such an incautious sudden policy change, if it turns out to have been a mistake, how can the CDC recover from it? In terms of both its credibility and also in terms of new, more cautious guidance?
This is a great vaccine but I fear that this new policy will backfire- on the CDC and all of us.
Wait, I missed the basic argument for the CDC to continue recommending masking? That there are some demographics that somehow can't find a vaccine despite doses being free and easily available at several locations in most towns? Doesn't seem like reason enough to ask everyone to perform the charade of wearing a mask when the chance they will contract and/or transmit the virus is very small.
Or is it that anti-vaxxers will also feel more free to remove their masks? I honestly don't know how many anti-vaxxers were masking to begin with, and I have no idea what messaging is best to reach them. I don't think the CDC knows, either. I think they've chosen the reasonable path of just telling the truth and offering reasonable guidance. If unvaccinated people chose not to follow the guidance and also unmask, is that a problem with the guidance or a problem with those people?
I think the reason the announcement was abrupt is that the CDC messed up the first announcement. They shouldn't have made it so complicated and made vaccination seem useless. They realized they were overly conservative and reversed course.
But why do the vaxed need a mask? Even if they are around the unvaxed, what risk do they face? Maybe they shouldn't be in a mixed choir, but otherwise?
And about vaxing kids: the way I read it, the mortality risk to an unvaxed healthy child is less than that of a vaxed senior. Shouldn't we be sending those doses to places with lots of unvaxed seniors?
Just out of curiosity. Are the drug companies still following the original participants of the drug trials? I hope so as one of the unknowns is how long the vaccine will remain effective. At what point might it be determined that an additional booster is needed? What recommendations does the CDC have for fully vaccinated people who get COVID? Get a booster? Do nothing? Go hang gliding? We still have a little over 40,000 new cases each day. What do we know about those new cases? What are the demographics? If you have been vaccinated but are living in a hot spot, do the new recommendations still apply?
This morning, as I go about normal errands, I see that there remains a lot of confusion about what’s acceptable and what’s not. Many people, inside and out, continue masking. Not sure what’s peer pressure or force of habit, and what’s inability to tell if “this is an OK place.”
I’m going masked if for no other reason than not to stand out. State-level guidance is definitely well behind the CDC.
The Yankees also got the J and J vaccine, and predictably many see this as “evidence” the shot is less effective.