CLEVELAND, Ohio – Most U.S. mask orders have been lifted, and new coronavirus infections and hospitalizations have slowed to a trickle in Ohio. Yet the World Health Organization has recommended that everyone wear a mask indoors, even those who’ve been vaccinated.
What’s the responsible person to do?
The Delta variant of the coronavirus has complicated the conversation about face masks. The variant, also known as B.1.617.2, is causing concern around the world because it’s more contagious than the original strain of the virus. It’s responsible for a spike in infections in India and the U.K. and has now become the dominant strain in the U.S.
As a result, the World Health Organization is recommending that everyone should wear masks indoors. Officials in Los Angeles and the St. Louis area have issued the same guidance, though they are largely alone in this country. The U.S. Centers for Disease Control and Prevention has continued to say only those who are unvaccinated should wear a mask. And there have been no new mask-wearing orders from Ohio Gov. Mike DeWine.
The various guidance is creating confusion for many individuals. But health experts told cleveland.com the varied guidance is due to the fact WHO, CDC and local officials are offering advice to different audiences.
The WHO is taking a more cautious approach than the CDC because other parts of the world do not have access to the vaccine the way the U.S. does. And infections doubled recently in Los Angeles County, prompting officials there to recommend a return to masks.
The various recommendations are confusing, but they’re also “the right thing to do,” said Dr. David Dowdy, an associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health.
“It’s important for people to recognize that there is going to be some confusion here, because the right message is not a one-size-fits-all message,” Dowdy said. “Just because the WHO is saying something doesn’t mean everyone in the world should be acting the exact same way. It’s just that they have to provide very broad level guidance.”
The issue, experts noted, is that different messages can confuse someone who is simply reading headlines in the news without considering that context. The confusion could diminish someone’s trust in public health guidelines.
That could also make it a harder sell if the Delta variant causes infections to spike in an area, and health officials there need to recommend a return to masks, said Ryan Demmer, an epidemiologist at the University of Minnesota’s School of Public Health.
“There’s so much political division over a lot of these policies that I think we have to make really clear decisions that minimize the appearance there’s inconsistency,” Demmer said.
Experts acknowledged it could be a tough sell to get everyone to wear a mask again. Many were staunchly opposed to them in the first place. And anyone who’s been vaccinated is at lower risk of infection and severe illness, so they might be hesitant to go back to a restriction that does little to benefit them.
However, most experts believe that if push comes to shove, even those who’ve been vaccinated would be willing to wear a mask if it protects others. If they followed the science before, they’re likely to do it again, said Richard Petty, a psychology professor at Ohio State University.
“I think many of the people who were wearing it before … would understand the argument of why it’s still in the interest of public health and do it again, even if it doesn’t necessarily benefit you personally,” Petty said.
Why are vaccinated individuals being asked to wear masks?
Data has shown the COVID-19 vaccines greatly lower the risk of the Delta variant. The Pfizer, Moderna and Johnson & Johnson vaccines have all been found to be effective at preventing an infection, and they’re even more effective at preventing severe illness, hospitalization and death.
But it’s clear the Delta variant poses a significant risk to anyone who hasn’t been vaccinated, including more than half of Ohio residents. Data has shown it’s 40% to 60% more transmissible than other variants, while at least one study from The Lancet found it causes more severe disease.
It’s still a little unclear how the vaccines affect someone’s ability to pass the virus on to someone else, said Dr. Joseph Khabbaza, a pulmonary and critical care physician at the Cleveland Clinic. But he believes the possibility is slim, because the vaccines reduce someone’s viral load and the severity of their symptoms even if they develop a “breakthrough” infection.
“I think, in general, a fully vaccinated person with a normal immune system is going to be extremely unlikely to be transmitting any COVID-19 virus, Delta or not,” Khabbaza said.
The biggest reason some health officials are asking everyone to wear a mask again is because it’s simply easier than singling out the unvaccinated, experts said. It eliminates the need to verify someone’s vaccination status before they enter a store or a restaurant, especially as so-called “vaccine passports” have become a political flashpoint.
Wearing a mask is also a less-restrictive option to protect public health than other measures, such as limiting capacity at a business, Dowdy said.
Could we return to masks in Ohio?
At the moment, experts don’t think Ohio needs to return to any kind of mask guidance. Unless a variant that is even more dangerous than Delta emerges, the risk to anyone who’s been vaccinated is relatively low.
“If you’re vaccinated, I can’t imagine a scenario, at least anytime in the near future, where we have to lose sleep over COVID like we did in the pre-vaccine days,” Khabbaza said.
However, masks could be needed if data shows the Delta variant is causing a spike in the Buckeye State. Demmer said he would keep an eye on hospitalizations and deaths; if they start to increase, officials may need to consider some restrictions.
Dowdy said he’d look for trends in the data, rather than certain benchmarks. For example, it could be a warning sign if infections double in a week the way they did in Los Angeles County.
“I don’t think that we’re in a situation where we’re never going to see cases go up again,” he said. “We can’t just hang up our shoes and say that it’s over and we’ve done our jobs.”
The trouble with varied messaging
One of the first rules of messaging is to keep it simple and consistent, Petty said. Offering different advice for different areas or parts of the world might make sense in practice, but it does create confusion and undermines public trust.
“It creates conflict when people don’t parse out exactly why one advice is being given in one place [versus] another,” Petty said.
However, experts generally agree that if there comes a time when masks are needed again in Ohio, even those who are vaccinated would probably wear one again. Although they’re at lower risk, they’d likely respond to the argument that they’re helping to protect others and being a good citizen, Petty said.
Ultimately, experts think that anyone who was willing to wear a mask before would probably be willing to do it again, regardless of whether they’ve been vaccinated.
“I think the old axion that past performance is the best predictor or future performance tells us that people who listen to guidelines are generally going to continue to do it, and people who don’t are probably going to continue to resent [them],” Demmer said.