Why not just tell everyone to mask up?

Health experts questioning CDC’s nuanced messaging

An internal presentation circulated within the Centers for Disease Control and Prevention last month, and obtained by the New York Times, offered clear advice for countering the contagious delta variant of the coronavirus: “Given higher transmissibility and current vaccine coverage, universal masking is essential.”

But the recommendation issued by the agency was considerably more nuanced, advising Americans, vaccinated or not, to wear masks in indoor public settings in areas with “substantial” or “high” virus transmission.

At the time, that included at least 80 percent of Americans. As infection rates soar, some experts are now wondering: Would it have made more sense just to call for everyone to mask up?

“Given the rising rates across the country, the clearer message would be, ‘In all parts of the country, wear a mask in public indoor settings,’ ” said David Michaels, professor of environmental and occupational health at the Milken Institute of Public Health at George Washington University.

In addition to Americans in COVID19 hot spots, CDC officials also recommended universal indoor masking for teachers, staff, students and visitors to schools, regardless of where they are and regardless of individual vaccination status.

And the agency suggested that people “might choose to mask regardless of the level of transmission” if they or someone in their household were immunocompromised or at increased risk for severe disease — or unvaccinated, a category that includes all children younger than 12, who do not qualify for immunization.

Also on the list: people who are overweight, smoke or have a disability, and anyone who has been in close contact with someone with confirmed or suspected COVID-19. That’s a lot of Americans.

“The messaging from the CDC was less than optimal,” said Dr. Ezekiel Emanuel, vice president for global initiatives at the University of Pennsylvania. “We need to be clear and relatively simple about it.”

Advice on masking from federal health officials has been changing through out the pandemic. In February 2020, Americans were urged not to buy masks, which were in short supply. In April 2020, officials recommended that masks should be worn outside the home. In May of this year, the CDC said vaccinated people no longer needed to wear masks.

Agency officials did not respond to requests for comment about the latest revised recommendations. But the agency’s director, Dr. Rochelle Walensky, has said she was compelled by early data indicating that the delta variant had changed the equation and that vaccinated individuals could spread the virus on the rare occasions when they were affected.

A significant piece of evidence emerged from an outbreak in Provincetown, Massachusetts, over the Fourth of July weekend. Nearly 1,000 people were infected, the majority of whom were fully vaccinated.

But many Americans have no idea week to week whether they live in a community with substantial or high transmission of the virus.

In many communities, mandates are gaining traction, and already the nuances about transmission rates and existing health conditions have been left aside. It’s easy to see why: As of Tuesday, the virus was spreading rapidly in 90 percent of the country. And masking is swiftly effective.

Masks “are actually amazing, because they work immediately — they start reducing transmission today,” said Julia Raifman, an assistant professor at Boston University’s School of Public Health. “Every case they prevent prevents several other cases, so their effectiveness grows over time.”