CDC’s new approach to COVID means most Americans can go without masks
The Washington Post February 26, 2022
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The Centers for Disease Control and Prevention eased mask recommendations for the vast majority of the country Friday under a new framework to monitor the coronavirus that immediately affects about 70% of Americans — a process that state and local officials had already begun amid demands for a return to normalcy.
The new guidelines, which took effect Friday, reflect the administration’s view that the United States has entered a different, potentially less dangerous phase of the pandemic. The change follows a relaxation of restrictions by most Democratic governors responding to nosediving case counts and public pressure, and well after most Republican governors.
CDC officials said the shift reflects the reality that after more than two years of living with the virus, most communities have greater protection against severe disease because of widespread immunity gained from both vaccinations and infections, as well as the increased availability of treatments, testing and higher-quality masks.
Officials said the guidelines will not immediately affect mask orders on public transportation. Americans will still be required to wear face coverings on buses, trains and planes until a decision is made closer to March 18, when the order is set to expire.
Schools are included in public settings where masking and testing may not be necessary if the COVID-19 disease risk is low based on the new metrics. If districts follow the guidelines, nearly 19 million children who are now required to wear masks could be allowed into school without them.
CDC Director Rochelle Walensky said the new guidelines, which classify the country into low, medium and high levels of disease, provide individuals with an understanding of what precautions they should consider based on the level of disease in their community, their underlying risk, and their own risk tolerance.
She stressed the new approach was also flexible and could be dialed up or down if an evolving virus posed new challenges.
“None of us knows what the future may hold for us and for this virus,” she said. “We need to be prepared and ready for whatever comes next. We want to give people a break from things like mask-wearing, when levels are low, and then have the ability to reach for them again, should things get worse in the future.”
The new approach is expected to be less disruptive to daily life at a time when cases and hospitalizations across the United States have plummeted, with the seven-day average of new cases now near 70,000, the lowest since late October and a drop of more than 85% from the end of January. Hospitalizations have dropped by nearly two-thirds, with under 55,000 covid patients.
Instead of focusing on eliminating transmission of the virus, the framework is aimed at preventing hospitals and health care systems from being overwhelmed and protecting people at high risk for severe illness, officials said. To that end, it incorporates new metrics for the number of new hospital admissions with COVID-19, and the number of hospitalized COVID-19 patients, in addition to case counts, in every county.
Under the approach, many parts of the country that were previously considered to have high or substantial levels of the virus are now reclassified as having low to medium levels of COVID-19 disease. Consumers can find out whether they face low, medium or high disease levels in their area by checking a new “county check tool” online at CDC.gov or by calling 800-232-4636.
People in communities with high levels of disease, including schools, are still urged to wear masks in indoor public places — but there are far fewer of them.
In communities with medium levels of disease, those at high risk for illness — including those who are immunocompromised or have underlying medical conditions — can consult with their health care providers and consider wearing masks.
In communities with low levels of disease, there is no recommendation for mask-wearing.
Regardless of the level of disease in a community, “people may choose to wear a mask at anytime, based on personal preference,” said Greta Massetti, a CDC official leading the agency’s covid response.
It’s also important for people to always wear a mask if they have symptoms, if they have tested positive, or if they have been exposed to someone with COVID-19, officials said.
The country’s two large teachers unions welcomed the guidance recommending universal masking in schools located in communities with high levels of disease, saying it was based on science, not politics — a swipe at those who argued mask requirements should be lifted because people were tired of them. Both the American Federation of Teachers and the National Education Association had asked the CDC for metrics to guide district decisions about whether lift mask mandates.
NEA President Becky Pringle said she was optimistic the virus is in retreat but said schools should be ready to reverse policies if the situation worsens.
“School districts should act cautiously in response to today’s announcement, with the health and safety of students, educators, and their families always in mind,” she said in a statement.
Approximately 43% of all public school children attend a district that requires masks, but where the new guidance recommends they be optional, according to preliminary data from the American Enterprise Institute’s Return to Learn Tracker.
All together, about 71% of all students can go to school without masks under the guidance, AEI found. That figure includes districts that currently require masks as well as those that do not.
The updated metrics change the U.S. map from what was almost exclusively red and orange — signifying substantial or high transmission risk — to one that will show green, yellow and orange, signifying states and counties with low, medium and high levels of disease. With omicron cases continuing to drop sharply, officials expect fewer communities to be facing high levels of covid-19 in the weeks ahead.
CDC had previously recommended masking in areas with substantial or high transmission, a category that applied to about 98% of counties, representing about 327 million people.
Under the new standards, only about 28% of people live in high-level disease areas, with 240 million living in medium and low areas and therefore free to go without masks.
Case counts provide a partial picture of the virus’s reach. But the number of hospitalized covid patients reflects the disease’s impact on a community — and its ability to respond to other emergencies. If hospitals or emergency rooms are filled with covid patients, people seeking treatment for heart attacks and strokes may have care delayed or even denied.
While not saying so explicitly, the new guidance provides a framework for living safely with a virus that is expected to remain at endemic levels for the foreseeable future — a goal that was out of reach for most of the last two years amid recurring surges and the arrival of new variants when far fewer people had gained immunity from vaccinations or infections.
“We are going to have to figure out our path forward for how we live with this virus,” said Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “Our population immunity has changed, from everyone being 100% susceptible two years ago, to what it is now, with our rates of vaccination and [increased natural immunity] among unvaccinated who just got through a big wave of infections.”
Using metrics that measure the burden of disease in a community can better identify places where surges in ICU admissions and deaths may overwhelm hospitals. CDC officials said communities can also use additional metrics, such as wastewater surveillance, to provide more tailored information.
Although surveillance of virus levels in wastewater can be an early warning sign for COVID-19, CDC’s current system does not yet cover every U.S. county.
While some experts and average Americans have criticized the CDC for being too slow to update guidance, many public health experts have expressed uncertainty about what comes next. They worry that political pressure to return to normalcy will heighten risks for the immunocompromised, those with disabilities, elderly and young children not yet eligible for vaccines.
Given the millions of those vulnerable individuals, Gerald E. Harmon, president of the American Medical Association, said in a statement that he would personally “continue to wear a mask in most indoor public settings, and I urge all Americans to consider doing the same, especially in places like pharmacies, grocery stores, on public transportation — locations all of us, regardless of vaccination status or risk factors, must visit regularly.”
Although masks may no longer be required in many parts of the country, “we know that wearing a well-fitted mask is an effective way to protect ourselves and our communities, including the most vulnerable, from COVID-19 — particularly in indoor settings when physical distancing is not possible.”
Several officials noted that while case counts and hospitalizations are declining, they are still at elevated levels. They also expressed concern that less than two-thirds of Americans are fully vaccinated, while only about half of people eligible for boosters have received the extra dose that studies show provide the highest level of protection.
State health officials applauded the framework, saying they wanted better barometers of covid’s impact in their communities.
The new metrics are “a timely step in the right direction,” said Nirav Shah, president of the Association of State and Territorial Health Officials and director of Maine’s Center for Disease Control and Prevention.
A focus on hospitalization rates gives states a benchmark to better understand COVID-19′s medical severity and its impact on the health care system, he said. It also recognizes the declining importance of daily cases, given the wider use of at-home tests, he said.
The federal government’s messaging about masks has drawn criticism since the pandemic began. The Trump White House delayed initial guidance on wearing masks in April 2020 to preserve enough of the higher-quality N95 masks for front-line health care workers. Some political advisers also worried that widespread mask use might cause panic. The CDC reversed itself one year later, recommending nearly universal masking but many Republican officials pushed back on the advice and declined to mandate the practice.
The Washington Post’s Jacqueline Dupree contributed to this report.