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July 23, 2021

Former surgeon general: I changed my mind on mask guidelines. CDC should too.

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    Some prominent public health experts are calling on CDC to issue stricter masking guidelines as the delta variant spreads in the United States.

    Is America's coronavirus future 'good,' 'bad,' or 'ugly'? It's all three

    Where critics say CDC's masking guidance went wrong

    CDC's current mask guidance, which was issued in May, states that fully vaccinated individuals can forgo masks in most situations, while unvaccinated individuals should continue to wear masks.

    But that guidance led to many unvaccinated people choosing to stop wearing masks as well, Ali Khan, a former CDC official, said. "Those who didn't want to wear a mask and didn't want to get vaccinated are out there now spreading disease to others who are not vaccinated," Khan said.

    Jerome Adams, who served as surgeon general in former President Donald Trump's administration, wrote in an op-ed for the Washington Post that when CDC issued its guidance in May, "the message many Americans heard was that, vaccinated or not, masks were gone for good."

    The public also wasn't prepared for the possibility that guidance could be altered in response to a rapidly changing pandemic, Jody Lanard, a physician who formerly worked as a pandemic communications adviser with the World Health Organization, said.

    CDC officials "always say they want to follow the science, but they did not prepare the public early on to say 'we are looking at multiple factors, including how science fits in with reality and social science, and how it fits with expected and unexpected changes, especially sudden changes, where we have to turn on a dime to try to protect more people,'" Lanard said.

    Some public health experts say it's time for CDC to change its mask guidance

    Now with the spread of the delta variant throughout the country, some public health experts are calling on CDC to revise its guidance.

    In his op-ed in the Washington Post, for example, Adams wrote, "I know what it's like to be well-intentioned but wrong on masking," citing his own statements in early 2020 that masks weren't necessary to stop Covid-19's spread.

    But, Adams wrote, emerging evidence forced him to change his mind then—and should lead CDC to change its approach now. "The agency urgently needs to revise its guidance on masking to combat the rapid growth in Covid-19 infections driven by the delta variant," he wrote.

    Carlos del Rio, an epidemiologist at Emory University, said he believes it would make sense for CDC to say "we would recommend that people go back to using masks indoors … it would be helpful for the CDC to say, if your numbers get to a certain level, you should recommend masking."

    Implementing indoor mask mandates for all people is "the right and scientific thing to do," Ali Mokdad, who tracks coronavirus trends for the Institute for Health Metrics and Evaluation, said. "That's the only way we can send a signal to the public in the United States that we're not out of danger, [while] we encourage [more] people to go and get the vaccine."

    Administration officials say discussions are ongoing about mask guidance

    According to CDC spokesperson Jason McDonald, the agency currently has "no intention of changing [its] mask guidance." However, people familiar with the matter told the Post that conversations on the subject are ongoing at the White House and CDC.

    In particular, sources told the Post on condition of anonymity that officials are considering asking Americans to wear masks when both vaccinated and unvaccinated people mix in public places.

    "It's fair to say they are reconsidering everything," Marcus Plescia, CMO at the Association of State and Territorial Health Officials, who has spoken with CDC and state officials recently, said. "I think everything's on the table," including changing masking or social distancing guidelines.

    "We are regularly in touch and have regular meetings with our public health officials, including the CDC, about how to continue to address the virus," White House Press Secretary Jen Psaki said. "That shouldn't surprise anyone. Those conversations cover a range of topics."

    President Joe Biden on Wednesday said he believes CDC will issue guidance recommending unvaccinated children wear masks in schools. "The CDC is going to say that what we should do is, everyone under the age of 12 should probably be wearing a mask in school," Biden said.

    "That's probably what's going to happen," he added. "Secondly, those over the age of 12 who are able to get vaccinated—if you're vaccinated, you shouldn't wear a mask, if you aren't vaccinated, you should be wearing a mask." (Huang, "Shots," NPR, 7/22; Adams, Washington Post, 7/21; Linskey et. al., Washington Post, 7/21; Samuels, The Hill, 7/22; Chalfant, The Hill, 7/21)

    Is America's coronavirus future 'good,' 'bad,' or 'ugly'? It's all three.

    looking aheadSince February, Advisory Board's Brandi Greenberg has been tracking three ways the U.S. coronavirus epidemic could end: the "good," the "bad," and the "ugly." But new data, she says, has forced her to revise her expectations about what Covid-19's future will look like—for America and for the world. 

    Read the latest take

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