The United States is in an unprecedented juncture of the pandemic where just under half the population is fully vaccinated, health and safety restrictions are looser than they’ve been in 18 months, and cases of new coronavirus infections are once again on the rise after months of decline.
“The pandemic is not over, and delta changes the calculus,” Joel Wertheim, an associate professor in the Division of Infectious Diseases and Global Public Health at UC San Diego, told The Washington Post on Saturday.
As the delta variant spreads, the messaging from public health experts and officials is unequivocal: Vaccines are the best protection against severe illness and hospitalization. More than 97% of new hospitalizations from the delta variant are from people who are unvaccinated, making what Rochelle Walensky, who directs the Centers for Disease Control and Prevention, calls “a pandemic of the unvaccinated.”
Health experts said even though the delta variant is more infectious than the original variant that first took hold in the United States last year, there are precautions that can help both vaccinated and unvaccinated people limit their risk.
On Saturday, Los Angeles County’s mask rules went back into effect – regardless of a person’s vaccination status – on account of rising coronavirus infections and hospitalizations. Some other cities have begun urging even the vaccinated to wear masks inside again.
Here’s what to know:
– If I’m fully vaccinated, do I need to wear a mask indoors?
The CDC announced this spring that people who are fully vaccinated can go without masks in most indoor settings, except when required by certain federal, state and local guidelines. Several health experts who spoke to The Washington Post disagreed that the CDC mask guidance is sufficient.
Emily Landon, the chief infectious-disease epidemiologist at University of Chicago Medicine, said the CDC should have included parameters on the mask rules, such as establishing a threshold allowing unvaccinated people to go without masks only if a certain percent of the population is inoculated.
“I think the CDC in May made a mistake,” Landon said. “They made a recommendation based on biological science, but not any social science. Unfortunately, the policy of letting people self-sort into vaccinated and unvaccinated resulted in a sort of behavioral science problem.”
Several experts consulted by The Post said it is safe for fully vaccinated people to spend time indoors with others who are fully vaccinated. The shots have proved widely effective, even in crowded indoor settings. But they said it is nonetheless a smart practice to continue wearing masks in environments where there might be people who are still vulnerable to getting the virus.
That can help protect both against getting a mild version of COVID-19 and protecting those who haven’t yet gotten the vaccine.
“If you yourself have been fully vaccinated for at least two weeks and if people you are spending time with have been fully vaccinated for a least two weeks, you can feel relatively safe about not having to mask indoors,” said Betty Jean “BJ” Ezell, who serves as a vaccine hesitancy outreach coordinator for Citrus County, Fla.
– Is it safe to attend a big outdoor gathering such as a wedding or a concert?
On the spectrum of risk, an outdoor setting for fully vaccinated, masked and socially distanced people is the safest – but maybe not an ideal party situation.
Ezell said it’s a good idea to mask up or socially distance if you’re in a large gathering outdoors and don’t know if the people around you are vaccinated as “the delta variant has shown that it’s rampant and unforgiving in its ability to spread.”
“When you talk about outdoor weddings and parks, I think physical distancing is still a good thing because an infected person may be asymptomatic,” Ezell said.
“This is a respiratory disease,” she added. “Talking, coughing, putting out expectorate of any kind – if anyone passes through an area an infected person has been and those molecules with the virus are still hanging in the air, someone can still become infected.”
– I’ve only had my first dose of the vaccine. Do I have enough protection from the delta variant?
While partial vaccination is better than none at all, the best protection from severe illness from the delta variant is to be fully vaccinated, Wertheim said.
“We have this large swath of America that has only gotten one dose, and if we could only get them to get a second shot, I think that’s a group where we could make a big difference,” he said. “If you’ve been slow about getting a second dose, now is the time. There’s no evidence to suggest that waiting longer [to get the second dose] is worse.”
– My children aren’t old enough to get a vaccine. How can I protect them?
Even though children tend to have milder cases of COVID-19, Landon said infections in children are following the trendlines in delta variant hot spots: States with large outbreaks are showing more children with infections.
“I understand that it’s really enticing to think of COVID as just another cold, but it’s not,” Landon said of the typically milder infections in children. “It’s always best to avoid getting sick at all.”
For children who aren’t old enough to get a vaccine, Landon said the adults and older siblings can reduce the risk to children by avoiding crowded indoor settings and wearing a mask inside.
Experts still also advise common-sense precautions to prevent all respiratory illnesses.
“We still pay attention to hand washing – sing that ‘Happy Birthday’ song twice – we still pay attention to masking and the fit of the mask,” Ezell said.
However, the intensive surface cleaning people engaged in early in the pandemic is no longer considered necessary.
– How do I talk to loved ones who are still hesitant about the vaccine?
Ezell, the vaccine hesitancy outreach coordinator in Florida, said when it comes to meeting vaccine skeptics, she follows the advice of her pastor: You gain people’s confidence not by “beating them over the head” but by planting a seed.
Give someone factual information to get them started, Ezell said, and the next person who comes along follows up by “watering,” increasing the number of times trusted voices have shared sound information.
“I think it’s especially important when you’re having these conversations to present with what I call an active listening voice,” Ezell said. “Ask people in particular what their objections are, and don’t interrupt them; let them finish. Then give them the facts in a very calm manner.”
– If cases continue to rise with the delta variant, will restrictions return?
No health expert can predict the future, but most who spoke to The Post were skeptical that there would be a return to widespread restrictions such as stay-at-home orders and shuttered businesses like those from 2020.
Some restrictions such as the return to indoor mask rules seen in Los Angeles County this weekend could be revived, though experts such as Landon said they are likely to be hyperlocal and responsive to infection and hospitalization rates in a specific area.
Landon likened state-imposed measures such as masking rules to a wearing fight with small children.
“It’s like being exhausted and telling your kids, ‘Fine, you can have ice cream for dinner,’ ” Landon said. “You don’t have the will to say ‘no’ anymore.
“The bottom line, we should have mask mandates indoors. In public buildings, there’s no reason we’re not mandating masks. But will we go back to that? I doubt it. Now I think it will be really hard to go back to those restrictions.”
Ezell, the outreach coordinator in Florida, agreed.
“The horse has left the barn on relaxing restrictions, so it’s going to be really important that there are perhaps more public service announcements, group meetings, more getting trusted voices involved in communicating information from reliable sources,” she said.