Change in Mask Guidance

Today, the CDC made a significant update to the mask guidelines for vaccinated people. These updated guidelines are based on several Israeli and US studies that confirm what we know. When you are vaccinated, you don’t get severely ill, end up in the hospital and die and your viral load if you do get sick is lower so you are not a good spreader of illness.

 

Several studies were cited during the mid-day press conference that show that the vaccine is 90%-97% effective at preventing symptomatic illness (depending on what groups were looked at) and 86% effective at preventing asymptomatic illness.

 

When it comes to variants, a study was presented that showed the vaccines were 100% effective at preventing severe disease with the commonly circulating variants. It was 97.4% effective against severe illness with other less common variants. Lastly, it prevented 89.5% of any illness with the U.K. variant (B.1.1.7) and 75% of any illness with the South African variant (B.1.351).

 

Finally, during the press conference, a study looking at viral load after vaccination showed that people had significantly lower viral loads if they were reinfected after being vaccinated.

 

All this data together, led the CDC to conclude that it was safe to lift the recommendation for wearing masks indoors. So the new guidelines say that most vaccinated Americans can go without masks in most places and can stop socially distancing themselves. This applies to both indoor and outdoor spaces regardless of size. Even in crowded places.

 

As Dr. Wilensky, the director of the CDC said: “You can start doing the things you had stopped doing at the beginning of the pandemic.” She continued “based on the continued downward trajectory of cases, scientific data on performance of vaccines and understanding of how the virus spreads, the moment has come for those who are fully vaccinated”.

 

Vaccinated Americans can take off their masks except in healthcare facilities, nursing homes, shelters, prisons as well as public transportation facilities such as bus depots, airports, train stations, etc.

 

When listening to the announcement, I actually had questions about transportation hubs and why they were included. So how is an airport different from a crowded restaurant? Luckily, Dr. Wilensky was on the Rachel Maddow show this evening and was asked that very question. Turns out that they couldn’t change guidance in transportation hubs or on public transportation yet because of the multiple agencies involved and the standing policies in place. Dr. Wilensky said that the CDC is meeting with these other agencies and will be updating the guidelines as soon as they can. So its not based on science but actually on needed policy changes. She also said that CDC guidance will be updated for schools and summer camps and businesses as well.

 

Another topic that was discussed was the weird dynamic in families that have kids under 12 years of age. What do you do with your family if you have some kids that are older than 12 and get vaccinated and some younger ones that are not yet eligible to be vaccinated. Or all your kids are younger than 12. According to Dr. Walensky, the kids under 12 that are not vaccinated are still considered at risk and should continue to wear masks and socially distance themselves. Wow, I was tortured by my sisters when I was a kid over normal things, imagine what will happen when there are some kids that can go mask free while the younger ones must wear a mask and be socially distanced!

 

Pfizer vaccine in Kids 12 and older

 

As you must know by now, yesterday, the Advisory Committee on Vaccination Practices (ACIP) of the CDC formally recommended that the Pfizer vaccine age limit be lowered to children 12 and older (it had been 16 and older). This will add about 18 million more people to the eligible vaccine pool. These vaccines are safe in children. We have not seen any data to suggest that there are any additional risks in kids and I feel confident recommending this for kids. Last evening, Dr. Fauci spoke about the next group of kids involved in vaccine trials, those age 5-11. A trial is also underway in kids 6 months to 11 years old. Dosing levels for three groups of kids are being developed, ages 6 months – 2 years, 2 years to 5 years and 5 years to 11 years.

 

In a trial of over 2000 adolescents, the Pfizer vaccine was found to be 100% effective. Side effects were the same as adults.

 

Breakthrough infections

 

There have been cases reported of people becoming infected with CoViD-19 even after getting the vaccine. The good news is that this is exceedingly rare and even when it happens, the people has asymptomatic or very mild illness. The other good news about breakthrough infections is that people have lower viral loads and don’t spread infection to other people.

 

India

As you have heard by now, India is in the middle of a terrible second wave. There appears to be several variants at play there and one is especially concerning. It has been labeled as a “variant of concern” by the World Health organization and needs to be watched. The B.1.617 variant has become the dominant strain in India in just a few weeks. This generally means that it has found a way to spread more efficiently than other viral strains. It may also have found a way to evade immunity slightly better than other variants.

 

This variant has 8 different mutations on its spike protein, the mechanism it uses to enter human cells. Two of the mutations are similar to mutations that have allowed other variants of concern to become more transmissible and a third mutation is similar to a mutation that might have allowed the P.1 (Brazilian) variant to partially evade immunity.

 

In an interview on CNBC last week, the head of BioNTech (codeveloper of the Pfizer BioNTech vaccine) said that he was confident that the vaccine would still be protective against B.1.617. He also added that people will most likely need a booster shot to protect against variants and as immunity wanes after 8 months or a year.

 

Reprogramming ourselves

 

So today after the CDC announcement, I tried to go into the local crowded supermarket to go food shopping without a mask and I just couldn’t. I stood at the door and tried to go in but every fiber in my body was screaming that this was dangerous. I have been programmed over the last 18 months that my mask kept me safe and people who were not wearing masks were a threat to me and my loved ones. I would walk down the street or ride the NYC subway and pass someone who was not wearing a mask and think how selfish they were or stupid. Now, I was asked to throw all of that away.

 

I guess that this is the reason that both Dr. Fauci and Dr. Walensky as well as the President all spoke about giving people space to make choices about wearing a mask. Today, I chose to keep my mask on in the supermarket even though I understand the science. Perhaps in a week, I’ll feel better about it. I suspect others will have the same hesitancy that I felt today. Its going to take some time to forget the messaging of the last 18 months but I look forward to returning to a normal life soon.

 

Lastly, life can be almost normal if you get vaccinated so go get vaccinated. There are no scientifically based reasons to not do it. I have not seen a single reliable study or piece of anti-vax’er literature (many people send me items all the time) that would make me change my recommendation to get vaccinated. Its an easy thing to do and will get us back to a normal life faster. So go get vaccinated or if you still have questions, find someone to answer them and then get vaccinated. Its the truly patriotic thing to do for our country.

 

Get your self vaccinated quickly so we can get through this together.

 

Dr. Stu Weiss

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