For a period of time earlier this summer, it seemed like the coronavirus pandemic was inching toward its end in the United States. Vaccinations were up and hospitalizations were down. For the first time in more than a year, many fully vaccinated people felt free to take off their masks, socialize and get back to something approaching normal.
But over the past two weeks, the pandemic has swerved yet again. Transmission is increasing, and the highly contagious delta variant now makes up more than 80% of new COVID-19 cases in the U.S. New research also suggests that vaccinated people are getting breakthrough infections.
“I do think we are in a moment of change. The delta variant is obviously very highly contagious — more contagious than the earlier editions of this virus, which is why it’s spread so rapidly and become the dominant strain in the population,” said Philip Landrigan, director of the Program for Global Public Health and the Common Good at Boston College.
Naturally, this raises a lot questions about what people should and shouldn’t be doing in order to stay virus-free. Here’s what experts want you to know about what’s safe and what measures you should take right now:
Why should I wear a mask again?
The Centers for Disease Control and Prevention recently changed its guidance about masks for the fully vaccinated, recommending that all people in parts of the country where the virus is surging should wear masks in certain indoor settings again.
The change was made because of new evidence suggesting the fully vaccinated can spread delta to others, based on a recent cluster of 469 COVID-19 cases in Provincetown, Massachusetts, three-quarters of which were among the fully vaccinated. Almost all of those people had the delta variant, and the viral load of those infected was similar regardless of whether they were vaccinated.
But those breakthrough cases and others do not mean the vaccines don’t work against delta. Only four fully vaccinated people were hospitalized, two of whom had underlying health conditions, per the CDC data. No one died. The primary purpose of the COVID-19 vaccines is to prevent severe illness and death, and in the recent Massachusetts cluster they did exactly that.
Experts also note that there is some important context missing. The CDC focused on how many people were infected, said Cameron Wolfe, an associate professor of medicine at Duke University School of Medicine who specializes in infectious diseases. “They didn’t talk about the numbers of people who would have been infected if they were not vaccinated.”
“They don’t talk about the denominator ... and without knowing the denominator of who would have gotten sick, you can’t tell the protection the vaccine really gave you,” he added.
When should I wear a mask indoors now?
The CDC continues to emphasize that when you’re fully vaccinated, you can resume many of the activities you did pre-COVID. But it now says it’s important to wear a mask indoors if you’re in a public setting and you’re in an area with substantial or high transmission.
Right now, that’s the majority of the country. Roughly 60% of U.S. counties have high levels of transmission and about 19% have substantial levels, per the CDC.
Also, if you’re using public transportation, you need to continue to wear a mask regardless of where you are in the country.
“It’s a changing situation, and it’s disappointing to all of us because we had thought a month ago that we were pretty much out of the woods, and now all of a sudden the thing has spread again,” Landrigan said. “It’s not helped by the fact that some 93 million Americans are still unvaccinated. What that means is that anybody needs to be very careful about public transportation. They need to be careful about going to parts of the country where we know there is high frequency of unvaccinated people.”
Can I visit fully vaccinated friends and family?
The recent tightening of CDC guidelines applies only to indoor public settings. When it comes to spending time mask-free and indoors with fully vaccinated family and friends, that’s still pretty low-risk.
“If everybody in a group is vaccinated, you all know each other, and nobody’s been in a high-risk setting in the last couple of weeks, I have no problem being unmasked,” Landrigan said.
But he quickly added that there is no one-size-fits-all answer. It’s essential that everyone continue to take into account what is happening where they live and whether people have any underlying conditions. Landrigan said “situational awareness” is key and should help guide people’s decisions.
What about outings and family gatherings with my unvaccinated kids?
Children under the age of 12 are not currently eligible for vaccination, so it’s important that those 2 and older wear a mask indoors in public settings and that they all spend time outdoors when possible.
“We let our kids play outdoor sports, do outdoor swimming activities, play in the park,” said Wolfe, who is himself a father of children who are too young to be vaccinated. Personally, he said his family will still consider dining out, but usually outdoors.
And visiting grandparents or other family members indoors and mask-free is probably still OK — with caveats.
“Can kids visit with their grandparents? Yeah, sometimes! But I think it depends on the grandparents and it depends on where people are, and it depends on the anticipated downside if you’re wrong about something,” said Adam Ratner, chief of the division of pediatric infectious diseases at Hassenfeld Children’s Hospital at NYU Langone Health.
If, for example, you have a set of grandparents who are healthy, vaccinated, do not live in a group setting, and who generally do not have a lot of contact with large groups of people — and no one (parents, grandparents or children) has any known exposures, that would be pretty low-risk.
“I think you can do that and it would be safe,” Ratner said. Though he added that the safest way to do it would be outdoors, if possible.
What other measures should I be taking right now?
It can be confusing to reassess risk in various situations once again, Wolfe said, but he noted that we have learned a huge amount over the past 18 months about what works.
“The basic premises and tactics are pretty clear now: Outdoor activities are generally OK. Less crowding is great ... if you know you’re indoors, and especially if you’re indoors in those ‘hot’ counties, then masking should be on your radar, no question,” Wolfe said.
He acknowledged that many fully vaccinated people feel upset that cases are rising again and that they’re being asked to wear a mask as a result of how the variants have reshaped the pandemic worldwide.
“Is that frustrating? Yeah, sure as shit it’s frustrating,” Wolfe said. “But we’re used to wearing masks and rethinking mitigation. It’s not like we’re asking people to do things they’re unfamiliar with.”
And getting vaccinated if you are eligible continues to be the most important thing people can do to keep themselves and others safe.
“People who are vaccinated remain highly protected against severe disease and death due to COVID,” Ratner said. “That’s super important, and it’s the main reason for people to get vaccinated. The people who we are seeing with severe disease and who are dying with the delta variant are overwhelmingly unvaccinated.”
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.