Let me see you smile (vaccinated and outdoors!)

Something small but significant happened to me today. I was coming home from work, and a stranger smiled at me on the street. I saw her smile, and I smiled back, unmasked.

There’s still a LOT to worry about in the world of COVID-19 these days - new variants, fading antibody levels, vaccine hesitancy, misinformation, the situation in India, etc… But that little smile exchange felt like hearing the first bluebird of spring. It felt like seeing a crocus peek out through the snow. It felt like a sign that things might just get better.

One of the very first interactions that any of us had with other human beings was the “social smile”. At around six weeks of age, for the very first time, we looked at someone’s smiling face and smiled in reply. For the first time, our brand new consciousness was communicating with another mind. We suddenly realized that we are not alone, that there are others out there, and that we can engage with them. That social smile is a cornerstone of civilization, and I miss it.

I have been a big promoter of the benefits of masks over the past year. Sadly politicized, they could have really blunted the effect of the pandemic if used correctly. Unlike lockdowns, which come at huge economic and psychological costs, this cheap little piece of material could have saved millions of lives and trillions of dollars worldwide. And unlike vaccinations, you can tell when someone is using one. Wearing a mask is not just individually protective, it’s messaging, it’s a statement. And so is taking it off when it’s safe.

I was happy when the CDC released new guidelines this week, saying that vaccinated people can now be in public without a mask as long as they aren’t in big, dense crowds (especially with a lot of singing or shouting). There is - of course - controversy about this decision. Some people have been calling for this for a while, some people feel that it’s too timid and doesn’t go far enough. Others are concerned that it's unwise and may reduce mask use indoors in public (I disagree, as I have written before). In New York State, the governor immediately adopted this federal recommendation, although the New York City is less clear on this question. There is clearly some wiggle room here.

So what do I personally do? I used to wear a mask everywhere outside, even when I was far away from other people (and vaccinated) because I wanted to send the right message. And now I think that it’s time to send a different message.

I want to send the message that we are making decisions and setting policy based on the steadily accumulating knowledge that we have about COVID-19. At this point, it seems pretty clear that outdoor transmission is fairly rare. More than anything else, ventilation stops transmission. The best designed indoor spaces have nowhere near the airflow of the great outdoors, not to mention the UV light that is also known to kill this type of virus. And when outdoor transmission does happen, it's generally not from passing encounters but from prolonged, maskless close contact.

Outdoor transmission was rare even before a lot of the population had some degree of immunity (from vaccines or previous infection). If anything, it should now be even less likely, as people with no antibodies become a smaller and smaller percentage of the general public, and the overall chance of transmission drops. The CDC hasn’t gone so far as to say that unvaccinated people can be maskless outdoors in public, but that may be coming soon, for the same reasons.

It’s important to take the win, and let people see that progress is happening. It’s important to show one more thing that vaccination lets you do. And it’s important to preach public policy based on honest and good faith reading of scientific evidence, and to not send mixed messages. Think of how silly it is to insist that everyone always wear a mask outside, but when they come into an indoor restaurant, to allow them take off their masks in a poorly ventilated space while sitting next to strangers who may or may not be vaccinated.

I understand the natural tendency to err on the side of caution, especially when dealing with a deadly global pandemic. But on the other hand, if your messages starts to sound to people like "masks in all pubic spaces, everywhere and indefinitely", your overall compliance where it matters is probably going to be less. Nuance is hard to communicate, and fatigue will eventually erode whatever community spirit there is.

I am taking my mask off outside now, and it feels good. It did feel strange at first, especially since I live in Manhattan, where seeing an unmasked face outside has been incredibly rare for so long. But over the past few days (since the CDC announcement), I have been seeing them more and more. Being outside, maskless and in scrubs initially felt like a political statement. Now it feels like a quiet way to give public health advice.

And of course, if you haven’t gotten vaccinated yet and you can, please do it - it’s the one thing you can do to move the whole country back towards normalcy, and give us all a great summer.

I’m looking forward to seeing all of your smiling faces in the parks and playgrounds!

#stopthespread