New from the CDC: 2 steps forward, 1 step back

This is very disappointing. We really had a chance to stick the landing here, but we didn’t. Getting a substantial proportion of the population vaccinated would have gone a long way towards shutting down this pandemic, but now cases are rising, community transmission is rising, and the CDC today revised their recommendations for vaccinated people. Here are some questions that I have been getting, and my best attempt at answering them.

1) What are the new guidelines?

As of July 27th, the CDC says that even for fully vaccinated people, “…To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.”


2) What does "indoors in public" mean?

Restaurants, stores, etc… Basically anywhere you will be indoors with potentially unvaccinated people. Since even in states with the best immunization coverage (like Vermont and Massachusetts) over 30% of the total population is still unvaccinated, that applies to pretty much every public space.


3) What does “substantial or high transmission” mean?

It’s a measure of how much circulating COVID there is in a region, graded as “low”, “moderate”, “substantial” or “high”. The threshold for "substantial" is a total of more than 50 new cases per 100,000 persons in the past 7 days, or a percentage of positive tests over 8%. You can check and track your county here, but right now the whole NYC metropolitan area (south of Westchester Country) falls into that range.




4) Why this, why now? Why does the CDC keep changing it's recommendations?

This is one of the concerns that makes people non-compliant with public health recommendations, and I do understand where this sentiment is coming from. We have heard years of political ads that criticize "flip flopping". We have the idea that a doctor who keeps changing their mind is not to be trusted. We think that the real experts know what to do and always have the same right answers. But that's simply not how you manage a pandemic like this with a new virus. You HAVE to be constantly reanalyzing data and looking for trends. There are ALWAYS going to be changes in policies based on new information. Stephen Colbert once said about a politician "...he believes the same thing Wednesday that he believed on Monday - no matter what happened on Tuesday". Don't be that guy.

So what happened is growing data to suggest that (1) the Delta variant is becoming more and more prevalent (over 70% of new cases in NYC), (2) the Delta variant seems to be significantly easier to transmit than previous strains, and (3) although though the vaccine virtually eliminates the risk of hospitalization or death (even from Delta), there are breakthrough infections in vaccinated people. These may be asymptomatic or mild, but they still are contagious. And with unacceptable numbers of unvaccinated people around - some by choice, some because they are under 12 - more spread means more cases, more variants and more deaths. Masking works. It significantly reduces indoor transmission. So when the risk of that transmission is high it makes sense to mask up, vaccinated or not.


5) What about eating indoors at restaurants?

I haven't found a specific CDC recommendation about vaccinated people eating indoors in restaurants. However, if the recommendation is that vaccinated people wear masks indoors in public in areas of elevated risk of transmission, I just don’t see how that’s compatible with indoor dining. I know that there are a lot of factors that go into all of the choices that we have had to make over the past year and a half. There is no book where you can look up the “right” answer.

But if it helps you to make a decision, here is what I am doing now. I personally no longer eat indoors in a restaurant, even though I am fully vaccinated. Unlike visiting a store for a few minutes, eating indoors involves an hour or two in a closed space, where I and all of the customers are unmasked (and statistically, some are unvaccinated).

There just is no overriding reason why I need to do that now - it’s an unnecessary risk. And the risk that I’m talking about isn’t just my personal risk. I’m pretty sure that if I get a breakthrough infection, the vaccine will prevent me from getting dangerously ill. It’s not even “long COVID” that I’m concerned about.

EVERY case of COVID is a chance for the virus to mutate, evolve and generate variants. Someday some variant may be resistant to our vaccines, and this whole horrible thing will start over again. It’s just such an unforced error, to do something unnecessary and contribute to that risk. I’m hopeful that the numbers will fall again, and we will be able to get back to the better days of spring and early summer. But right now, acting responsibly with public health in mind is the right thing to do. It’s the patriotic thing to do. It’s the moral thing to do.

I know that there are a lot of people out there who legitimately have concerns about the vaccine, and I do NOT mean to dismiss these concerns out of hand. I believe that the vast majority of them are unfounded, and often they come from deliberately spread misinformation. But they still need to be addressed, and I'm ALWAYS happy to chat, if anyone has questions.

PLEASE get vaccinated if you haven’t. And get your eligible kids vaccinated as well. Right now, only around 30% of New Yorkers between age 12 and 17 are fully vaccinated. If you have a child in this age group who hasn’t been immunized, there is no reason to wait. Since it takes about 5 weeks from the first shot to become immune, this is the last week that you can get this done before school opens. It’s very easy to get it these days, this isn’t like the spring when people were pulling favors and cutting lines.

We have another chance to stick the landing. Let’s do it.