Masks: Demystifying the CDC’s updated Recommendations

One of my roles as Chief Medical Officer of Mountain Pacific Partners is to help provide clarity and guidance on medical and scientific issues. I hope to use this forum to provide an overview of any recent public health and safety “headlines,” COVID-19 or otherwise. In a digital age where information is instantaneous and often uncurated, differing opinions abound and recommendations may vary by agency, state, or country, making it difficult to sort through the noise and decide what is right for you.

Though there is no single worldwide authority on public health threats, the U.S. Centers for Disease Control and Prevention (CDC) is considered one of the best when evaluating and assessing public health risks, both domestically and abroad. They collaborate with scientists all over the world to set the tone and establish recommendations on matters of public health, including COVID-19. This guidance may change from time to time, especially given the ever-changing fluidity of this pandemic, the continued access to new data and the evolving nature of this virus. The role of our Public Health officials is to provide recommendations that serve the best interests of our entire country. Many times, these initiatives are aligned across the world, but each country has their own public health directives intended to protect their citizens, which they roll out at their own pace and capability. My intent is to “depoliticize” and demystify the ongoing barrage of information needed to get through this pandemic and beyond.


While it may seem counterintuitive and confusing to tighten the guidance on mask use, especially in the vaccinated population, the latest recommendations are based on new circumstances and data from the COVID-19, B.1.617.2, Delta variant. To be clear, the updated mask recommendations are not politically motivated or flip-flopping on the messaging. They are not due to a failure in the vaccinations. In all instances, the purposes of masks during the COVID-19 pandemic are to prevent and protect against infection. Public health officials are charged with providing the best practices that protect the greatest number of people within any population. For the sake of today’s discussion, I am only referring to 3-ply face masks for washable/reusable masks general use. There are significant differences in the quality and type of masks available, but at a minimum, confirm you are using masks that have NIOSH or FDA approval. As you may have noticed, the CDC may specifically provide additional recommendations[JRM1] based on the unique risks within each subpopulation. For all groups, the messaging around masks has remained steadfast for quite some time: Wearing a mask protects others and yourself.

Mask guidance for the unvaccinated. Since vaccines became available, there have not been any significant changes to the overall recommendations regarding mask-wearing for the unvaccinated population. Although there was previously a relaxation of mask use when outdoors, all unvaccinated and not fully vaccinated persons above the age of 2 should mask when in indoor public places and should consider wearing their mask outdoors, in crowded areas with high number of COVID-19 cases, or when they are in close contact with others who are unvaccinated.

While it may not have been universally enforced, the unvaccinated were always recommended to wear “well-fitted” masks while in indoor public places. Only the recommendation to resume masking outdoors in crowded places or where COVID-19 cases are high seems to have been a step back in our progress against the pandemic. But in fact, this revision was due to the emergence of the Delta variant spreading at alarming rates, among both vaccinated and unvaccinated groups without predilection. The vaccines work, but masks are needed again as the virus evolves through mutation.

Mask guidance for the vaccinated. Everyone age 12 is eligible for vaccination. People who are immunosuppressed are now recommended to get a 3rd dose of the mRNA vaccine (Pfizer or Moderna). For those who are fully vaccinated, mask use is not currently necessary while either indoors or outdoors with a few exceptions. In an effort to maximize protection from the Delta variant and minimize the likelihood of spreading it to others, the CDC now recommends wearing a mask indoors in public if you are in an area of substantial or high transmission and outdoors when there are activities with close contact to unvaccinated individuals. Again, these changes are not because the vaccine doesn’t work, or the CDC had a change of heart. This is because the Delta variant is so highly contagious among those have not been vaccinated — either by choice, because they are too young to receive it, or due to limited access — that additional public health measures were needed to protect the vulnerable since anyone can unknowingly contract and spread the Delta variant.

Mask guidance in K-12 schools. On August 5, 2021, the CDC provided updated guidance to prevent the spread of COVID-19 in K-12 schools, based on new evidence. Their current recommendation is “universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.” As many school-aged children are not yet eligible for vaccination, all the other previously established prevention strategies should remain in place, including social distancing, hand washing, respiratory etiquette, screening, testing, and contact tracing to name a few. Click here for full guideline recommendations. Lastly, the risk associated with mask use in children is highly debatable, and I will dissect both sides in another update, but for now, the risks of mask use in children (3-ply disposable, or washable/reusable masks) is significantly less than the risks associated with getting COVID-19.

Key Takeaways

1) Masks protect and prevent against the spread of infection.

2) They must be worn fully over the mouth and nose to be fully effective.

3) Not all masks are the same. Use NIOSH or FDA approved masks to ensure intended effect.

4) Due to the COVID-19 Delta variant, regardless of vaccination status, masking indoors is recommended in areas of high number of COVID-19 cases and outdoors when distancing is not possible, or in the presence of unvaccinated individuals.

5) In order to prevent COVID-19 in K-12 schools, the CDC strongly recommends that everyone, regardless of vaccination status, wear masks, including students, staff and visitors in addition to the existing layered public health measures to limit the spread of infection.

Written by Jason Radick, M.D.



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