[Originally published: July 28, 2021. Updated: Jan. 20, 2022]
As the highly contagious Omicron variant continues to sweep across the country, the Centers for Disease Control and Prevention (CDC) has updated its guidance around masks.
In mid-January, the CDC revised its full list of mask recommendations, including updates that describe types of masks and respirators that can be used to prevent transmission of SARS CoV-2, the virus that causes COVID-19. The CDC says some types of masks and respirators, such as N95s and KN95s, provide more protection than others, but recommends that you wear the most protective mask you can that fits well and that you will wear consistently.
In terms of who should wear a mask, the CDC recommends everyone 2 years or older who is not fully vaccinated wear a mask in indoor spaces, and consider wearing one in crowded outdoor settings and for activities where there is close contact with people who are not fully vaccinated. If you are fully vaccinated, it recommends wearing a mask if you are in an area with substantial or high transmission or if you have a weakened immune system.
“There is still a lot we don’t know, especially as the new variants continue to emerge,” says Carlos Oliveira, MD, PhD, a Yale Medicine pediatric infectious diseases specialist who recommended people hold on to their masks regardless of their vaccination status even in late Spring 2021, when the CDC eased its recommendations as the virus seemed to be waning, before Delta—and then Omicron—became the dominant variants. “There could be spikes in [coronavirus] transmission for a variety of reasons,” he said.
Sheela Shenoi, MD, MPH, a Yale Medicine infectious diseases specialist, adds that while the U.S. as a whole has made progress in vaccinations, rates of infections and deaths are still high in other parts of the world where overall vaccination rates are significantly lower. “I hesitate to say that we are approaching a post-COVID world when so many are still being ravaged by this virus,” she says. “If there is anything we should have learned, it is that we are all interconnected; what happens in one part of the world affects everybody.”
In Spring 2021, Dr. Shenoi also held onto her masks, and continued to wear them inside in stores, partly because she was interacting with people and had no way of knowing whether they were vaccinated. “There's nothing that's ‘safe’—it’s always ‘safer.’ If you are fully vaccinated, it is safer than it was two years ago to be around people without a mask,” she said.
Dr. Oliveira says his greatest concern is for children exposed to adults who could be infected, especially children younger than 5 who are not eligible for the vaccines, and the majority of whom he says have gotten COVID-19 got it after exposure to an infected parent or other adult. He suggests parents do whatever they can to limit a child’s exposure to unvaccinated people. “My advice—if your children can’t get the vaccine—is to make sure they are with immunized people outside of school,” he says. “Try to get everyone in the family who can get the vaccine to get it.”
Karen Jubanyik, MD, a Yale Medicine emergency medicine specialist, stressed the importance of wearing a mask among people who have compromised immune systems, whether they are elderly or taking immuno-suppression medications, or if they are an organ transplant recipient or have a condition such as cancer that affects the immune system. “The vaccinations weren’t well tested in those populations, and we remain concerned that the vaccines might not be as effective in them,” Dr. Jubanyik says.
Dr. Jubanyik also said the decision to wear a mask is important when considering the potential for breakthrough infections and geographic location. The vaccines are effective at preventing severe disease and hospitalization, which is good news for any given person, but across 350 million people in the U.S., that's still a lot of potential infections, she says, especially with the highly transmissible Omicron variant.
“That means you have to know the status of where you are and where you're going. There are pockets in this country and entire other countries where there aren't many people who are fully vaccinated and infection rates are high," she says. "I think it is important to realize it could be potentially dangerous to you, as well as other people, to not wear a mask.”
You can wear a mask to protect yourself during cold and flu season
Cases of respiratory syncytial virus (RSV), a common respiratory virus that can be serious in children, immunocompromised people, and older adults, was ticking upwards in some places in the U.S. “It’s problematic because we are still in the COVID-19 mindset, so anyone who is sneezing or has a runny nose may think they need to get tested for COVID-19,” says Dr. Shenoi. “It’s particularly hard for parents. Under normal circumstances—before COVID-19—kids would have a sniffle going on from November to March, and we knew to expect that.”
Dr. Jubanyik also urges adults to consider wearing masks during flu season if they are at risk for or interact with people who are vulnerable to complications from the flu. “Because the flu hits you all of a sudden—you may feel fine even though you are potentially contagious, then all of a sudden you have a fever of 102,” she says.
Making a personal choice about masks
Wearing a face mask has been a topic of debate among some Americans; however, masks are part of the culture in some Asian countries, where people wear them to protect from circulating viruses like the flu.The habit took hold after those countries were hit hard by severe acute respiratory syndrome (SARS), which led to more than 8,000 infections and almost 800 deaths in 2002-2003.
Mask mandates, which have been discussed as an infection prevention strategy at the local, state, and national levels, have not been popular among everyone in the U.S., where individualism prevails. “I’m not sure it has sunk in how interconnected we are—that what one person does affects the next person, affects the neighborhood, affects two people down the chain—and all that can have consequences,” Dr. Shenoi says.
At the same time, maybe COVID-19 has led some Americans to think about masks in a new way, Dr. Shenoi adds. “Now that we’ve lived through this, I think masks are much more familiar to us. We know how easy it is—how straightforward it is—to wear a mask. We’ve learned that this is doable.”