After the well-publicized exchange between Rand Paul and Dr. Fauci last week, a lot of people have been asking the question, “Why are masks still needed, especially if I’ve already been vaccinated?”
Fauci pushed back against the Kentucky Republican with two scientific reasons for why we should hang on the masks, at least for a little while longer, but it seems to me that there are several other valid reasons to not toss away our masks just yet. I’ll start with Dr. Fauci’s answers.
It’s possible that vaccinated people can still be spreaders. First, Fauci noted that the study referenced by Senator Paul was “in vitro,” a lab-based study rather than one conducted in the real world. We need more real-world data on what protections vaccines offer and that takes time.
There is a possibility that vaccinated people could still spread the Coronavirus. One prominent theory is that the virus could live in the nasal passages of vaccinated individuals where it might not be reached by antibodies. This could enable the virus to spread when these people cough or sneeze.
Vaccines offer varying amounts of protection from new variants. Fauci’s second point was the new virus mutations are spreading and the effectiveness of vaccines against the new strains is uncertain. It is also possible that some vaccines will offer better protection against new strains than others.
The UK strain (B.1.1.7.) has an increased risk of death and spreads more easily than the original COVID-19. It is already present in all 50 states per the CDC and is becoming the dominant strain in California and Florida. Fortunately, existing vaccines seem to be effective against this strain.
Two other strains, from South Africa (B.1.351.) and Brazil (P.1), have also been identified in the US. The Brazilian strain is particularly worrisome because it is extensively mutated to the point where it may not be recognized by antibodies.
Testing is underway to determine how effective the existing vaccines are against the mutations, but that will take time. New generations of the vaccines will likely be tweaked to offer greater protection, but for now, we have to race with what we brought to the track as the saying goes.
Not everyone has had a chance to get the vaccine. In addition to Dr. Fauci’s points, it should be obvious that the vaccination effort is far from complete. Becker’s Hospital Review reports that, as of March 21, more than 44 million Americans have been fully vaccinated. That sounds like a lot but it only represents 13 percent of the population.
We are currently administering more than 2 million doses per day so that share of the population should increase rapidly, but the majority of the country is still unprotected at this point. That means it is premature to go back to normal.
We need to reach herd immunity. A target for vaccinations is 70 to 90 percent of the population since that is the level believed to be necessary for herd immunity. As noted above, we are far off that mark with respect to vaccinations, but if we consider people who have already had COVID the protected share of the population increases somewhat. However, considering that COVID survivors might not be protected from mutant strains sends us in the other direction.
The bottom line is that we need to get as many people vaccinated as possible to protect the most vulnerable Americans. Until we get to a point where it is difficult for the virus to spread, we need to keep up the mitigations. This is also important because it will help to reduce the chances that new and more dangerous variants will mutate.
Many pandemic skeptics have argued for the past year that herd immunity should be the goal. Now we are able to achieve herd immunity through the use of vaccines rather than letting the virus run its course and kill millions more people. The problem is that many of the herd immunity advocates are also vaccine skeptics. For that reason, I’m skeptical that we will ever achieve herd immunity, especially if it requires getting periodic booster shots.
Many scientists and doctors are also skeptical that total herd immunity will be reached and that COVID-19 will be totally eradicated. A recent episode of “Podcast 19” discussed the possibility that the disease will become endemic, regularly encountered throughout the world. The podcast speculated that in the future, children will become infected with COVID-19 at an early age and become less susceptible to the disease as adults. In the long run, COVID might yet become similar to a cold or the flu.
To honor local rules. Even if you’ve been vaccinated, local laws and rules from private businesses may require you to wear a mask. I’m an advocate for the rule of law and private property rights so I advocate obeying these guidelines. If local policies allow you to exempt yourself from mask-wearing if you are vaccinated, then I wholeheartedly say, “Get vaccinated and take the mask off if you want,” but know that there is still some risk, to others as well as to yourself. One problem with a no-mask-after-vaccination policy is that…
There is no vaccine “passport” program. I would support a policy that said two weeks after you are fully vaccinated you can go back to normal if you want. I think that providing such a powerful incentive to get vaccinated as quickly as possible (although it would also be a powerful incentive to counterfeit vaccination cards) would outweigh the risks of going maskless. We don’t have such a program, however, and I can already hear the shouts of “Fascism!” and “Authoritarianism!” if the Biden Administration proposed one. Cue the memes that show police demanding, “Your papers please!”
The anti-mask crowd worked against their own interests with early and overly dramatic opposition to showing proof of vaccination. Showing vaccination “passports” to exempt from mitigations and masking would have allowed a safe return to normal more quickly.
Showing proof of vaccination would not be an unprecedented idea. Nor would it be permanent. We already show immunization records for certain travel, to register for school, and even for some jobs. Proof of a COVID vaccine for access to local events and locations would only be needed until vaccinations are widespread and case numbers fall although I think many countries will require it for international travel and it will probably be added to the list of immunizations required by schools for the foreseeable future.
Vaccines are not foolproof. Even though, like masks, vaccines greatly reduce the risk of COVID-19, like masks, they are not foolproof. That’s especially true when the new variants are considered.
Statista provides a handy chart that shows the effectiveness of the various COVID vaccines and it’s easy to see that that there is a lot of variation in the effectiveness shown in clinical trials. The Pfizer and Moderna vaccines are considered more than 90 percent effective while Johnson & Johnson was tested at 66 percent. However, this can be misleading since the Pfizer and Moderna trials were done before the mutant strains emerged while J&J’s numbers include the newer variants.
The ratings are also a bit misleading because all of the big three vaccines were 100 percent effective in trials at preventing hospitalization and death due to COVID-19. While people who have been vaccinated might still become infected with Coronavirus, being vaccinated makes it much more likely that you will have a mild case. A vaccine that is effective at preventing infection two-thirds of the time and hospitalization or death 100 percent of the time is well worth taking.
However, it’s also true that if you want to avoid even a mild case of COVID, it’s a good idea to keep using mitigation strategies. Given how little we know about the long-term effects of COVID-19, continuing to mitigate until there are fewer unvaccinated people around to infect you is a sensible strategy.
COVID cases are on the rise again. Finally, even though vaccinations are on the rise, COVID cases are once again on the rise in many parts of the country because unvaccinated people have once again relaxed their preventive behaviors. In 27 states, Coronavirus cases are increasing and may signal that the country is entering a fourth wave of the pandemic.
Although we have several effective Coronavirus vaccines, there is still no effective treatment. Even though vaccines are out there, if you don’t get one and you contract COVID-19 there is a decent chance that you will find yourself struggling for breath on a ventilator or suffering from the effects of “Long COVID,” cases where symptoms persist for months.
The other danger of an increasing number of COVID cases is that where there is more virus, there is a greater chance of dangerous mutations. If we want to avoid the creation of new strains that can evade antibodies, we need to minimize the spread of the virus.
I think that we are only a few months away from a return to normalcy. I expect a high level of vaccinations by June as we increase from the current, already frenetic rate. As more people are vaccinated, the virus will have fewer and fewer hosts to infect and it will be harder for it to spread. But if we return to normal too soon, more of our friends and neighbors will die needlessly.
If I was a governor, I would be talking with my health and science advisors about setting defined and public metrics for lifting restrictions and guidelines. These metrics would be based upon vaccination rates and infection levels for defined areas such as cities or counties. The idea here is that if people get vaccinated and act responsibly to slow virus transmission, then they can get back to normal more quickly.
No one should want to be the last person to get sick and die in a pandemic. Normalcy is just around the corner if we get vaccinated, but until your area is fully vaccinated, stay safe, stay healthy, and stay masked.
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