Western Pa. health experts cautious about CDC's mask-shedding guidance

Western Pennsylvania health professionals say the newest public health guidelines about maskless gatherings are a “measured step toward normalcy” — but they also come with some concerns.

“I worry a little bit, frankly, that people will maybe misinterpret this particular guidance, and think it gives more freedoms than it really does,” said Dr. Carol Fox, chief medical officer at Excela Health.

The Centers for Disease Control and Prevention on Monday announced updated guidelines, saying people who are fully vaccinated can congregate indoors in small numbers without wearing masks. Up to this point, masks have been encouraged for everyone in nearly all circumstances — including after vaccinations. The guidelines share details for vaccinated people visiting with unvaccinated people indoors — also a low-risk activity, the CDC says, if the unvaccinated person is not at risk for severe covid-19.

Dr. Marc Itskowitz, an internal medicine physician at Allegheny Health Network, said the change is among the best news since the start of the pandemic. Itskowitz said the update is reasonable, based on evidence gathered from other countries — the vaccine is preventing serious disease and hospitalization, as well as curtailing transmission of the virus.

“This is the first step to get back to normal,” Itskowitz said. “It does give me tremendous hope.”

But physicians at the region’s major health systems each repeated worries that the guidelines would not be followed “as they were intended.” They wonder whether people would misinterpret the increased freedom and shirk mask-wearing altogether, gather with people who haven’t been vaccinated, or attend larger gatherings than the guidelines suggest.

“I think this guidance will be widely used in order for people to gather in small groups, but it will likely also be used in ways that go beyond what the guidelines are recommending,” Itskowitz said. “In other words, the risk here is that we don’t actually follow the guidelines with small gatherings with fully-vaccinated people, but use this as a launching board for more widespread gatherings, especially among people who aren’t vaccinated.”

The guidance is full of caveats, Fox said. It is very specific to small gatherings, not medium or large ones. It defines vaccinated people as those who received their second dose (or first dose, if they received the Johnson & Johnson vaccine) two weeks ago. And for indoor gatherings with both vaccinated and unvaccinated people, it recommends the unvaccinated be limited to only one household.

Fox said the changes will be extremely helpful for people who have been especially isolated during the pandemic, but she worries people will let down their guard too much. If attending a small gathering, Fox said she’s encouraging people to continue wearing masks if there are people they don’t know. She noted many people who are eligible for the vaccine still have been unable to receive it.

“We’ve made great strides, and I really don’t want to see a step backwards,” Fox said.

Dr. Graham Snyder, medical director of Infection Prevention and Hospital Epidemiology at UPMC, said it’s important for people to note this is a “focused” piece of guidance, not a blanket announcement. The guidance applies only to people who have been vaccinated and are of low-risk for covid-19, and it refers only to gatherings in “private settings” — not businesses, work places, entertainment venues or health care settings.

“I think they’re well-founded fears,” Snyder said. “We have already seen, before these were released, that some public health authorities, typically at the state level, have made recommendations that are not aligned with the CDC’s guidance. And individuals don’t necessarily align with public health guidance — people choose to do what they want to do. … We need to interpret what the CDC is saying, exactly as it is, because it is a measured step toward normalcy.”

Itskowitz said, the larger the gathering, the greater the risk there is someone present who is not fully vaccinated or for whom the vaccine was not effective. For that reason, he said he is advising his patients to get together only with people they know very well and whom they trust.

Either way, transmission of the virus likely will continue even in these small groups, he said. While the vaccine does prevent severe symptoms and complications of the vaccine, it doesn’t entirely eliminate the virus from spreading. The risk of gathering, even after vaccination, is very low, but it is not zero, he said.

It’s a fine line the CDC must follow when implementing and relaxing restrictions, Snyder said — a position he does not envy. But this move, if followed correctly, seems to be an effective way to allow people in the U.S. to increase their social contacts.

“What they’re trying to do here is give us some of that normalcy back,” Snyder said. “At the same time, taking a very small risk that it would worsen the pandemic. I think they’re trying to walk that line. I think they’ve done it well.”