The CDC’s New Guidelines on Covid Risk and Masking Send Confounding Signals

Lambert here: After Walensky termed masks a “scarlet letter” — which the Biden Administration let pass, so I assume they agree — I find it difficult to believe that CDC leadership is acting in good faith on anything. Why would a scientist continue to work there? “Change from within”? In any case, I disagree the message is “confounding.” The message is clear: Let ‘er rip!

By Colleen DeGuzman, Kaiser Health News Reporter. Originally published at Kaiser Health News.

When the Centers for Disease Control and Prevention last month unveiled updated covid-19 guidelines that relaxed masking recommendations, some people no doubt sighed in relief and thought it was about time.

People have become increasingly comfortable being out shopping, attending live events, or meeting up with friends at restaurants. And many are ready to cast aside their masks.

Still, a recent KFF poll pointed to an underlying tension. Just as a large swath of the American public, 62%, said that the worst of the pandemic was behind us, nearly half were worried about easing covid-related restrictions — like indoor masking — too soon. The poll, conducted in February, found that 49% of adults were either “very worried” or “somewhat worried” that lifting pandemic restrictions would cause more virus-related deaths in their communities. About 50% were “not too worried” or “not at all worried” that death tolls would rise in their communities.

The CDC’s move triggered some of the same mixed feelings from the public that the poll uncovered and laid bare a split within the health care community.

On the one hand, there’s applause.

The CDC’s protocol change is an indicator that the nation is approaching a “transition from the pandemic phase to an endemic phase,” said Dr. Georges Benjamin, executive director of the American Public Health Association. Rather than pushing messages of prevention, Benjamin said, the agency is changing its focus to monitoring for spikes of infection.

On the other hand, there is criticism — and worry, too.

“When I hear about relaxing regulations,” said Dr. Benjamin Neuman, a Texas A&M University professor and chief virologist at its Global Health Research Complex, “it sounds a lot like people giving up. And we’re not there yet, and it’s a little bit heartbreaking and a little bit hair-pulling.”

What Are the New Guidelines, and How Are They Different?

Before the update, the CDC considered a community at substantial or high risk if it had had an infection rate of 50 or more new cases for every 100,000 residents in the previous week.

According to the agency’s new community-based guidance, risk levels can be low, medium, or high and are determined by looking — over a seven-day period — at three factors: the number of new covid cases in an area, the share of hospital beds being used, and hospital admissions.

This change had a profound impact on how covid risk was measured across the country. For example, the day before the CDC announced the new guidelines, 95% of the nation’s counties were considered areas of substantial or high risk. Now, just 14% of counties fall into the high-risk category, according to the agency.

The CDC doesn’t make specific mask recommendations for areas at low risk. For areas classified as medium risk, people who have other health problems or are immunocompromised are urged to speak to their health care provider about whether they should mask up and take other precautions. In areas deemed to be high risk, residents are urged to wear masks in indoor public spaces.

“This more stratified approach with this combination of those factors gives us a better level of understanding of covid-19’s impact on our communities,” said Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “Specifically, the impact of severe disease and death.”

But people shouldn’t get rid of their masks yet, she said. Even as the nation’s infection rates fall, the virus continues to spread on a global scale. “We have to fully recognize that there are so many people on this Earth who are unvaccinated internationally, and this is where the variants come from,” Althoff said.

Roses and Thorns From Experts

The same week the CDC rolled out its new guidelines, it reported a national seven-day average of about 71,000 new covid cases, along with 5,400 hospital admissions. Around 2,000 people were dying because of the disease every day.

It’s numbers like these that led some public health experts to question the CDC’s timing.

“I think we have prematurely opened and prematurely unmasked so many times at this point, followed by remasking and reclosing and just seeing our hospitals absolutely swamped, that I don’t really trust this,” said Texas A&M’s Neuman.

There have been “too many times,” he said, when the CDC has put down its guard and the virus came back stronger. “We’re basically taking our foot off the accelerator in terms of what we’re doing to slow down the virus, and that just means that there will be more virus going around and it’s going to keep swirling around,” he said.

The CDC’s goal for easing mask mandates, Neuman speculated, was to create regulations that are more appealing and easier for people to abide by, because “it’s hard to sell prudence as something really attractive.” Plus, public health officials need to have a program that the entire country can follow, he said. The battle against the virus can’t be won with policies “that people follow in blue states but not in red states,” he added, “because the virus is very much a collective risk.”

There also are questions about how effective the new approach is at signaling when risk is increasing.

Joshua Salomon, a professor of health policy at Stanford University’s medical school, said that although the CDC designed its new guidance to incorporate a stronger indicator of surges, it has “a very late trigger.”

Salomon, along with Alyssa Bilinski, an assistant professor of health policy at Brown University, looked into the delta and omicron surges and found that a rough rule of thumb during that period was that 21 days after most states rose to the high-risk level, the death rate hit three people for every million. That equals about 1,000 deaths a day at a national level.

The updated CDC guidance “is intended to provide a sort of warning that states are entering a period in which severe outcomes are expected,” he said. But the new approach would not sound that alarm until death rates were already reaching that “quite high” mark.

Others, though, point to another set of numbers. They say that with 65% of Americans fully vaccinated and 44% boosted as of March 8, relaxing covid protocols is the right decision.

The new strategy is forward-looking and continues to measure and track the virus’s spread, said the APHA’s Benjamin. “It allows a way to scale up and scale back the response.”

Since the guidelines are based on seven-day averages, he added, they are a good way to monitor communities’ risk levels and gauge which set of mandates is appropriate. “So if a community goes from green to yellow to red,” he said, referring to the CDC’s color-coded map that tracks counties’ covid levels, “that community will then need to modify its practices based on the prevalence of disease there.”

The guidelines, Benjamin said, are “scientifically sound, they’re practical.” Over time, he added, more communities will move into the low and moderate categories. “The truth of the matter is that you just cannot keep people in the emergency state forever,” he continued. “And this is never going to get to zero risk. … [Covid’s] going to be around, and so we’re going to have to learn to live with it.”

What About Those Who Are Not Eligible for a Vaccine or Are Immunocompromised?

The CDC’s relaxed recommendations do not prevent anyone from wearing a mask. But for millions of Americans who are immunocompromised or too young to receive a vaccine, less masking means a loss of a line of defense for their health in public spaces.

Children younger than 5 are not eligible to receive a vaccine yet, and people who are immunocompromised and are susceptible to more severe cases of the disease include cancer patients undergoing active treatment and organ transplant recipients. People living with chronic illnesses or disabilities are also vulnerable.

“You only have control of so much,” Neuman said. “And if you’re exposed to enough of the virus and you’re doing all the right things, you can still sometimes end up with a bad result.”

Masks are most effective when everyone in a room is wearing one, Neuman added, but the new mandate is similar “to victim-blaming — basically saying, ‘You have a problem and so here’s the extra burden to go with your problem.’”

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Roger Blakely

    Isn’t the pandemic over in the UK? In today’s weekly report of the ZOE COVID Study Professor Tim Spector is reporting infections are up, especially in Scotland. It would seem that hospitalizations and deaths will be on their way up too. That’s probably the story that we will be told tomorrow when Professor Christina Pagel give us the weekly roundup on the Independent SAGE meeting.

    1. PlutoniumKun

      From what I can see from the Irish data, which is generally mirroring the UK, there has been a distinct uptick in hospitalisation rates out of synch with infection rates. This may be due to less testing, but is generally being attributed to the BA2 variant and waning immunity (natural and booster shot). Its a little early to judge whether or not this is the start of a major second wave. I’ve noticed much weaker masking compliance here over a few weeks, especially among younger people, and lots more tourists and travel, so my guess is that only luck will prevent another wave similar to that of January.

      1. Cat Burglar

        Recent LGFA football game videos I watch on youtube make it look as if masking and distancing have been totally dropped in Ireland. Only a few spectators are wearing masks, everyone is sitting in the stands together, and, as usual, the crowds are cheering on their teams. Though it is all outdoors, it looks very high risk.

  2. jhallc

    “We’re basically taking our foot off the accelerator in terms of what we’re doing to slow down the virus.” (Dr. Neuman).
    While I agree with Dr.Neuman’s criticisms, his suggestion that the CDC has had its foot on the accelerator to stop the virus is just plain wrong. The CDC has been tapping the brakes throughout the pandemic. 1.) Fauci – Don’t wear masks..tap..tap, 2.) It’s droplet’s not airborne..tap..tap, 3.) Get vaccinated and you can take off your mask..tap..tap. 4.) Don’t use the “horse paste” ..tap..tap. The only thing they put the pedal to the metal on was vaccines, because there was money to be made and it was hoped to be a “silver bullet”.

    With respect to the risk assessment by the CDC, this is not like any risk assessment I ever did for soil and water environmental risk. We always looked at the most vulnerable populations exposure scenario over time (i.e. residents exposed over a lifetime).

  3. Samuel Conner

    I’m guessing that food price inflation will have follow-on effects in terms of the prices of restaurant meals. Think of it as a progressive tax on the wallets (and the health) of the more complacent members of the better off classes.

    Squinting really hard, perhaps one can discern a 2nd order (but probably small) public benefit from the current geopolitical situation: long COVID is certainly going to impact US military force readiness, and perhaps this threat to national security will motivate a rethink of the wider question of public health.

    1. ambrit

      Don’t forget that the military can act on it’s own, independent of the general government, in matters of health and safety of it’s troops and other workers. We might see parrallel institutions acting out of concert here.

      1. Samuel Conner

        Agreed, for active-duty forces (and perhaps also for people with what I assume are contractual obligations, such as National Guard and perhaps reservists).

        But the recruit pool is also vulnerable to long COVID and if general population fitness significantly declines (and it isn’t great to start with), I would expect that to have noticeable consequences for the medical condition of recruits. I think that I read not long ago that in recent years physical fitness standards for new recruits into the armed services had to be relaxed — in order to meet recruitment goals — due to the realities of the recruit population pool.

        If multiple COVID exposures before adulthood becomes the norm, and a significant fraction of those lead to chronic sequelae, I would think that would be problematic for the fitness of new recruits cohorts.

        I imagine that this is a matter of concern to the military establishment.

        Perhaps the VA and the military medical research establishment will be a source of innovation for the treatment of long COVID.

        1. JBird4049

          One of the problems that the British had during the First World War was finding healthy recruits as so many people were suffering from the inadequate diet, non existent healthcare, and the awful environment of cities like London. Some of it was hidden and only revealed by all the testing.

          IIRC, some of the impetus for the current system in the UK was not only to get canon fodder, but also not to be so unaware of health issues in the population.

          It helps to want to have the ability to collect and keep good records of course, which the CDC doesn’t look like it wants to.

  4. CGKen

    Correct me if I’m wrong, but doesn’t vaccine effectiveness, even with a booster, drop from >90% to 50% or lower after ten weeks? So everyone who got vaxxed last year is now flipping a coin. I’ve seen nothing in discussions of ending mask usage and other interventions that takes this into account. I mentioned it to my elderly parents who have the tv news on all day and they had no idea.

    1. Sutter Cane

      People’s responses seem to be based on 100% wishful thinking and ignoring of reality.

      Now that things are opening up I see events touting that proof of vaccination is required to get in, as if that means anything. If people got vaccinated last summer, they aren’t particularly protected anymore? Masks are optional, though.

      I also see a lot of people who had covid and it wasn’t that bad, who think they are bulletproof now. The fact that you can get it again after a few weeks, and get an even worse case, doesn’t enter into their minds.

      It’s funny that the actions of the Democrat “I believe science” crowd now are basically no different from the Republican “covid isn’t real/is over/is just the flu” crowd, yet they would be loathe to consider it to be so.

    2. XXYY

      I think the larger issue is that existing vaccines do not prevent the spread of the virus to any significant extent, since your body has already been amplifying and shedding the virus for several days by the time any effects of the vaccine take place. What they seem to do is keep the symptoms of a particular vaccinated individual from progressing as much as in non-vaccinated individuals. That’s important and worthwhile to the extent that it’s true (and hasn’t worn off yet, as you say) but it has no bearing on whether a particular variant of the virus is going to spread throughout the society or not.

  5. ambrit

    I “like” how the piece mentions the ‘vaccines’ as if they were proper sterilizing vaccines.
    ” They say that with 65% of Americans fully vaccinated and 44% boosted as of March 8, relaxing covid protocols is the right decision.”
    You relax the protocols if the vaccines are stopping the spread of the virus. The evidence shows the opposite. This rises to the status of “willful neglect,” or perhaps “depraved indifference.”
    Now we wait for the next major variant of this coronavirus to emerge. If it presents as a visibly worse variant, any public trust in the “official” health authorities will evaporate.
    American civil society is taking another giant step backwards.

  6. eg

    There’s an election in June in Ontario, so the mask mandate is going away March 21 (when students return to classes from March Break) and ALL emergency measures will be revoked by the end of April.

    None of this has anything to do with data, obviously.

  7. Arizona Slim

    Once again, nary a word about early treatment, which could involve a certain drug that shall not be named.

    Why am I saying this? Because masks aren’t perfect. They won’t prevent you from getting the ‘Vid, although they do offer protection.

    If you do get the ‘Vid, you need something better than being told to sicken in place and go to the hospital when you turn blue.

    1. Jeff

      How much protection do they offer? Were masks more effective with different variants, or was it the same regardless of variant? Were masks more effective in winter than warmer months due to more people coughing and sneezing during winter?

      I’m asking partly/mostly because I’d like to know what works, but also because states that had no mask mandate werent meaningfully different in terms of hospitalization numbers than states like California from a percentage of population standpoint.

      We’ve all been gaslit on every part of the covid experience and it seems as though masking was a key part of that effort. I want to be wrong about this, but visiting PHX in late 2021 where perhaps 15% were masked has me doubting masking effectiveness. If masks work, phx should have seen massive numbers of hospitalisations throughout the entire cov period.

      1. Cat Burglar

        See the links page today for a study on the effectiveness of mask mandates that compares county results — the effect of masking is significant.

        Studies of masking found that their greatest beneficial effect is not from filtering the air you inhale, but from filtering pathogens out of the air an infected person exhales — something that the new CDC guidance seems to ignore. You are not wrong to treat every claim skeptically.

      2. david anthony

        They are masks. They are effective. We know this because of many studies and years of experience. Again, they’re MASKS. It’s a thing over your face that stops stuff from going in your face hole.

        Florida had a 30% higher death rate than California per capita in the last surge. Helps to not guzzle a huge amount of the virus.

    2. HotFlash

      For Ms Slim (and anyone else who is interested) — some recent not-generally-reported news on that front: a letter from Dr. Tess Lawrie to Dr. Andrew Hill re his Iv’n report to the WHO (video), more digging by Phillip Harper into how, exactly, that happened here (podcasts) and here (substack). I expect the CDC and WHO to get right on this any minute now.

      1. Arizona Slim

        Thanks for posting the links, HotFlash. I’m aware of that story and I hope it goes even more viral than, oh, you know.

  8. Sutter Cane

    Hospitalizations are a lagging indicator, so using them to gauge when things get “bad” means it will have already been bad for three weeks or so before the CDC mentions it.

    Basically, the poor and frontline workers who are the first to be exposed because of their jobs will now serve as the canaries in the coalmine for the wealthy and the PMC who work from home. When hospitalizations and deaths start climbing, they’ll know it’s time to cancel brunch and pay attention to covid again.

  9. Milton

    I think I will place this article here as it can be applied to the current Covid environment. It illustrates the scientific communication feedback loop and how researched findings can be misinterpreted or hidden from the general publics view.
    Within the academic community, scientists are responsible for collecting and analyzing data, drawing conclusions, and publishing these findings in scholarly journals – the output often hidden behind steep paywalls and written in inaccessible jargon. Part of the reason for this isolation is necessity; new findings must be vetted and debated extensively within the broader scientific community before the knowledge can be openly shared.

  10. Greg

    I came across this risk estimation tool for social situations that is very well put together. The real detail is in the scenario definition on the right hand side.
    I think it might be very useful for at least some of the NC community.

    The tool is customisable enough, and states the outputs in a calculated risk of infection. It uses reasonable midpoints from the available scientific studies, as far as I can tell, for each potential risk factor (effects of social distancing, masking types, vaccination, boosting, room size, number of people, duration of visit).
    There are also some pre-calculated estimates for common settings like visiting a grocery store.

    Finally it suggests reasonable risk mitigation steps to take to reduce your exposure.

    Very cool tool.

    p.s. from a nerd perspective I like that it uses naked url’s to control settings so it’s highly useable from an idiots automation perspective e.g.

    1. JBird4049

      So, only ~700,000 deaths for 2022? That is if the numbers are accurate and if there is not an even more lethal variant this Summer?

  11. david anthony

    It’s as if Long Covid does not exist. And when we have many, many people unable to work, one wonders what the response will be from a government that does not remotely care about human life.

  12. MarkT

    Here in NZ the government has instituted isolation regulations. But only for ‘close contacts at home’. ‘Close contact at work’ seems to fall into a different category : ppl need only to check for symptoms but can continue to work. Two rules that make no sense other than ‘keep the wheels grinding’.

    1. drumlin woodchuckles

      And keep covid spreading. Perhaps some secret messengers arrived in New Zealand from Davos World Command Central and quietly read Ardern the Riot Act. As in ” make sure the covid starts spreading or you will be removed from office and perhaps deleted from existence with the kind of plausible deniability which my masters at Davos World Command Headquarters are very capable of, as you will find out if you disobey their orders”.

  13. drumlin woodchuckles

    ” Why would a scientist continue to work there? “Change from within”? ” Maybe ‘change from within’. Or maybe because a scientist lives in the same no money = you die society that the rest of us live in and has no hope of finding other work to go to, and/or also cannot afford to burn down his current precarious lifeboat of modest house/ meager pension if he/she toughs it out till retirement in place . . . . in order to make a statement by becoming the last hired- first fired nobody at some other institution . . . . if there even is one.

    So if that scientist privately offers covid-safety information to the people of his/her social circle that is not CDC-tainted, he/she is doing the best he/she can and may save some of the lives which the CDC leadership and their minions and servants are conspiring to kill.

  14. Peter Zelchenko

    Good piece. I haven’t set foot on my native U.S. soil since before COVID. In Jan. 2022, I was invited to a subsistence farm in deep rural Guangxi for the holidays, days before the Wuhan incident. We ended up stuck on the farm, blocked by a simple bamboo boom barricade from even entering the village. Last month, I left Wuxi for another farm, in a remote part of Yunnan, just as Suzhou and Shanghai got hit. I was supposed to stay only four days, but am again (happily) stranded here for weeks just as several cities have now now been locking down. I feel very lucky.

    In these quasi-zomian spaces, people are almost entirely unaffected by the outside world of the virus. Yet throughout China, compliance with masking, social distancing rules, nucleic swabbing, and showing our QR codes is not just high, it’s absolute. Nobody is complaining. In two years I haven’t seen one single rant, aside from a few sheepish objections by young folks (invariably wearing Nikes), hurrying to board the metro.

    One thing that dawned on some people early on is that virus transmissibility seems to be a “first world” affair, hitting first and fastest through the trappings of luxury (air travel, tony cities, hotels and cruises, other high-density commercial events and venues), and leaving lower-density, less attractive settings relatively unharmed. But it doesn’t take an epidemiologist or economist to foresee that the liberalizing policies derive from power and benefit power, and that the U.S. mask policy will still ultimately harm the poorest populations and areas most gravely. My early communication with U.S./China CDC and WHO leadership betrayed something of a blanket lack of clarity about masking’s benefits. Until you dig into the literature, the value of masking remains unclear. But once you understand the simple calculation for effectiveness of a “filter mat” (= the denser the better), the policy should be clear: two filters (e.g., one each on carrier and on potential victim) are obviously better than one. Judging from 100 years of mask literature, apparently this was never clear until COVID, and now it’s like amnesia is setting in. Equally clear now is that making masking optional, as someone mentioned, is to set up blame for the weaker victims, the front-line wage workers, the aged, immunocompromised, and children.

    Say what you will about China, but in terms of the notion of a mask, consider general socialist and liberal capitalist ideologies and their selective on-the-ground policies of what it means to protect the whole public. This serves as a potential marker for why and how the mask policies have evolved in these two countries in these ways. I’m struck and rather ashamed by the policy differences.

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