Outrage of the Month: CDC Jettisons Common Sense With Premature Update of Mask-Wearing Guidance

Health Letter, June 2021

By Michael Carome, M.D.

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Since Donald Trump vacated the White House and President Joe Biden quickly installed a highly competent and experienced team of public-health and medical experts to lead the federal response to the coronavirus pandemic, the country has made significant strides toward controlling the pandemic. Since their record peaks in early January, the numbers of new COVID-19 cases and deaths have fallen dramatically.

But in a move that left many public-health and medical experts dumbfounded, the Centers for Disease Control and Prevention (CDC) on May 13 abruptly loosened its recommendations on mask-wearing. Specifically, the agency declared that people who are fully vaccinated for COVID-19 no longer needed to wear masks in any outdoor or indoor setting, except where required by federal, state or local laws and regulations, including local business and workplace guidance.

The revised guidance predictably created widespread confusion across the U.S. in workplaces and other venues where vaccinated and unvaccinated people mix. Many businesses expressed uncertainty regarding who was responsible for confirming vaccination status of customers. In the wake of the CDC’s action, numerous states and large store chains simply rescinded their requirements for mask-wearing in all indoor settings.

With only 37% of the U.S. population fully vaccinated at the time the CDC announced its updated guidance, daily confirmed COVID-19 cases and deaths in the country averaging more than 30,000 and 550, respectively, and many unvaccinated people already refusing to wear masks, the sudden relaxation of the CDC’s guidelines on mask-wearing was premature, violated the precautionary principle of public health and may lead to new surges in infections in many communities.

In a May 16 op-ed in the Washington Post, Leana Wen, an emergency physician and former Baltimore health commissioner, appropriately lambasted the CDC’s decision to revise its guidelines as follows:

If such a head-scratching turn of events had occurred under former president Donald Trump, the administration surely would have been blamed for the lack of coordination and resulting widespread confusion. The Biden team has excelled on many aspects of the covid-19 response, but this was a major blunder that threatens to set back much of the progress made. President Biden needs to fix it, urgently.

Irrespective of the merits of the CDC’s revised guidance, among the most troubling aspects of the agency’s decision to loosen its guidelines on mask-wearing by fully vaccinated people was the failure of the agency to engage in a transparent, consultative process with the multiple affected stakeholders — including state and local public health officials; occupational health and safety experts; teachers and school administrators; labor unions; and business leaders — before making such a consequential public health decision in the midst of the ongoing COVID-19 pandemic.

At a minimum, the CDC should have convened a public meeting of one of its standing advisory committees to discuss and make recommendations regarding the revisions to the existing guidelines on mask-wearing that were being contemplated by the agency. This would have allowed the wide array of affected stakeholders and members of the public to prospectively share their views on the proposed changes, ensured that the CDC fully understood the potential ramifications of these changes, helped rebuild public confidence in the agency, and avoided the widespread confusion that has ensued since May 13.

At the start of the pandemic, there was an urgent need for the CDC to quickly issue guidelines on important public health measures to address the unfolding public health emergency; under such circumstances, prior consultation with an advisory committee at a public meeting would not have been reasonable or feasible. In contrast, there was no urgent need for the CDC to abruptly loosen current key national public health guidelines for controlling the pandemic, such as those related to mask-wearing, without crucial, feasible prior consultation with an advisory committee at a public meeting.

Defending her agency’s new guidance, CDC Director Rochelle Walensky insisted that the available scientific evidence supports the CDC’s conclusion that it is safe for people fully vaccinated for COVID-19 to forego mask-wearing in any indoor setting. But such a major public-health decision also needed to be based on common sense. And common sense would have told the agency that now was not the time to lift mask-wearing requirements for fully vaccinated people.

Although significant damage from the CDC’s ill-informed action has already been done, the agency should promptly convene an appropriate CDC advisory committee to reconsider the most recent changes to the agency’s guidelines on mask-wearing. The agency also should convene an advisory committee meeting before making any future major decision about loosening guidelines on key public health measures that have been critical to containing the pandemic.