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The CDC recently updated its guidelines to say that even vaccinated people should wear masks indoors in areas with high or significant COVID-19 transmission.
According to The Washington Post, the CDC updated its guidelines after reviewing data from outbreak investigations and studies showing that vaccinated people who contract the Delta variant may be able to transmit the virus just as easily as unvaccinated people.
In view of the changed guidelines, Elisa Choi, MD, FACP, FIDSA, an internal medicine and infectious disease specialist in clinical practice in Massachusetts said it is crucial for primary care physicians to emphasize the importance of vaccination to their patients.
“We are working hard to encourage those who have reservations about moving the COVID-19 vaccine forward. These patients may ask, “Why should I bother now? Even if I am vaccinated, I have to mask myself. ‘ That’s not the message I want to take with the public, ”Choi told Healio Primary Care.
The vaccines, she added, have significantly reduced deaths related to COVID-19.
“Even if someone has a breakthrough infection and is fully vaccinated, they are unlikely to need to be hospitalized and extremely unlikely to die of COVID-19,” Choi said. “That means the COVID-19 vaccinations are working.”
However, the rapid spread of the highly contagious Delta variant justifies additional preventive measures.
“This does not mean vaccine failure – it is just the opposite,” she said. “This is a new phase of the pandemic so we must all use our tools.”
We spoke with Choi about the CDC’s new masking guidelines, what PCPs should tell their patients about COVID-19 prevention measures, and more.
Healio Primary Care: Do you agree to CDC’s new masking guidelines?
Choi: I very much agree with the CDC masking guidelines. The vaccinations are working, and we have made remarkable strides in reducing serious illnesses and deaths related to COVID-19. But what we are seeing now is that the COVID-19 variants are more contagious and communicable, and we are currently seeing another surge in cases in the US. There are certainly large numbers of COVID-19 cases around the world. This is the right time to step up our infection prevention efforts: vaccinations as well as increased measures to control and prevent infections.
We know masking is working and it is appropriate at this stage of the pandemic to tie masking guidelines to local COVID-19 transmission rates. We also know that the risk of infection can vary. For example, exposure to COVID-19 in poorly ventilated indoor spaces carries a greater risk of infection than COVID-19 exposure outdoors or in a well-ventilated room. The risk of COVID-19 exposure could be increased if you come into contact with more or unvaccinated people. There is also a greater risk if there are higher background rates of COVID-19 infection in your geographic area. CDC’s masking guidelines recognize these different nuances in transmission and make sense as part of a comprehensive, comprehensive infection prevention strategy given our current situation in the pandemic.
Healio Primary Care: How should patients know if they live in a high transmission area?
Choi: The CDC has provided a very helpful site: the COVID Data Tracker. The CDC’s new masking guide recommends masking either in an area with significant or high transmission. Use this link to see if local geography falls into one of these categories.
Healio Primary Care: Misinformation was a problem during this pandemic. How can CDC and HHS better get their messages across to the public?
Choi: Misinformation is such a huge barrier to our patients and poses significant challenges for doctors as we have to actively refute inaccurate information about COVID-19 vaccines, transmission, and clinical manifestations. The CDC and HHS have done a very admirable job, especially given the rapid pace of change in information and the increasing complexity of information.
There could be ways to provide even better patient-centered information such as infographics. I know the CDC has some, but it never hurts to have more. The infographics can be a very simple image that can contain the take home points. Patients really need to know the bottom line. It will only be beneficial to provide as much information as possible and be easily accessible to patients.
Doctors can be messengers and ambassadors of medically correct information. There are opportunities for the CDC to continue and perhaps even strengthen some of its partnerships with doctors, health organizations, and various medical groups to provide topics for conversation or scripts for how doctors can talk to their patients. Personally, I think that with this revised masking guideline it will now be important to emphasize that this is not a vaccination failure. Vaccinations really work – they are good vaccines – but this is part of the evolution of the COVID-19 pandemic. We know that this virus can mutate and develop variants; that’s what happened. The guidelines are not changing because vaccinations fail, but because of the need for increased and intensified infection prevention as SARS-CoV2 has become more contagious and contagious. This new guide to masking, combined with vaccines that remain successful, will increase protection against COVID-19. We are reinforcing the messages that vaccines are working, but we also need masking as additional infection prevention will help allay some patients’ fears and public concerns.
Healio Primary Care: What is the role of PCPs with all of this?
Choi: Family doctors are one of the most trusted sources of information for patients. Patients trust their GPs when it comes to information about COVID-19 vaccinations. Likewise, patients trust their GPs in providing advice and information about COVID-19 in general, especially because so much information is published so frequently and the information can often change.
General Practitioners can and should be an important source of information about the new CDC Masking Guidelines, in my opinion. No doubt there will be confusion among the lay public as to why the guidelines have been changed. Family doctors can help provide the more nuanced context that the guidelines haven’t changed because of a vaccination failure, but because this variant – the delta variant – is more contagious and we want to make sure we are protecting our patients, including those who are not vaccinated. Family doctors can help discuss the importance of following these new masking guidelines, given the current situation with the pandemic, and also instill confidence in those vaccinated that their vaccines are working. The masking policy is not being changed out of fears that vaccinated patients are likely to succumb to COVID-19 illness, become seriously ill, or be hospitalized and die. The data shows that this is not that important. What GPs can explain to their patients is that masking guidelines are changing to protect those in our communities who for some reason are not fully vaccinated against COVID-19. For those who are not vaccinated against COVID-19, they may not have had a chance to get vaccinated, or they may not be vaccinated because of various other medical problems, or maybe their medical conditions (e.g. immunosuppression) may be too increase the risk of COVID-19 disease. The change in masking guidelines is part of a multi-layered approach to increased efforts to prevent infection against COVID-19 that recognizes different levels of risk for the transmission of infections. It’s really more for the good of the community and an attempt to push back a bit on the currently rising case numbers, in a way that we know will prevent infection.
The bottom line is that the GP plays such an important role as the trustworthy voice of medically correct information for their patients and also as a healthcare professional who can help explain the reasons why some of these various measures have changed and may continue to exist switch. For a person who is not a medical professional, knowing where to find accurate and trustworthy information must be really overwhelming. While the GP can refer the patient to the CDC website, which is a valuable resource, there can still be a lot of information that is overwhelming for someone who is not medically trained. The role of the family doctor can be to translate this medically complex information into much more manageable everyday language that the patient can then understand and rely on to receive the most up-to-date and accurate information.
* Editor’s note: The opinions expressed by Choi in this interview represent their own and are not necessarily the guidelines or positions of any organization with which it is affiliated.
References:
Christie A. et al. MMWR Morb Mortal Wkly Rep. 2021; doi: 10.15585 / mmwr.mm7030e2.
The Washington Post. “The War Has Changed”: Internal CDC document calls for new messages and warns of likely more serious Delta infections. https://www.washingtonpost.com/health/2021/07/29/cdc-mask-guidance/. Accessed July 29, 2021.
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