San Diego County recently announced that it will lift the public mask mandate on June 15, in accordance with new CDC guidelines. In a vacuum, this new policy is consistent with the medical evidence. Those who are otherwise healthy and fully vaccinated are at a very low risk of catching the virus, and if they do catch it, they are almost entirely protected from severe illness or death. Furthermore, if infected, they will not spread the virus to others. In a vacuum, it is therefore completely logical to say that fully vaccinated people should not have to wear masks anymore if they’d rather not.
The problem, of course, is that we do not exist in a vacuum; we exist in an interconnected community. And these new guidelines do not entirely take into account how the virus is transmitted in the real world, by real people, in ways that may result in yet another destructive surge if we lift masking mandates too soon.
One rather large problem is that the new guidelines seem to mostly boil down to an honor system in which those who are not yet vaccinated will continue to wear masks to prevent spreading possible infection to others. And unfortunately there is no reason to think that the chance to remove one’s mask is going to motivate people to get vaccinated if Krispy Kreme donuts, stickers and (importantly) the promise of protection from severe COVID-19 disease have already failed to do so.
The other – and bigger – problem is that these new guidelines individualize the response to a population-level problem. A public health problem. In the words of CDC Director Dr. Rochelle Walensky, “your health is in your hands.” Currently, about 64 percent of San Diegans ages 12 and over have gotten at least one shot, and 48 percent are fully vaccinated, but these levels have plateaued in recent weeks. Vaccinating nearly half of San Diegans in a five-month period is an amazing accomplishment. But it is still far from the target of 70 percent. Moreover, looking at the numbers in aggregate hides real differences in vaccine uptake by age and by race/ethnicity. While more than 90 percent of those 70-79 years of age are vaccinated, only 41 percent of those 20-29 and 50 percent of those 30-39 years have been vaccinated. And less than a third of eligible Black and Native American San Diegans have been vaccinated, compared to 48 percent of Hispanic and 51 percent of Whites in the county. In San Diego, grassroots organizers, community members, Sharp HealthCare and the Health and Human Services Agency have done a remarkable job ensuring vaccine access in South County in particular, where 68 percent of residents ages 12 and over, and 66 percent of Hispanic residents have gotten at least one dose of the vaccine. But statewide, only 40.5 percent of Hispanic residents have received at least one dose, compared to 60.4 percent of White residents.
A tenet of behavioral science is that behaviors often cluster, and those who have been reluctant to wear masks may also be the least likely to vaccinate and most likely to minimize the possible risks of contracting COVID-19 – leading to more risky behaviors as restrictions are relaxed. Lifting the mask mandate too soon will risk increasing virus spread among people in their 20s and 30s, as well as children who are not yet eligible for the vaccine. While these individuals may not run the risk of severe disease themselves, they can still transmit the virus to people who are immunocompromised or those who have not developed full immunity yet. Furthermore, they could become the source of new viral variants with the potential to undo the progress made to date to control the epidemic.
A key component of public health ethics is asking ourselves: Who is likely to accrue most of the benefit of this intervention? Who is likely to accrue most of the harm? The benefit of this change will not accrue equitably across lines of wealth, age, race, and disability status, while the potential harms and increased risk of infection from unmasked individuals (either vaccinated or claiming to be vaccinated) will fall to racialized and marginalized communities. This pandemic has not hit us all equally. It is not good public health to suggest guidelines that may further harm populations that have already suffered the most.
Personally, we plan to keep our masks on in public even after June 15. It is not the CVS manager’s job to arbitrate who is vaccinated and who is not. Coffee shop staff should not have to worry about their unvaccinated child or their immunocompromised mother every time somebody sits down to enjoy a muffin. The heart of public health is social justice, and the heart of social justice is caring for the people around us, even if it means dealing with one’s glasses fogging up in the frozen food section for another six months.
Rebecca Fielding-Miller is an assistant professor, Richard Garfein is an infectious disease epidemiologist and professor and Nancy Binkin is a professor in the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego.