WASHINGTON - Top White House aides and Biden administration officials are debating...
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White House officials debate masking push as covid infections spike
Annie Linskey, Dan Diamond, Tyler Pager and Lena H. Sun, The Washington Post
July 21, 2021Updated: July 21, 2021 7:11 p.m.
WASHINGTON - Top White House aides and Biden administration officials are debating whether they should urge vaccinated Americans to wear masks in more settings as the delta variant causes spikes in coronavirus infections across the country, according to six people familiar with the discussions.
The talks are in a preliminary phase and their result could be as simple as new messaging from top White House officials. But some of the talks include officials at the Centers for Disease Control and Prevention who are separately examining whether to update their masking guidance, according to a Biden administration aide and a federal health official.
Officials cautioned that any new formal guidance would have to come from the CDC, and they maintained that the White House has taken a hands-off approach with the agency to ensure they are not interfering with the work of scientists. But the high-level discussions reflect rising concerns across the administration about the threat of the delta variant and a renewed focus on what measures may need to be reintroduced to slow its spread.
One idea batted around by some officials would be to ask all Americans to wear masks when vaccinated and unvaccinated people mix at public places or indoors, such as at malls or movie theaters, according to two people familiar with the conversations.
So far, leaders in the White House have been hesitant about any policies that would explicitly require Americans to show proof of their vaccination status, according to a person familiar with those talks. Depending on where discussions lead, that decision could ultimately fall to business owners who want to offer mask-free environments.
The conversations are taking place as the country is seeing more than 40,000 new cases of coronavirus infections a day, an increase from a low of about 11,000 cases a day in June. The uptick is largely driven by the delta variant, a far more infectious strain of the novel coronavirus. Moreover, the rate of vaccination continues to slow, with about 500,000 people a day getting shots now, according to The Washington Post's vaccine tracker. And breakthrough infections also are cropping up among vaccinated sports stars and politicians who are tested regularly.
"At the White House, we follow the guidance and advice of health and medical experts," said Kevin Munoz, assistant press secretary. "Public health guidance is made by the CDC, and they continue to recommend that fully vaccinated individuals do not wear a mask. If you are not vaccinated, you should be wearing a mask."
Any new masking recommendations would be primarily aimed at protecting the unvaccinated population, which makes up nearly all current hospitalizations and deaths caused by the virus.
A return to a recommendation of more masking or a shift in White House messaging that urges Americans to wear face coverings in more situations would be a blow to President Joe Biden's efforts to convince Americans that the virus is in retreat.
Success against the virus is a message that Biden hopes to use in the 2022 midterm elections to help his party retain control of the House and Senate.
Biden celebrated in May when the CDC said that vaccinated Americans no longer needed to wear masks in most settings, a change that some public health officials said was premature. He doubled down weeks later, throwing a Fourth of July blowout that featured 1,000 mostly unmasked people on the South Lawn of the White House as the delta variant strengthened.
The resurgence of the virus also could undercut the country's economic progress over the past six months and threatens to interfere with the Biden administration's other top priorities, including passing a sweeping infrastructure package, reopening schools in the fall and returning to a sense of normalcy for all Americans.
A number of White House officials, and people in touch with the White House, have privately said that changes to the masking guidance would be difficult to communicate, confusing to Americans and hard to enforce.
But, at least in the minds of some White House officials, the need to find ways to mitigate the threat posed by the delta variant makes remasking a topic worth discussing.
"It's fair to say they are reconsidering everything," said Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, who spoke with CDC and state officials on several calls this week. "I think everything's on the table," including whether to revisit recommendations on wearing masks and social distancing, Plescia added, noting that officials were particularly worried about the surge of coronavirus cases in the South and Midwest, where a disproportionately large proportion of Americans remains unvaccinated.
The context of the conversations is "what are the levers we can pull to fight delta," said one person familiar with the talks.
People infected with the delta variant appear to carry a viral load that is 1,000 times higher than earlier versions of the virus and can easily spread it, particularly among the unvaccinated, experts say.
Officials said the White House would defer to the CDC on whether to recommend broader use of face coverings, including among the vaccinated, according to two administration officials familiar with the talks.
"This should be CDC's call," one official said, speaking on the condition of anonymity because of not being authorized to speak to the news media.
The official noted that Biden and his deputies have vowed to "follow the science," in contrast to President Donald Trump, who often pressured the CDC and other scientific agencies to modify their guidance last year.
"But as we saw in May, there are problems with just leaving it to the CDC," the official added, referring to the agency's decision to relax its mask recommendations on May 13, which caught the White House by surprise.
Experts at the CDC are thinking through all options, including masking, according to a federal health official who spoke on the condition of anonymity because the discussions continue.
"At this time, we have no intention of changing our masking guidance," said CDC spokesman Jason McDonald.
Public health experts say the situation has changed drastically since May, when the CDC issued its guidance for fully vaccinated individuals. The delta variant is surging, accounting for 83% of sequenced coronavirus infections, a dramatic increase from 50% for the week of July 3, CDC Director Rochelle Walensky told a Senate panel this week.
Nearly two-thirds of U.S. counties have vaccination coverage of less than 40%, and more than 97% of people hospitalized with severe covid-19 infections are unvaccinated, according to the CDC.
"They would be irresponsible if they did not reconsider mask advice," said Jody Lanard, a physician who worked for nearly two decades as a pandemic communications adviser consulting with the World Health Organization.
But reconsidering mask advice would put the CDC in a difficult position.
When the agency issued guidance for fully vaccinated people in May, saying they did not need to wear masks in most places, the announcement was not explained well, Lanard said. Some people interpreted it as giving a pass to unvaccinated people to not wear masks, she said.
CDC officials "always say they want to follow the science, but they did not prepare the public early on to say 'we are looking at multiple factors, including how science fits in with reality and social science, and how it fits with expected and unexpected changes, especially sudden changes, where we have to turn on a dime to try to protect more people,' " Lanard said.
But, she added, the CDC could gain credibility by directly acknowledging to the public the confusion and mixed messaging. Such a message could be: "We have delta. We are going to take a chance of enraging people who are already understandably enraged by our mask advice. . . . This is a new phase of the pandemic not being under control, but it's better than the last phase."
Many Americans have stopped wearing masks, and officials are bracing for a challenge in convincing skeptics to put them back on.
Fifty-two percent of Americans say they are regularly wearing a mask when they are in public, down from 84% in early May, according to an Axios-Ipsos poll released Tuesday.
"When CDC issued its guidance on masking a couple months ago, that people who were vaccinated didn't need to wear them, we didn't have the delta variant around," said Linsey Marr, a Virginia Tech engineer who has studied the transmission of airborne diseases. "But cases are rising now, vaccination rates have stalled, and delta transmits much more easily than the earlier variants. And so I think we do need to revisit that guidance."
Covid-related hospitalizations have risen 34% nationwide in the past week, according to The Post's tracking, with some states reporting sharply higher figures; Louisiana has registered a 75% increase in covid-related hospitalizations over the past week, and Florida has reported a 52% jump.
"When you're starting to see hospitalizations tick up, you have to do something.
You have to make a move or you find yourself back in a place where we don't have enough hospital capacity," said Caitlin Rivers, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security.
Rivers said that she didn't see the need for a national mask mandate but thought that states that were reporting "over 10 cases per 100,000 people per day could stand to use a mask mandate" - a threshold that would apply to 20 states today, according to The Post's tracking. Those states are mostly in the South and Midwest, where fewer than half of residents have been fully vaccinated.
Already, some jurisdictions are taking matters into their own hands. Health officials in California last week recommended or required that residents in eight counties resume wearing masks indoors. That includes Los Angeles County, where officials reinstituted an indoor mask mandate over the weekend, requiring all residents regardless of their vaccination status to wear masks in indoor public spaces.
But, in an example of the power of the current CDC guidance, the L.A. county sheriff cited the federal guidelines when he said that his department will "ask for voluntary compliance" and not aggressively enforce the new local guidelines.
In Virginia, state officials are urging all elementary school students and employees to wear masks indoors this fall even if vaccinated. Virginia issued guidance Wednesday "strongly" recommending that elementary schools continue requiring mask-wearing until the coronavirus vaccine is available for children under 12. The guidance says students and staffers in middle and high schools should wear masks indoors if they are not fully vaccinated.
The tone also is shifting in Congress. On Tuesday, the attending physician of Congress, Brian P. Monahan, sent out a message that vaccinated people "may consider additional protective actions" including wearing masks, according to a copy of the message obtained by The Post.
The message also warned members of Congress and their staffers that the rules about masking could be tightened in coming weeks and months.
"Individuals have the personal discretion to wear a mask," according to the message, "and future developments in the coronavirus delta variant local threat may require the resumption of mask wear for all as now seen in several counties in the United States."
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