To Mask, Or Not To Mask?

ABSTRACT

TO MASK, OR NOT TO MASK! That is the Question!

It is difficult to get good information regarding the status of COVID-19 spread and infection. Much of the information available is tainted by political and media bias and misrepresentation. The rapidly spreading Delta variant, the dominant variant in the US, is presenting new challenges for a US public that is experiencing COVID fatigue.

Dr. Greg Lawton

July 7th, 2021

To Mask, or Not to Mask? That is the Question!

No doubt everywhere you go you and every store or venue that you enter is filled with people who are “unmasked”. Even though most of the countries in the world are still neck deep in the COVID-19 pandemic, and the World Health Organization recommends wearing a mask (even vaccinated individuals), loosened US CDC guidelines and state mandates say that fully vaccinated persons do not have to wear a mask in certain venues.

Since the development and deployment of the experimental COVID-19 vaccines (96 were under development in April of 2021) we have heard or read various predictions in the media regarding the vaccines effectiveness or efficacy in preventing COVID-19 infection. The first efficacy statistics resulting from a published study of the Pfizer vaccine in 2020 was 95 percent and then more recently the number was presented as 82 percent, then last week the results of a recent Israeli study showed the Pfizer vaccines effectiveness in preventing symptomatic COVID-19 infections of the Delta variant at 64 percent. The SARS CoV 2 Delta variant was first identified in India. It is now in at least 104 countries and accounting to the CDC it accounts for 51.7% of new Covid cases in the US. Why the decline in the effectiveness of the vaccines since they were first developed and administered? There are several reasons which include media and political bias in releasing actual effectiveness data, the mutation of the original SARS CoV 2 Alpha Coronavirus into various variants and leading to the current rapidly spreading Delta variant (and Delta Plus), and the inherent inaccuracy of the “effectiveness” numbers presented by the media and governmental agencies for the public. The data and terminology that epidemiologists use goes beyond the statistical ability of the average US citizen and is based upon computations of vaccine efficacy that are generally reported as a relative risk reduction (RRR), vaccine attack rates, and absolute risk reduction (ARR).

How effective is the COVID-19 vaccine in preventing infection from the Delta variant? That question is the elephant in the room. If you have been vaccinated, you are probably aware that your risk of a serious infection or hospitalization is significantly reduced. Based upon studies from the United Kingdom and Israel this is true, but you have probably seen stories about fully vaccinated individuals getting serious COVID-19 infections and being hospitalized or dying. That is not exactly reassuring.

If fully vaccinated individuals are contracting serious COVID-19 infections, being hospitalized, or dying what is that all about? The same factors, age, overall state of health, obesity, heart disease, diabetes, respiratory disease, auto immune disorders, immune system compromise, certain prescription drugs, as well as other health risk factors, that have increased the risk of a serious COVID-19 infection or hospitalization throughout the pandemic, also diminish or limit the effectiveness of the vaccine. This has been true of many vaccines ever since vaccines

were invented. We have also known from the onset of the pandemic and the development of vaccines for SARS CoV 2 that the virus would “outsmart” the vaccines and learn to defeat them.

Individuals and agencies who are calling for a departure from mask wearing are citing the low levels of the Indian Delta variant in US states, but the Delta variant is already the dominant variant in the US. The Delta variant is highly infectious and spreads more easily and rapidly than the Alpha, Beta, Gamma and the rest of the Greek alphabet of current variants. Within a few weeks the Delta variant will account for over 90 percent of all COVID-19 infections in the US. The symptoms of the Delta variant are said to be “similar to a bad cold” but also include all the symptoms seen in the original Alpha form of the coronavirus including serious infection and inflammation of the respiratory track in at risk individuals.

Vaccinated or unvaccinated, what is your risk of acquiring the SARS CoV 2 Delta variant? As discussed above the answer to this question depends on several individual health risk factors.

The more compromised your immune system is by these health risk factors the more vulnerable you are to the virus and although you may be vaccinated, or you may have natural immunity to some of the other COVID-19 variants because you were previously infected by one of them, you are still at risk of acquiring the Delta variant. At least one study showed that individuals with natural immunity to the coronavirus through previous infection with either the Alpha version of the virus or its later variants had no antibodies to the Delta variant. This matter requires further investigation.

How do you determine whether to wear a mask and to continue to practice frequent handwashing, social distancing, and limiting close interpersonal contact? This is a decision that is both personal and in certain cases mandated by federal and state requirements. If you are over the age of 50 and you have any of the long list of illnesses and disorders that compromise your immune system and its responses, you should continue to protect yourself from exposure to the coronavirus and its variants. If you are on any of the long list of immune suppressant prescription drugs you should continue to exercise caution and limit your exposure to the Delta variant through protective measures. If you live in an area or region with increasing Delta variant levels, you need to remain vigilant regarding the growing spread of this virus. Once the Delta variant has gained a foothold in a country it will spread to the point that it will become the dominant coronavirus infection found in infected individuals, whether symptomatic or asymptomatic, as it has in countries around the world and the US. In addition, vaccinated individuals can acquire the virus, and whether symptomatic or asymptomatic, they can spread it to others.

Federal and state OSHA regulations dictate what infection control procedures must be put in place by employers and followed by employers. Individual businesses can require certain infection control policies and practices that go beyond official mandates or guidelines including employee, client, or customer screening and the wearing of masks. Most hospitals and health care clinics are maintaining COVID-19 infection control measures and procedures as are many schools.

Is it really time to stop wearing a mask? That is a question that at the current time, and based upon your age, personal health, and risk factors, only you can answer. Only you can assess your personal health risks based upon factors like your age, overall health status, obesity, medications, and comorbidities. The CDC is suggesting that if you have chosen not to be vaccinated you need to pay serious attention to the Delta variant and to practice protective measures such as mask wearing, frequent handwashing, social distancing, and avoidance of casual close interpersonal contact in group situations and environments.

About the author: Dr. Gregory Lawton is a health science writer, physician, and teacher.