The announcement by the Centers for Disease Control and Prevention (CDC) that fully vaccinated people do not have to wear face coverings indoors, unless specified by their states or local jurisdictions, triggered a backlash from public health experts.
They called the new guidelines premature — rightly so — and said that the coordination and rollout should have been better planned with the states and the rest of the Biden administration. While the criticism is accurate, the guidelines reveal another deep problem that the CDC can’t fix on its own: Americans don’t trust each other, and around half don’t fully trust the CDC.
One of the most fascinating takes around CDC’s masking update: “now unvaccinated people are going to just stop masking too!”
It’s fine to have that take— but then don’t also preach that we need to ‘trust the public’ & see them as partners
Just admit you don’t trust the public
— Abraar Karan (@AbraarKaran) May 19, 2021
A big concern has been that unvaccinated people, who could have Covid-19 and not know it, could choose not to wear masks or face coverings when out in public. This means to me that Americans are concerned not only with what the CDC said or did, but whether some of their fellow citizens are going to abuse these guidelines.
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Mistrust will be a long-standing public health ripple effect from the Covid-19 pandemic.
This isn’t solely the CDC’s fault, since it does not dictate or implement mask mandates. Those come from governors and states. I should know: I worked on the Covid-19 response for the Commonwealth of Massachusetts for most of 2020. Through this work, I came to understand that CDC guidelines are analyzed, interpreted, and implemented in different ways by different states depending on local factors.
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While I agree that mask mandates should remain in place for a while longer, I don’t agree that the CDC deserves most of the blame for states that have removed their mandates. The CDC was transparent with the public that fully vaccinated individuals do not need to mask in most circumstances: this is true. But what is true for an individual isn’t necessarily what is true for a community.
The goal now should be to communicate this nuance more clearly to the public, a responsibility that should be shouldered by the states just as much as by the CDC.
Consider what would have happened had the CDC withheld its announcement because, like many Americans, CDC officials decided they can’t trust what people will do in public settings if states end up dropping mask mandates. The agency would have been criticized for infantilizing Americans and withholding information to the public, which surely won’t build trust. At a time where public trust in the agency is already faltering, the stakes for each public policy decision are high.
And this is the CDC’s second mask blunder: in the spring of 2020, as the pandemic raged, its advice to the public was not to wear masks at all.
I remember scratching my head when the CDC made that first recommendation. Some of the arguments I heard from colleagues in public health — many of them seasoned experts — were that if we told people to wear masks they would suddenly stop doing other preventive activities, such as physically distancing from each other. This presumption was based on the idea that people would not understand that masks were additive; instead, they would become reckless and end up worse off.
This argument, known as risk compensation, has been used in many ways, including to argue that requiring people to use seat belts would create riskier drivers.
In short, experts did not fully trust the public to act safely. So they withheld tools that could have protected them. Yet this risk compensation didn’t end up happening. For some people, the opposite happened, with masks becoming a visual reminder to stay six feet or more away from others.
Weeks later, when the CDC recommended that people should wear masks, the public’s trust had been lost. Some people questioned why the change was made; others were understandably upset to know that they had not been trusted to protect themselves.
This time, as the agency once again decided to weigh in on wearing masks in public, it was forthright on the benefits of Covid-19 vaccines, and may have hoped that the goal of not wearing masks in public would further incentivize people to get their shots. But the argument from public health professionals, as well as members of the public, has again been that people are too irresponsible or selfish to follow the guidelines, and unvaccinated people will abuse this system.
To be sure, no one knows know what will happen next. Where mask mandates are dropped, some unvaccinated people will stop wearing masks in public. It’s also possible the new mask guidelines will indeed be the incentive some people need to get vaccinated.
The bigger concern here is not with what the CDC actually said, but with the fact that there is a deep lack of trust in our society. People don’t feel like they can rely on one another to follow guidelines that aren’t enforced with mandates or penalties. And while there’s good reason for why that trust has evaporated, the CDC’s choice to release or withhold information to us all should not depend on whether some people might abuse that information. The public deserves to be told the truth about where the science stands; the public also deserves competent governors and public health department chiefs who can communicate nuance and decide what policies make sense to implement at a community level.
There’s no question that trust must be rebuilt between members of the public, and between the public and health agencies and leaders. But for this to happen, we must all acknowledge that the lack of trust is what’s bothering us.
Abraar Karan is an internal medicine physician at Brigham and Women’s Hospital in Boston and a clinical fellow in medicine at Harvard Medical School.
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The CDC's latest blunder is really about trust, not masks - STAT - STAT - STAT
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