Leading public health figures suggested over the weekend that it was time to reevaluate requirements for wearing masks indoors as COVID-19 cases continue to decline and more than half of all American adults have received at least one dose of a vaccine.
On CBS's "Face the Nation" Sunday, former commissioner of the Food and Drug Administration Dr. Scott Gottlieb, encouraged jurisdictions with low rates of infection to begin relaxing mask mandates.
"I think we're at the point in time when we can start lifting these ordinances in a wholesale fashion," he said, noting that half the states in the country are seeing daily infections at just 10 per 100,000 and almost a quarter have infection rates of 5 in 100,000.
The former FDA chief advocated lifting restrictions on outdoor gatherings entirely and eliminating other required mitigation measures under certain criteria. "The states where prevalence is low, vaccination rates are high, and we have good testing in place—we're identifying infections—I think we could start lifting these restrictions indoors as well, on a broad basis," he said.
It's possible that mask ordinances may have to be reimplemented if there are outbreaks or if there is a decline in immunity, Gottlieb advised. "But that's a long ways off. We'll worry about that in the fall and the winter," he said. "We're at the point right now where we could start lifting these ordinances and allowing people to resume normal activity."
Asked about Dr. Gottlieb's comments, top White House medical adviser Dr. Anthony Fauci agreed that it was time to start relaxing indoor mask mandates. "Yes, we do need to start being more liberal as we get more people vaccinated," Fauci said on ABC's "This Week."
The CDC recommended relaxing restrictions on outdoor mask use last month and announced a number of outdoor activities that were considered safe for vaccinated Americans, including outdoor gatherings and dining. The agency still recommended mask use for large outdoor events, like concerts or sports games, as well as indoor activities.
Dr. Fauci anticipated the CDC would again update its guidance as more people get vaccinated and COVID-19 cases drop below the current rate of about 43,000 per day. At rates lower than that, he said, the risk of indoor and outdoor infections "diminishes dramatically."
The promise of rolling back restrictions will come as a relief to many Americans, especially those who got shots but were still told to strictly follow mitigation measures. Current data suggests that the Pfizer, Moderna and Johnson & Johnson vaccines are effective against known COVID-19 virus variants. There is also growing evidence that vaccinated people cannot spread the virus, in rare instances of breakthrough infections.
"It's important to continue to provide incentives for more people to be vaccinated as we move forward," said Dr. Jennifer Horney, co-founder of the epidemiology program at the University of Delaware.
Benefits like gathering indoors without a mask, traveling or returning to large events will help encourage more vaccine uptake, Horney noted. "I think people are ready for some optimistic news and maybe a pat on the back."
More than 152 million Americans have received at least one shot and over a third of the population is fully vaccinated. Despite the slowing demand for vaccines across the country, there is growing optimism after federal regulators approved the Pfizer vaccine for children as young as 12.
Currently, about half of all states still require masks in certain settings to prevent the spread of COVID-19, according to AARP. A handful of states never formally required mask usage on a statewide basis. Florida, Idaho, Missouri, Montana, South Dakota, South Carolina and Tennessee allowed counties and cities to decide to implement mask mandates. Earlier this month, governors of Florida and Montana reversed those orders and took the extraordinary step of banning local governments from enforcing mask mandates.
Texas was the largest and one of the earliest states to lift its mask requirement. In early March, Republican Gov. Greg Abbott ended virtually all COVID-19 restrictions put in place at the state level last July. In lifting restrictions, he also urged Texans to continue exercising "personal responsibility" for mitigating the spread of the virus.
Local and federal political leaders argued that Texas was letting down its guard too soon. Similar warnings were issued for Mississippi, which ended its mask mandate in early March as well. President Joe Biden attacked the governors of Texas and Missippi for "neanderthal thinking." Public health officials anticipated a new surge in infections, hospitalizations and deaths.
So far, the surge hasn't come. Instead, cases in Texas continue to drop and up to 40% of the population has been vaccinated. As of Monday, Texas had fewer than nine cases per 100,000. Mississippi was down to six cases per 100,000.
Dr. John Zerwas, senior medical adviser to Gov. Abbott on the pandemic response, explained the decision to repeal the mask mandate was not "some random leap of faith." It was informed by the progress of the vaccination effort among the most vulnerable and confidence in the effectiveness of the vaccines. Simultaneously, Texas was seeing a decline in cases and rising natural immunity. Over the course of the pandemic, up to 12 million Texans recovered from the virus.
"Each state and each region of the country has, perhaps, a different perspective on it," Zerwas said. "In Texas, we looked within ourselves, we looked at what we had done, what we were doing and what we thought the future would look like."
In loosening formal restrictions, Texas did not stop local jurisdictions or businesses from requiring masks. "The lifting of the mask mandate was a message that, look, you don't need the weight of the state telling you to wear or not to wear a mask," Zerwas explained.
Since the mask ordinance was lifted, compliance is waning in some places, he noted. "As people continue to see the movement back to normality, if you will, they'll also continue to gain that confidence in the vaccination effort that's out there."
Alabama is another state that eliminated its mask mandate. Republican Gov. Kay Ivey instituted a statewide mask mandate last July amid a surge in cases and deaths. Last month, she announced she'd let the mask mandate lapse, while still encouraging Alabamians to wear a mask when in close contact with other people.
Since the repeal, Alabama has not seen a spike in coronavirus cases. Since late March, Alabama's weekly average of new COVID-19 cases has not exceeded more than 550 and hospitalizations have remains stable at around 450, down from the January peak of more than 3,000 per day.
"We certainly do know that many of our citizens continue to follow the guidelines even though there is no mandate," said Alabama Deputy Health Officer Dr. Karen Landers.
Vaccinations are also contributing to the decline in new cases but not as much as public health officials had hoped. Alabama is tracking below the national average with roughly 30% of the population receiving at least one dose of a vaccine.
"Our cases have been going down but our vaccine rates are still not where we need them to be at all," Landers said. "We are concerned our citizens aren't taking advantage to the extent we want them to." Alabama, like other states, is encouraging everyone over the age of 16 to get get a shot and making vaccines available from pharmacies to rural health clinics, hospitals to mobile vaccine units.
With the CDC loosening recommendations and states across the country lifting mask mandates, some people may resist lifting the restrictions after a year of being told to wear masks and avoid close contact. According to a recent Ipsos poll, 57% of Americans wear masks at all times when they're in public.
"I think part of the hesitation right now is cultural," Gottlieb said. "I think it's going to take some time to get back in the normal swing of things and get that socialization back."
There are also lingering safety concerns among individuals who are immunocompromised, the elderly or others who were considered among the highest-risk groups. Even with vaccines proving to be nearly 100% effective in preventing hospitalization and death, many people may continue to wear masks under certain circumstances.
"Hopefully, one of the lessons moving forward in a post-plague world, when we’ve moved beyond COVID, is that the concept of wearing masks becomes more culturally appropriate," said Dr. Daniel Van Durme, director of the Center on Global Health at Florida State University's College of Medicine.
Five years down the road, Van Durme anticipates some portion of the population will continue to wear a mask on a regular basis, whether it's to protect themselves or protect others, especially during cold and flu season.
On NBC's "Meet the Press" Sunday, Fauci suggested that mask use could become "seasonal," with more people electing to wear face coverings during the winter to diminish the risk of spreading COVID-19 or other diseases.
"No one is going to tell you—or hopefully not—'Take that mask off; you have to remove your mask,"' Van Durme said. "They'll say, 'We'll remove the mask mandate.' But if your individual circumstance is such that you want or need that added protection, then keep that mask on."
Some people may be eager to burn their masks and party like it's 2019, while others will likely gravitate to places where they are comfortable, like small gatherings with family, vaccinated friends or outdoor activities.
"I think it will be very incremental for many people, particularly those who have been more cautious all along," Horney said. "Hopefully, over the summer, as people are able to do more outdoor activities safely, they'll gain confidence and comfort in doing some more indoor activities without their masks."