Do we still need to wear masks? Making sense of mandates amid reopenings and rising variants

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Seattle Sounders fans exit Lumen Field after a match on June 23. (GeekWire Photo / Kurt Schlosser)

Some people don their mask for a walk, while others rip theirs off the minute they order a drink at a bar. Some seem to not wear masks at all, and everyone seems a little unsure about the rules.

Even for those who are vaccinated, it’s still unclear when mask-wearing is appropriate, if at all. The issue is top-of-mind across the globe as new variants rise in prevalence and pandemic restrictions are lifted. Here’s what you need to know.

Do I need to wear a mask?

In the Seattle region, one reason for the confusion is that King County has different mask rules than Washington state, which is reopening its economy next week. Washington is not the only state with a patchwork of masking requirements, which vary widely throughout the country.

King County set a mask directive on May 20 that called for masks in indoor public settings such as restaurants, regardless of vaccination status, or outdoors if unable to maintain six feet.

Since then, the COVID-19 case rate in the county has dropped more than 60%, as vaccination rates have risen. 70% of King County residents over the age of 12 are now fully vaccinated; King County was the biggest U.S. county to reach the milestone on June 22.

King County will lift its mask mandate on June 29, and then the state rules will hold: Masks will still be required in public spaces indoors for unvaccinated people, and in healthcare and similar settings regardless of vaccination status, with some narrow exceptions. Other pandemic restrictions will lift throughout the state by June 30.

“It is the right thing to do, it is time for us to reopen,” said Umair Shah, Washington’s secretary of health, at a media briefing earlier this week. The state will be open for business and recreation, and restaurants, bars and grocery stores will operate at full capacity.

(Amazon Photo)

The state rules follow guidance set by the U.S. Centers for Disease Control, which shifted its own rules in May to allow vaccinated people to not wear masks.

As pandemic restrictions lift, “even vaccinated people may choose to continue wearing masks in public places,” said Jeffrey Duchin, health officer for Public Health — Seattle and King County. “Some may choose to continue wearing a mask if they are at increased risk for severe infection, have an underlying health condition, or are in close contact with someone at increased risk.”

Others may just feel more comfortable wearing a mask. And businesses anywhere can ask people to wear one.

Public health experts have disagreed about when mask rules should be relaxed.

While masks are one of the most effective ways to stop transmission, vaccines are the real pandemic stopper: between April and May 29, 98% of cases in the state were among the unvaccinated.

Washington state will open up before its June 30 target rate if rates of first vaccination reach 70% in people over 16, a number that reached 68% on June 20 — though vaccine uptake is slowing. At the media briefing on Tuesday, officials did not anticipate delaying the opening of the state, even as COVID-19 case rates begin to level off and new variants take hold, posing an additional threat to the unvaccinated.

“For those who are unvaccinated, the message is clear. This is your time to get vaccinated,” Shah said.

What about the variants?

The delta variant, which is highly transmissible and may make people sicker, currently accounts for about 9% of cases in Washington state, and is rising nationwide.

Delta (red) and gamma (light green) variants are on the rise in Washington state. Data is from sequenced specimens. (Washington DoH)

Another concerning variant, the gamma (P.1) variant, prevalent in Brazil, is rising even more rapidly in the state. The gamma variant now accounts for more than 20% of COVID-19 cases in Washington, and has the highest hospitalization rate in Washington of all of the variants, said Scott Lindquist, acting health officer for the state, at the media briefing.

“This is like a gladiators game out there. Right now the viruses are competing for people that are unvaccinated, essentially,” he added.

Vaccines have shown strong protection against some other variants, though data on delta and gamma are still emerging.

A study in England, where the delta variant is highly prevalent, found that two doses of the Pfizer RNA vaccine were 96% effective at preventing hospitalization from the delta variant, but people with one shot showed only a 33% reduction in risk of developing COVID-19. There are less data on the Johnson and Johnson vaccine, which accounts for a small percentage of vaccinations in Washington state.

A recent study in Brazil suggested that gamma is about twice as transmissible as earlier strains in the country, and is able to circumvent immunity from some previous COVID-19 infections.

Such partial immunity may leave previously-infected people susceptible to the variant. And though vaccines afford protection, there are few studies that shed light on their degree of effectiveness against the gamma variant. In Washington, the variant accounts for the highest proportion of “breakthrough” infections among vaccinated people, said Lindquist.

A naturopathic pediatrician at the state briefing, Mary Alison Koehnke, encouraged people to ask their medical providers if they have questions about the vaccine, and to check out information at the U.S. Centers for Disease Control and Naturopathic Doctors for Vaccines.

Lindquist added in a statement: “As we get closer to reopening, you can help keep your community safe by getting your vaccine and talking to the people you know about getting theirs.”