It’s time to rethink ‘one-size-fits-all’ approach to mask guidance, expert says, as Delta variant is spotted in every US state

With uneven vaccination rates across the US and a dangerous variant now spotted in all 50 states, a health expert is warning the federal government’s mask guidance should be more focused, instead of a “one-size-fits-all” approach.

The Delta variant has been detected in all 50 states and Washington, DC, CNN’s latest tally shows. The variant, which is more contagious and aggressive, poses a particularly harmful risk to people and communities who remain unvaccinated.

And given the extreme disparity between areas with low and high vaccination rates, Dr. Peter Hotez told CNN Wednesday that the current mask recommendation created by the US Centers for Disease Control and Prevention should be more nuanced to account for those differences.

“Part of the problem is that the CDC is trying to use a one-size-fits-all recommendation for the country rather than being a bit more surgical in identifying hot spot areas where transmission is accelerating,” Hotez told CNN’s Jake Tapper.

Hotez, who is dean of the National School of Tropical Medicine at Baylor College of Medicine, noted people in areas where vaccination rates are low and the virus is more prevalent may not want to do the same activities as people who live in areas where vaccination rates are high and the virus is more contained.

“If you were in southern Missouri right now where the Delta variant is now the highest percentage of virus variants anywhere in the country and the vaccination rate is really low, what that means is a lot of virus transmission going on,” he explained. “So you might do one thing if you’re a parent there with little kids, or yourself even if you’re vaccinated versus in Washington, DC, where the vaccination rate is really high and transmission has slowed dramatically.”

He added that the CDC’s current mask guidance, which says fully vaccinated people do not need to wear a mask indoors or outdoors, needs to be more specific with the Delta variant in mind.

“I think that’s what we need from the CDC is to be able to cut it a little finer, come up with … a force of infection map that combines those two variables: the low vaccination rates, high Delta. Those places are at great risk for lots of transmission, including some vaccinated individuals who will have breakthrough infections.”

Breakthrough infections occur when vaccinated people contract Covid-19. A recent CDC study showed that when vaccinated people are infected, they experience milder illness than unvaccinated people.

Dr. Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, said Tuesday he doesn’t expect the CDC to make changes to its mask guidance but warned Americans must take the Delta variant seriously.

Fauci noted vaccines make Covid-19 case surges “entirely avoidable, entirely preventable.”

CDC Director Dr. Rochelle Walensky highlighted Wednesday the increasing number of hospitalizations among young people ages 12 to 29.

“The first thing I think is really important to recognize is hospitalizations are generally going down for Covid in this country,” Walensky said, but since May, people ages 12 to 29 have accounted for about a third of hospitalizations — a greater proportion than in the past.

“So while all hospitalizations are going down, the proportion that are attributable to our young populations are actually going up,” Walensky said.

While still lagging, vaccination coverage among young adults is improving, CDC data shows. Over the past two weeks, the 18-24 age group made up 12.6% of those becoming fully vaccinated, the CDC said.

As of Wednesday, 46.7% of the total US population is fully vaccinated, CDC data showed. In the past seven days, the US averaged 26.6 new Covid-19 cases per 100,000 people.

Experts: Children should mask up, even around fully vaccinated people

Children under 12 are another vulnerable group in the face of Covid-19 variants because federal officials have not cleared them to receive a vaccine.

Dr. Yvonne Maldonado, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, told CNN Wednesday that children not yet vaccinated should still mask up, even if they’re around fully vaccinated people.

“The vast majority of new infections are occurring among unvaccinated individuals and creating a ‘pod’ of vaccinated individuals around young children, as well as continuing them to mask and distance in indoor settings and among crowded settings, will be important in keeping them safe,” Maldonado said in an email to CNN. “For these unvaccinated children, masking, distancing and avoiding large crowds is recommended.”

Maldonado noted that there is not much information available yet on how the Delta variant may affect children.

Hotez echoed Maldonado’s stance on children wearing masks.

“I would say right now, if your kids are old enough to wear masks, then they should when they’re indoors, at least until we can get our arms around this Delta variant,” said Hotez, noting that parents should take their area’s vaccination rate and variant levels into account.

“This requires parents, and really anyone, to have some situational awareness of what their region looks like, what their state looks like, what their county looks like in terms of vaccination rates and Delta variants,” he explained.

Meanwhile, federal health officials plan to analyze vaccine data for children younger than 12 in the upcoming fall or winter, said Dr. Peter Marks, who heads the US Food and Drug Administration’s Center for Biologics Evaluation and Research.

“It makes sense that it’s going to take a little longer there, because there had to be dose de-escalation — lower doses used, essentially dose de-escalation — and as well as we want to see longer follow-up data to make sure that we have the kind of safety in that population,” he said during a joint Johns Hopkins University and University of Washington symposium.

More research shows vaccines work, and they’re highly effective

A study that examined nearly 4,000 frontline health and emergency workers shows that the Pfizer/BioNTech and Moderna Covid-19 vaccines were 91% effective in preventing infection after two doses and 81% effective after a single dose.

“If you get vaccinated, about 90% of the time you’re not going to get COVID-19,” Dr. Jeff Burgess of the University of Arizona, which participated in the study, said in a statement. “Even if you do get it, there will be less of the virus in you and your illness is likely to be much milder.”

The team, led by CDC epidemiologist Mark Thompson, studied 3,975 health care personnel, first responders, and other essential and frontline workers.

“From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs,” the team wrote in a report in the New England Journal of Medicine.

Weekly tests can capture even asymptomatic infections.

“SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated, 11 partially vaccinated, and 156 unvaccinated,” the researchers wrote.

Those who were vaccinated and got infected anyway had less virus in their bodies — 40% less, researchers added. Vaccinated people were 58% less likely to have fevers. “And the duration of illness was shorter, with 2.3 fewer days spent sick in bed,” the researchers added.

Only 39 of the workers got the Johnson & Johnson vaccine, so their results were not included.

Walensky, CDC’s director, said Wednesday there is no information to suggest that people need a booster of a second coronavirus vaccine after receiving the Johnson & Johnson vaccine.

“Right now, we have no information to suggest that you need a second shot after J&J, even with the Delta variant,” Walensky said on NBC’s Today.

There has been less data so far about the Johnson & Johnson vaccine and the Delta variant, but that data is coming, she said.

“We have every reason to believe, based on how J&J is performing with other variants of concern — and that is quite well — and how its sister vaccine, AstraZeneca, has performed against the Delta variant in other countries — which has done quite well there as well,” she said. “So, generally people are agreeing that they anticipate that the J&J will perform well against the Delta variant, as it has so far against other variants circulating in the United States.”