How should you decide whether to keep wearing a mask? An expert weighs in

By Katia Hetter, CNN

    (CNN) -- The US Centers for Disease Control and Prevention has released a new measure for determining Covid-19 community levels. According to these new metrics that now take into account hospitalizations and hospital capacity in addition to infection numbers, nearly 70% of the United States population resides in areas where masks are no longer required.

Why did the CDC make this change? How can people make sense of the Covid-19 community level in their area? Should individuals still mask if they no longer are required to? What about kids in schools? And how should parents evaluate activities like sleepovers and playdates?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of "Lifelines: A Doctor's Journey in the Fight for Public Health," and the mother of two young kids.

The following conversation has been lightly edited for length and clarity.

CNN: What changes did the CDC make to masking guidelines, and why did they make them?

Dr. Leana Wen: Previously, the one measure the CDC used to determine whether people should mask was infection numbers -- the number of new diagnosed Covid-19 cases. In recent months, many experts have questioned whether this is still the best measure, especially because those vaccinated are much less likely to become severely ill.

The CDC now takes three factors into account. The first two are measures of severity and hospital capacity: the number of new Covid-19 admissions per 100,000 population in the past seven days and the percentage of staffed inpatient beds with Covid-19 patients. Because hospitalizations lag behind infections, they kept the measure of infection in place as the third factor (the number of new Covid-19 cases per 100,000 population in the past seven days).

The CDC then categorizes the Covid-19 community level into three categories. Areas in green (low) or yellow (medium) no longer need to require masks. People can still decide to mask if they wish, especially if they are immunocompromised. Those in orange (high) areas should still mask.

CNN: How can people look up the Covid-19 community level in their area?

Wen: The CDC's website has a helpful tool where you can look up your location by state and then county.

I recommend that people look up all the locations that are relevant to them, as many people may live, work and socialize in different areas. This is not unlike what we would do with a weather forecast: Before you decide how to dress for work and decide whether you need to wear a heavy coat or bring an umbrella, you look up what's going on around you.

Here's my specific example. I live in Baltimore City, Maryland, and work both there and in Washington, DC. According to the CDC tool, both areas are in green. Many of my family's social contacts are in Baltimore County and Montgomery County, Maryland, and in Fairfax County, Virginia. All of these areas are in green, too. If I were going to a conference in, say, Los Angeles County, California, or Cook County, Illinois, I would look up that county to understand the level of risk and decide what kind of protective measures I'd take. Just like with a weather forecast, I'd recommend that people check these numbers regularly, because they could change.

CNN: Should people be taking off their masks now that they aren't required to wear one?

Wen: Not necessarily. Just because a mask mandate may be lifting in your area doesn't mean that you should go maskless. And just because the CDC has your area in green or yellow doesn't mean that it's suddenly safe. You could still become infected with Covid-19, and a high-quality mask (N95, KN95 or KF94) remains an important tool that can reduce your risk of infection.

I would definitely advise that if you live in an orange area, follow the CDC guidance and continue masking in indoor, public spaces. If you live in a yellow area, it's still a good idea to mask, especially if you are in crowded, poorly ventilated locations. This is particularly important if you are immunocompromised or otherwise have chronic medical conditions that could make you more likely to have severe outcomes if you became infected with Covid-19.

Those who live in green areas may still choose to mask. My recommendation is that immunocompromised people should mask when indoors around those of unknown vaccination status. Others should decide based on how much they want to avoid contracting Covid-19 and the importance of being unmasked.

There are many people who think that as long as they are vaccinated and boosted and therefore unlikely to become severely ill from Covid-19, they want to resume pre-pandemic normal, including going maskless. Others want to avoid the possibility of long-haul Covid-19 and will still choose to mask in indoor public areas. This is a personal decision, and I think we need be very understanding of individuals who may still wish to mask for any reason going forward.

CNN: What about kids in schools? Should they still mask even if they no longer have to?

Wen: This will also depend on the family and their specific medical circumstances, tolerance of risk, and desire to go maskless. Kids are much less likely to become severely ill compared to adults, and I think many parents will make the decision that if everyone in their family is vaccinated and boosted, it's reasonable to go unmasked in schools. Many others may choose to keep masking as an additional level of protection, especially if someone in the household is medically vulnerable.

CNN: What about kids under 5? Should they keep masking?

Wen: Again, it depends. My 4-year-old's school is going mask-optional this week. It aligns with CDC guidance, since our area is in green. I am fine with my son not masking in school. That's because the level of Covid-19 in our area is low; my son and his little sister are generally healthy, and my husband and I are vaccinated and boosted; and quite a few kids in his class recently had Covid-19, meaning that the number of people who could still get infected and then transmit it to him is pretty low.

That said, I still would want my son to mask when in other indoor, non-school settings. When I take him to the grocery store, when we're on the train, when we're in church -- in these settings, he and I will still be masking.

Other families will make different choices. For us, the benefit of him going maskless in school outweighs the risk of Covid-19 in that setting. In other settings, we prefer to continue to reduce risk.

CNN: How should parents evaluate other activities like sleepovers and playdates?

Wen: I'd evaluate them based on the CDC's three risk levels, and then think about the family's circumstances and risk tolerance. At the orange level, I'd consider cutting down nonessential social activities and try to move as many indoor activities to the outdoors as possible.

At yellow, it depends on the family's medical circumstances: If everyone is vaccinated and generally healthy, it's probably fine to resume many activities, while still working to reduce risk when possible. For example, parents might choose to allow sleepovers, but ideally ensure that everyone there is vaccinated; or go to the movies, but ask that their kids still mask during the movie.

At green, there can be more latitude to have indoor playdates and sleepovers, understanding that the risk is still there but the benefit of the activity to your children might outweigh potential risks.

The-CNN-Wire
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