Even if you are vaccinated, you should wear a mask if you are in a public place indoors, a crowded place outdoors, or around someone who is not in your close contacts. This is because the Delta variant of COVID-19 is much more contagious than the variants we saw around the country last year. Over 95% of confirmed cases in Maine (and around the country) are Delta variant (footnote 1), and ICUs around the state are filling up with them. It is also infecting people of all ages a lot more. Make no mistake, we are in another surge, and you are at risk. Consider how things have changed in a short time. On July 18 the seven day average of new daily COVID cases in Maine was about 15, there were only 4 people with COVID on a ventilator, and 11 in critical care. It seemed like we had really turned a corner. But then the Delta variant started to show up in Maine. Our current 7-day average is 348 confirmed cases daily. We have 36 people with COVID on ventilators today, and 67 in critical care according the Maine CDC. Most of these people are unvaccinated.
So, you might conclude that your vaccine will protect you, and that you don’t need to wear a mask. I am sorry to say that you would be wrong. We should talk about vaccines to understand why we still need masks.
No vaccine is perfect. We knew from the beginning we would not have 100% success with these vaccines. And, we knew from the beginning that if we lagged in getting everyone vaccinated we would just give the virus more of a chance to mutate into something worse. Many people did, and it has. While the vaccines are still excellent tools, and while I wholeheartedly advise vaccination, protection from the Delta variant with the available vaccines is less than it had been for other variants. It has been estimated that with Delta the Moderna, Pfizer, and Johnson & Johnson vaccines well over 70% protection against infection at any level of severity, and well over 90% effective against severe infection or death. It sounds good, but what this means is that even with vaccination you are still at risk. However, risk drops as more and more people are vaccinated. More than ever we need as many people as possible to be vaccinated for the math to work. If everyone is vaccinated the likelihood of getting an infection drops dramatically, though other steps help too, as outlined below.
As for individual protection with the vaccine, I have heard Dr. Michael Osterholm of the Center for infectious Disease Research and Policy (CIDRAP) compare the vaccine to a fire suit. A firefighter would of course wear a fire suit to protect her from injury. It is a great tool, even a life saving device if used properly, but if the firefighter walks directly into the inferno she will die. The vaccine is very much like that. It does help. It reduces greatly the risk that you will become infected, and if you do become infected it dramatically reduces the risk that you will have a severe or life-threatening illness. But, it is not perfect. If you are vaccinated, but still choose to expose yourself unnecessarily by going unmasked into public places, then you still place yourself at risk. If you breathe in the air around someone who is asymptomatically or pre-symptomatically shedding virus-especially indoors, it is like walking into the inferno. Don’t do it. What we are talking about here is breakthrough cases, infections in the fully vaccinated (people who are at least 14 days out from the final dose of a COVID vaccine). The total number of vaccine breakthrough cases in Maine as of today is 2,258 (out of around 890,000 people fully vaccinated, or about 0.25% of vaccinated people). Among those breakthrough cases 109 were hospitalized “associated with COVID” (footnote 2).
Since we started testing for COVID-19 2,371 people have been hospitalized with COVID. There have been 993 COVID-19 associated hospitalizations since the first date Maine residents could be fully vaccinated. Because the number of people getting vaccinated over time keeps increasing, we cannot simply calculate the number, but know that at least 90% of the people admitted to the hospital with COVID-19 even now are unvaccinated.
So let’s close by talking a little more about masks.
-The best mask is the N95 respirator. If everyone wore them properly (fit-tested, handled and stored correctly, etc.), the pandemic would be over. N95s should fit tightly against the skin, and do not work if placed over facial hair, or if they are wet for example. N95s are the safest respiratory protection the average person can buy in a store, and protect you from both aerosol and droplet spread. N95 is one of the respirators doctors and nurses may wear when we see patients with COVID in the ICU (along with eye protection, gloves, and a gown). We are also fastidious about hand washing and sanitizing. Note that an N95 with a vent is a poor substitute because it vents unfiltered air to others, and if you are carrying the virus that causes COVID-19, you are placing those around you at risk. At any rate, you are sending a message to others that you do not care about them, that this mask is only for your protection, and that is not the way to win friends or end a pandemic.
-The paper surgical mask if worn properly (colored side out, fit tightly against the skin over the nose and mouth, wire bent tightly over the bridge of the nose) is still very helpful in preventing the spread of droplets. Studies have shown a reduction in risk of catching COVID-19 when people wear them (especially when everyone is wearing them). They should be combined with limited exposure to potential risk. In other words, get in and get out of the store, don’t linger. Have your conversations outside.
Cloth facial coverings tend to offer less protection than the paper surgical mask. If you wear one it should be several layers thick. A single layer of fabric is probably better than nothing, but only a little better.
Face shields alone offer very little protection, but if combined with a mask they can be very helpful, except for those tiny clear chin guards some people wear. Those do nothing.
Finally, if you are not vaccinated, HOLY COW, GET VACCINATED! COVID kills people, and unvaccinated people are keeping the pandemic going, and exposing those who care for them in the hospital to unnecessary life-threatening risk.
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Please note the links to URLs are verified today, 9/12/21, but may change as websites update.
Footnote 1: We know the cases are Delta variant because the Maine CDC runs genetic tests on all positive test samples, whether or not the patients are hospitalized.
Footnote 2: A COVID-19 associated hospitalization or death is defined by the Maine CDC as resulting from an illness that is clinically compatible with COVID-19 that is confirmed by an appropriate laboratory test. It is not necessary that COVID-19 be the primary cause of death or hospitalization.
