Mira Irons, MD, clarifies the CDC's updated mask guidelines

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 Update, AMA's Chief Health and Science Officer Mira Irons, MD, reviews COVID-19 numbers and trending topics related to the pandemic over the past week. Dr. Irons also looks at the CDC's updated mask guidelines and the science behind it, as well as global COVID-19 trends and numbers.

Learn more at the AMA COVID-19 resource center.

Speaker

• Mira Irons, MD, chief health and science officer, AMA

Unger: Hello. This is the American Medical Association's COVID-19 Update. Today we have our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Chief Health and Science Officer Dr. Mira Irons in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Dr. Irons, over the past week we had a chance to hear from President Biden, his joint session with Congress. What was his key message on the pandemic in that speech?

Dr. Irons: Todd, the president largely struck a hopeful tone on the pandemic. He pointed to his accomplishments with vaccines. You know, he hit the 1 hundred-day mark this past Friday, April 30, and the administration actually reached 200 million vaccine doses about a week before that date on April 22, and his goal was a hundred million vaccine doses. He also noted, and this is really important, that nearly 70% of seniors are now fully protected from the virus and senior deaths from COVID-19 are down 80% since January. Despite the successes, he did implore the public to remain on guard.

Unger: Well, you got to say we're in a much different position than we were a few months ago with some states where vaccine supplies even exceeding the demand right now. I think the key concern is when you pass those milestones that you just talked about was, are we going to be able to continue this pace of vaccination to get to where we need? And there's some indications that it seems to be slowing. What's your perspective on that?

Dr. Irons: Yeah, it is slowing and that's concerning. Although, I think a lot of people are saying that that should have been expected because when we had demand much higher than supply, they were groups of people that really were waiting for the vaccine, so we were kind of waiting for this to happen. The average number of daily shots has declined 20% in the past two weeks. If vaccinations had continued on their earlier pace, about 10 million additional Americans would have received their first shot in April.

The fact that they didn't will lead to obviously more cases, more hospitalizations and death than needed to happen. You know, the CDC said as of last Thursday, about 143.8 million people have received at least one dose of a COVID-19 vaccine, including about 99.7 million who have been fully vaccinated. Providers are administering about 2.63 million doses per day on average and that's a large number but it is a 22% decrease from the peak of 3.38 million reported April 13.

Unger: Yes, we definitely moved through that kind of wave of high-demand folks for the vaccine. I will say, personally, I did a good job this week of working through some concerns with somebody on my particular team. And I'm proud to say she's getting her first dose today, so shout out to her. In other news last week, there was a change in guidance from the CDC regarding masks, which means when I walk my dog by myself I don't need to wear a mask because I'm fully vaccinated and out there by myself. Why don't you tell folks out there, Dr. Irons, what exactly are the new guidelines for masks?

Dr. Irons: You're right. The CDC did ease outdoor mask guidance for vaccinated Americans, but it's small steps. They're taking very careful small steps and it's nuanced, so understanding it is really important. The mask guidance is modest, and carefully written, and based on evidence. Americans who are fully vaccinated against the coronavirus no longer need to wear a mask outdoors when walking, running, hiking or biking alone or when in small gatherings, including with members of their own households.

However, masks are still necessary in crowded outdoor venues like sports stadiums. The CDC also stopped short of telling even fully vaccinated people that they should shed their masks outdoors altogether, citing the worrying risk that remains for transmitting the coronavirus, unknown vaccination levels among people in crowds and the still high case loads in some regions of the country. The guidance also cautioned even vaccinated people against going without masks in medium-sized outdoor gatherings.

Unger: You know, this is something I think, again, people are just not used to the fact that we are still learning about this and the science continues. Can you talk about the science behind this revision and guidance?

Dr. Irons: Yeah, you're absolutely right, and we're still gathering information and that's what the CDC's doing. They're waiting until they get the science and the evidence before making recommendations. A growing body of research indicates that the odds of the virus spreading outdoors are far lower than they are indoors, but that risk is not zero and is hard to quantify. Most, if not all, of the research about viral transmission outside was done before the vaccine was available, so it does not distinguish between the risk to those who are inoculated and those who are not. We do know that virus particles disperse quickly outdoors, meaning brief encounters with a passing walker or jogger pose very little risk of transmission.

However, the way you think about it and the way I think about it, is that the risk of getting COVID is much lower outdoors than indoors, and vaccination decreases that risk even more. In addition, vaccinated people have a significant degree of protection, while unvaccinated people don't. So you have to think about the risk to yourself and your family, the risk to others that you are in contact with who are not vaccinated, as well as the current COVID activity in the community. But the guidelines reflect some basic coronavirus math. As the number of vaccinated people goes up, cases are going down.

Unger: Well, that is good news. Again, everybody get those vaccines so we can keep learning. Dr. Irons, let's talk about the actual number of cases and deaths. Start with the U.S. and then let's take a look more broadly at some trouble spots around the world.

Dr. Irons: Absolutely. The numbers are 32,289,907 people in the U.S. diagnosed with this condition, and 575,197 people have died from it. But we're starting to see really important declines. More than half of U.S. states have seen a significant decline in new virus cases over the past two weeks, suggesting that the trajectory is improving. In addition, more specifically, case numbers have fallen by 15% or more in 28 states, the District of Columbia and Puerto Rico, and we've seen drops of 30% or more in 14 states and the District of Columbia. Michigan, you know we've talked about Michigan for the last few weeks, which has endured one of the nation's most severe recent outbreaks, is now seeing rapid improvement with cases. They are down 40%.

And I think that it's important to note that federal officials have also taken note. Dr. Rochelle Walensky, a few weeks ago had expressed a concern of impending doom. She's now, last Wednesday, said she was beginning to see progress. And I think her quote is really important. "Cases are starting to come down. We think that this is related to increased vaccination, increased people taking caution, and so I'm cautiously optimistic that we're turning the corner. However, the virus is an opportunist and could strike in communities with low vaccination rates. As we've discussed, persistent vaccine hesitancy remains a challenge."

Unger: So that's good news in the U.S., and I'm glad to see Dr. Walensky becoming a little bit more optimistic on what we're seeing, and it probably explains as the vaccination rates go up and we do see people let their guard down, you see these kind of things blow up. We saw that in Michigan. Now we're seeing that in Oregon, and so hopefully folks, let's keep the vaccinations rolling. India, different story. Let's talk about what you're seeing in the rest of the world.

Dr. Irons: Oh, really tragic. You know, the numbers. Just hearing about what is happening in India just is tragic. India, as we've talked about, is still struggling. Its virus caseload is reaching new highs and its vaccination drive is faltering. The Health Ministry on Thursday reported more than 375,000 cases and more than 3,600 deaths, and hospitals warned of critical shortages of ventilator beds, medical oxygen, medicines and other life-saving supplies. Last Wednesday, the U.S. government authorized families of diplomats to leave India and advised other Americans there to leave as soon as it's safe to do so.

But India isn't the only country struggling. We also saw COVID-19 deaths surging to record highs in Pakistan, with the government responding by sending troops to the streets to help enforce coronavirus precautions. Vaccination efforts there, too, are progressing slowly. It's a similar story in Turkey, which is bracing for its strictest lockdown yet as the virus surges and vaccinations lag. Just serves to remind us that we really need to address this pandemic on a global level in order to get past it.

Unger: Well, thank you so much, Dr. Irons, for being here today and for giving us your perspective. We'll see you next week for another update. In the meantime, for more information on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.