In addition, the agency is urging universal masking for all teachers, staff members and students in schools, regardless of vaccination status.
The guidance, to be announced at a 3 p.m. news briefing, would reverse the CDC’s May 13 recommendation that vaccinated people did not have to wear masks indoors or outside because of the protection afforded by coronavirus vaccines, according to several people familiar with the decision who spoke on the condition of anonymity because they were not authorized to discuss it. At the time, cases were dropping sharply and the delta variant, which is thought to be more than twice as transmissible as earlier strains of the virus, had not gained significant traction in the United States. That earlier guidance had angered some people, including parents with young children ineligible for the vaccines, who feared that relaxing mask rules would put them at greater risk.
Top health officials, who were debating the new masking guidance on Monday afternoon, said the game-changer was new data showing that vaccinated people infected with the delta variant carry the same viral load as unvaccinated people who are infected, according to three people familiar with the data. Vaccinated people are unlikely to become severely ill, but the new data raises questions about how easily they might transmit the disease, said the three individuals. Such transmission did not happen in any significant way with earlier variants.
Albert Ko, an epidemiologist at the Yale School of Public Health, said in an email prior to the CDC announcement that the finding of similar viral loads among vaccinated and unvaccinated people would suggest the need for changed guidance for vaccinated people. “There are several hoops in logic to pin down (duration of viral shedding being one) but the finding if rigorously proven would be concerning,” Ko said.
One federal health official, speaking on background to provide context for the CDC announcement, said the administration still believes that vaccinated people play a “very small” role in transmission, with the unvaccinated accounting for most of it.
President Biden and CDC Director Rochelle Walensky have repeatedly described the recent case surge as a “pandemic of the unvaccinated” because unvaccinated people make up the vast majority of patients hospitalized with covid-19, the disease caused by the virus. Confirmed coronavirus infections nationwide have quadrupled in July, from about 13,000 cases per day at the start of the month to more than 54,000 now, according to Washington Post tracking.
News of the changed guidance was welcomed by medical and public health experts, given the surging cases in the United States. People infected with the delta variant appear to carry a viral load that is 1,000 times higher than earlier versions of the virus and can easily spread it, particularly among the unvaccinated, experts say.
“Nobody wants to go backward but you have to deal with the facts on the ground, and the facts on the ground are that it’s a pretty scary time and there are a lot of vulnerable people,” said Robert Wachter, chairman of the Department of Medicine at the University of California at San Francisco. “I think the biggest thing we got wrong was not anticipating that 30 percent of the country would choose not to be vaccinated.”
Natalie Dean, a biostatistician at Emory University, noted that the picture in the United States has changed significantly in recent weeks.
“Things were going all right for a little bit. … Now it’s like, well, what are we doing here? The trends are not good,” she said, adding, “The situation has evolved. Literally.”
James Musser, chair of the Department of Pathology and Genomic Medicine at Houston Methodist Hospital and Research Institute, said he thinks the vaccines are still superb at preventing severe illness. Nonetheless, he said, about 20 percent of the covid-19 patients in his organization’s eight hospitals have breakthrough infections after being vaccinated — most of whom have serious underlying medical conditions.
He noted that he and his colleagues wear masks in group settings even though Houston Methodist requires staff members be vaccinated. He also wears a mask at the grocery store. “You can still carry delta if you’re vaccinated. And we just think that’s an abundance of caution,” he said. “I personally continue to wear a mask whenever I’m in public, period.”
“Hospitalizations in Florida, Arkansas, Louisiana, Missouri are where they were this winter and rising rapidly,” said Caitlin Rivers, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. “Indoor masking is a simple intervention that will help slow the spread.”
Experts and some senior health officials in the Biden administration had grown frustrated that the CDC has not moved more quickly to change its guidance. One senior administration official said the agency was wary of being viewed as “flip flopping,” but senior health officials came to the conclusion that the picture on the ground had changed substantially with the delta variant.
Three people with knowledge of the guidance said that CDC leaders pushed for more data about the benefits of masking and how the hyper-transmissible delta variant has spread, frustrating other administration officials who wanted to move more quickly as coronavirus cases surged.
“They waited too long,” said one Biden official who spoke on the condition of anonymity to discuss confidential conversations.
Some administration officials were also concerned that requiring vaccinated people to wear masks would further discourage vaccine-hesitant Americans from getting the shots.
“People don’t realize how bad delta is,” James Lawler, an infectious-disease doctor at the University of Nebraska, said in an email. “We are looking at transmission dynamics at least as bad as in the fall — with no mitigation measures in place in most states with low [vaccination] rates.”
Some of the CDC’s international partners had already moved to reinstate mask mandates or delay plans to loosen them. In Israel, an indoor mask mandate was lifted on June 15, only to be reinstated on June 25 as cases of delta surged. Other nations, including Australia and France, have seen regional rules on mask-wearing return this summer amid new outbreaks and concerns about the delta variant.
In South Korea, one of the first East Asian countries to chart a path out of the pandemic, the government announced in June that soon partly inoculated residents would be allowed to go mask-free outdoors. But before the newly relaxed rules could go in place, the South Korean government canceled them in Seoul and neighboring regions and ordered even fully vaccinated residents to wear a mask inside and outside.
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