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Might be time to let people get their masks off outdoors, infectious-disease specialist says

Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, writes it might be time to say it's OK for people to go outside without a mask on - but to keep one handy for those inside visits.

Transmissions do not take place between solitary individuals going for a walk, transiently passing each other on the street, a hiking trail, or a jogging track. That biker who whizzes by without a mask poses no danger to us, at least from a resipiratory virus perspective. ...

So he proposes:

Dangerous - crowded indoor spaces with poor ventilation, in particular with unmasked individuals talking, shouting, singing. Wear a well-fitted mask until case numbers are down and more people are vaccinated.

Safe - outdoors, especially while distanced. Masks only needed for lengthy interactions with others at close distance.

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Comments

These big brains never stop to think about human behavior ad how it affects service employees.

No mask outside quickly becomes "Oh Im only going to be inside starbucks for less than a minute it will be fine"

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Thank you Doctor Sax. It sometimes feels like we are living in a gulag here in Boston. It is OK to take your mask off folks once you are fully immunized. What was the point of getting immunized of not to return to a healthier less isolated way of living?

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There is a race to forget the half a million Americans who died, just to toss masks as soon as you're vaccinated? The vaccine does NOT protect you from catching COVID-19. Not everyone is immunized. This is two steps back thinking, then again, y'all seem hard pressed to think these days as it is.

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Against getting the virus. Add a couple of 9s against death.

No one is saying to take a mask off inside. But outside where, again, they do basically nothing, they're even less necessary.

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The point of immunization is to create enough immunity to the virus AS A GROUP to prevent its spread and ultimately end its pathogenicity as an infectious agent.

AS AN INDIVIDUAL, you only get a chance at immunity. This is true for all vaccinations you get. Just because you get a rubella vaccine doesn't mean you can't get rubella. It means all of us are unlikely to get rubella, so the chance you run into someone with rubella to give it to you is EXTREMELY low (effectively zero in the US). But there are still a dozen or so cases of rubella in the US each year (always a factor of traveling somewhere that it's more prevalent and/or vaccination is not great and/or immunosuppression in the individual).

We are still infecting each other with COVID-19 *as a group* at a pretty high rate. That means your immunity *as an individual* is likely to be tested. People with immunity have also been shown to get infected (possibly due to variations spreading) however the severity of the infection is heavily reduced and death is no longer a likely risk of infection to the vaccinated. But it does mean those people are possibly infectious while infected making them a danger to the unvaccinated.

The point of vaccination is to control the spread of the virus, not to give you a magic shield that guarantees you can't get infected or harm someone else. Once the virus is limited in its ability to spread, we might even see it disappear completely (it only exists if it can finding new hosts to infect, multiply, and then leave to infect again).

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...but not all are supported by science. That is, of course, if you believe the CDC.

So far the CDC has come out to indicate that those who are vaccinated do not transmit the disease, and that among the 7 million+ who have been vaccinated there have been 5800 cases of infection. That's 0.08% for you math nerds. Even if they are wrong by a whole order of magnitude, it is still under 1%.

I think it's a pretty performative and anti-vax stance to say "oh yeah, go get vaccinated, but yeah the [extraordinarily remote] risk is still there."

No offense, but i'll take the word of the CDC over someone in the comments section.

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Nobody's telling you that I'm right and the CDC is wrong. Everything I wrote agrees with everything the CDC is saying (because I'm getting it from the CDC). There are a lot of factors into why there have only been 5800 "breakthrough cases", as they're called. One is whether people who get vaccinated end up in situations where they're exposed to the virus at all (one could presume someone doing everything right and getting vaccinated probably isn't doing risky things after vaccination either). What we know is that the two more prevalent vaccines are ~95% effective. The J&J is ~75%. That is your personal risk of whether the vaccine "worked" to give you any sort of immunity *as an individual*. The 5,800 is more an indication of the immunity *as a group* (because we're presuming vaccinated people are taking good precautions even though they're vaccinated).

If vaccinated people started doing riskier/more "free" things around people with the virus then the "breakthrough" amounts would come much closer to the individual percentages...because that's how those percentages were figured out in the first place. They vaccinated people in high risk situations (like nurses in a COVID-19 ward) and then determined how many of them got COVID-19 even though they were vaccinated. This is how they proved efficacy in order to convince the FDA to give out the emergency use authorizations for their vaccines as effective preventatives.

The point is to get everyone vaccinated, while that's taking place, keep everyone trying to reduce the spread by not testing their 5% personal chance to get sick even though they're vaccinated by doing risky things in and around people with the virus that's still trying to spread itself, then as the total population comes close to herd immunity levels of vaccination, let people start doing more risky activities because the virus will be limited in who it can spread between and will eventually find no new hosts in time during any given infection.

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But a few points

1) Effectiveness against severe cases does appear to be much higher than those numbers, it isnt quite accurate to say that if you had the J&J vaccine you have a 25% chance of having no immunity. Severity is much lower among the vaccinated. Im not saying the vaccinated should be out licking doorknobs or anything given the large unvaccinated population, current prevelance, and the presence of highly transmissible variants. But in practice, if you are vaccinated, you are at very negligible risk of death or hospitalization from COVID. We are really getting bailed out of a poor public health response by miracle vaccines.

2) It seems highly unlikely that the US is going to reach herd immunity through vaccination. Estimates range from 70-100% vaccination rate needed to reach herd immunity from COVID. We are somewhat unlikely even to reach the bottom end of that range as a nation (MA perhaps will get there, but we arent a walled garden) At the very least, we wont be reaching in until 2022 when kids can be vaccinated.

3) The doing more "free" things cat is sort of already out of the bag. The USA is not pursing an elimination strategy. Tying it back to the original article, we are discussing masking outside in a world where there is 100% capacity for indoor dining, we have virtually unfettered travel, schools are fully reopen, etc. It is patently absurd policy to "require" (Im aware it isn't enforced) masks outside when distanced but also, hey, go sit for an hour and a half in a restaurant and eat a meal, have fun.

So we are going to have to figure out what mitigations we need to continue to apply in a world where the vaccinated are well protected but herd immunity is still a year off best case. Relaxing mask restrictions outside seems like a pretty easy give.

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Re: the "gulag" comment... could you slow your roll with the hyperbole?

Were you forcibly taken from your home into forced labor? Is Lenin running the country? Are you subject to extrajudicial punishment because you're not wearing a mask? No... you're just making a mountain out of a molehill.

This is closely related to the myopic "deprivation of liberties" argument that a lot of people make.

Did the state take away your house? Are you subject to forced sterilization for committing a crime? Is your marriage not recognized where you live, so that you're legally barred from being an executor to a life estate? Are you being denied social security benefits? Contraceptives? These are examples of *real* liberty issues.

Take an extra minute to think about the hyperbole arguments against using medical protective equipment during a global pandemic in conjunction with what "liberty" really means... and all you're left with is just as pedantic as grumbling about the fact that it snowed in April.

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the variants are growing so much that they're taking over - look at the numbers in Ontario Canada or Brazil. Do we want another shutdown? Until the WORLD has acheived herd immunity, even the vaccinated still stand the chance of catching this (they just won't get as sick). With the current rate of mutation, the experts are saying that the vaccinated will likely need a booster 3rd shot in the next year and it will likely become an annual shot. Numbers are going down but aren't low and the trend isn't steep - our high rate of vaccination is fighting the growth of the variants. Wear a damn mask.

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Part of the way they got these vaccines approved so quickly was to limit the scope of the clinical trials to safety and just the efficacy at preventing disease, hospitalization and death. What they didn't do was determine whether or not you could be free of symptomatic disease but still spread the virus if you were exposed to it.

Given how common asymptomatic spread is with this virus the best course is to continue to wear masks when you're around crowds or unvaccinated people until we have the data to demonstrate that you are unlikely to infect another or we have reached a level of immunization that cases have dropped to make the odds of exposure much more unlikely. Remember, masks are mostly effective at limiting transmission rather than individual protection.

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- None of the vaccines are 100% effective.
- The vaccine is effective to prevent serious illness, hospitalization, and death.
- It is not yet proven if the vaccine prevents infection or passing the infection forward to others.-
- We don't know how well the vaccine works against variants, which I think are now or in some locations more common than the original strain.
- There are cases of people testing positive for COVID after receiving the vaccine.
- There are cases of people recovering from COVID and getting it a second time.
- We don't know how long immunity lasts after someone receives the vaccine. (And if immunity is temporary, it's not like it's going to announce itself so people can suddenly know when they need to wear a mask again.)
Just wear a mask. Seriously, what's the big deal?

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That is, not having to wear masks outside

this is what’s going to happen

though it's been about 50:50

I'm still 100% wearing a mask outside and will continue to do so until it's officially ok not to, but I don't think it's at all unreasonable for people to be requesting quantitative thresholds at which outdoor masking can stop.

Granted, we're probably going to have to mask indoors until well into 2022, especially in spaces that include children. However, I don't buy the slippery slope/ message discipline arguments in favor of hiding nuance from the general public. Especially if other areas forgo outdoor masking and the sky doesn't fall, overkill policies are going to erode trust in messaging if they extend past their necessity.

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However, I don't buy the slippery slope/ message discipline arguments in favor of hiding nuance from the general public.

There are people who claim that the CDC & NIH are just making shit up about masks because Dr Fauci asked the general public to refrain from wearing masks at a time when those supplies for front line health care workers were extremely scarce. Do you really think that the general public is going to understand nuance on this topic?

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And taking too cynical of an attitude about public communication creates a race to the bottom.

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When they give one message rooted in the circumstances at one time and then, a bit later, when those circumstances have changed give another message and people jump all over that as evidence that the health experts don't know what they're talking about I think we can conclude that nuanced messaging is doomed out of the gate.

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I decided awhile back that I'll just be wearing a mask for most of the rest of my natural born life. And I'm okay with that

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Would get suicidal just thinking about this. I for one cannot accept the possibility of never going back to normal.

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There is no single normal. What is normal to you was not normal to previous generations, nor will it be normal to future ones. It probably was not normal to you when you are younger, nor will it be when you are older. Embrace the doctrine of Heraclitus; the Universe is made of change. You cannot step into the same river twice.

I don't expect to wear a mask forever, but if appeared to be necessary I'm sure I, and most other people, could adapt. When I was much younger I would have been horrified at the prospect of never again spending long days in the sun without any thought of protection. That was normal then. It isn't any more.

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There is ZERO reason to think we can't get back to mask-free living right now, and people who are OK with this being permanent scare the fuck out of me, because I'm worried all else being equal that their influence will result in (truly) unnecessary delays in lifting restrictions.

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NZ took measures to eradicate the virus that the US was not willing to take. Want to go back to normal? Do what is necessary to get there.

What measures did NZ have to take to practically eliminate covid there, and do you think that Americans would adhere to them?

I was in the Marketbasket in Waltham on Saturday. There were several hundred people in the store and they all had masks and no one was really suffering. At this point, it's just something you do and hardly even notice. Sure, I don't want to do that forever, but a few more months isn't going to kill anyone.

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I sincerely doubt many people in the marketbasket were speed walking or biking. A cloth mask starts to get wet with rigorous breathing, then folds into your nostrils and mouth. It's impractical to wear them outside, and if you're not experiencing this discomfort, you're not moving fast enough. Everyone's fine with carrying one in their pocket for going indoors, the issue is with outdoor use, which is purely performative rather than functional.

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...is my best guess.

I regularly make a 6 mile, 40 minute bike ride wearing a well-fitting cloth mask (2-layer, tight around nose, cheeks, and chin) and it has only been an impediment once or twice—once when the fit was messed up, and once in the rain when it got totally soaked. It sometimes slightly inhibits my breathing, but nothing "impractical".

OK, so maybe I have better lungs than average. That's possible, I guess. But if you're talking about wearing a mask while *speed-walking* being impractical, you might benefit from taking some more time to determine how to make or get a mask that fits you well.

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I understand my experiences are purely my experiences, but I've gone through over 30 different masks. Some from my workplace, some from volunteer orgs, some bought online, and they all fold into my mouth after becoming damp. As a former smoker, I don't doubt you've got better lungs than me, and maybe you don't inhale hard when walking uphill. If your trip timing and distance is accurate however, it doesn't sound like you have cause to breathe hard. For me, anything less than 20 mph on a bike makes me uncomfortable, with the mindset that if I'm not passing cars, I'll be rear-ended by one. I'm gasping and sweating at all times, and the mask makes a huge difference.

There are special masks for wearing during exercise that do not have the problems you've described. The mask I wear for biking even prevents my sun glasses from fogging over. The basic cloth mask or paper surgical mask is fine for many circumstances, but they are by no means the only masks available, nor are they the right mask for other circumstances. Get the right kind, problem solved.

lots of people Would get suicidal just thinking about this.

Then they're pretty weak, because that's not really much in the grand scheme of things.

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It’s illegal to go out in public with your genitals exposed. In many jurisdictions it’s illegal for women to go out in public with their breasts exposed. Compared to these restrictions, at least the mask mandate has a basis in public health. To the “But my freedoms...” crowd: I’ll start taking your liberty argument seriously when you argue for an end to the pants mandate and the shirt mandate with the same vehemence that you argue for an end to the mask mandate.

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When people start crying about their loss of freedoms with regards to masks, I tell them their freedoms end when their actions can harm, or even kill, others.

My biggest concern right now are the anti vaxxers who will prevent us from getting to 70%.

From what I've read, if we do not get to 70% within six months (so mid summer), we will all have to get boosters and will continue to get them for a few years until we've stamped this out.

Unfortunately this is pretty much a given. Air Travel is opening up again and many places like Europe still aren't being vaccinated yet.

And the biggest thing.. this could have been prevented. And the two men who are responsible for gross incompetence are still walking the earth free.

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From what I've read, if we do not get to 70% within six months (so mid summer), we will all have to get boosters and will continue to get them for a few years until we've stamped this out.

I think it'll be boosters if we're lucky. The truly worrisome scenario is that the high rate of new daily cases plus the not-high-enough percentage of fully vaccinated people allows faster evolution of vaccine-evading strains. Six months to 70% feels like too late to me.

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@Citygirl. Heck it works for the Japanese. Not to mention it's a good way to avoid cold and allergy symptoms too.

Mr Don't Panic.

Safe — outdoors, especially while distanced.

Of course we don’t need a mask while walking our dogs at 6am when no one else is around, but a year into this thing and people still don’t understand personal space or what 6 feet actually looks like. And I don’t have special vision allowing me to discern who is vaxxed and who is not.

I don’t necessarily ascribe malice to strangers who ignore Covid personal distance guidelines; at worst they are careless and inconsiderate; at best, like most of us, they are absent-minded from time to time. I am looking forward to mask-free bike rides this week, but also think we should stick with outdoor masking in downtowns, business districts, T platforms, and bus stops until (at least) the numbers look more like last summer’s lows—and considering the vax rates, it could be a matter of just a few weeks.

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I judge my masking/mask-free existence by where I am - the denser the area, the more likely the mask stays on. In my neighborhood, where there are less people, the mask is off until I reach a denser area (like the retail strip), and then the mask goes on.

I think once vaccinating those 16 and over gets underway (my 2nd shot is next week) and the number vaccinated brings us to last summer's numbers and/or the doorstep to herd immunity, you will see some of the restrictions relax, sooner than later. At the very least it will be the masks to go first, and perhaps bringing space a bit closer (3ft instead of 6ft) between people.

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Yeah I admit I'm the same now after being fully vaccinated (today was day 14 after my 2nd shot).

The mask comes off when I'm on empty streets but is nearby when someone walks by. I no longer wear masks when taking out the trash or talking to my neighbor(s) from a distance.

But I still refreshed my mask supply over the weekend so there's still some concern in my mind.

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Everyone could handle nuance as well as you can. One thing that I've learned from this pandemic is that many people on "my side" (educated, liberal) don't handle nuance well at all, even in hypothetical discussions. "It is the mark of an educated mind to be able to entertain a thought without accepting it." Lots of people have something to learn from Aristotle.

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I don’t necessarily ascribe malice to strangers who ignore Covid personal distance guidelines; at worst they are careless and inconsiderate; at best, like most of us, they are absent-minded from time to time.

I, on the other hand, think of people who don't wear masks in public as antisocial shit stains who don't deserve the benefits of society. It's been a year, they have no excuse to be forgetful. There's a pandemic on, and when I see someone without a mask I see someone who isn't doing their part to help stop the spread of disease. They may as well be those filthy scumbags who like to stand on the T platform, spitting onto the tracks.

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I was at my friend/cohort's house. We've been in the same bubble since the beginning. I left my mask at home without thinking about it because I keep a spare one-time-use one in my car for emergencies and I was only going to their house and back home again. We made dinner but just before the birthday girl asked for dumplings which wasn't on the menu. We ordered from a place down the street. When it was ready, I was asked if I wanted to get some exercise and walk the 3 blocks there and back with the mom. I agreed, but as we're walking there, I realized I didn't have my mask and I didn't get the one in the car. So, we walked the rest of the way there and when we passed one or two others, I ducked my face into my jacket for their sake. I stood outside maskless when we got there too.

So, not everyone without a mask in public is an antisocial shit stain. Sometimes you just don't find it in your pocket where you thought you had it and you're only going a few blocks and not indoors anyways.

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My comment was more about physically distancing outdoors, but the fervent no-mask crowd and the performatively half-assed compliance people who make it seem like a mask is some burdensome crown of thorns deserve little or no charity.

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because they are ridiculous. Science can go both ways. What happened last summer when everyone was hanging outside without masks? Case numbers dropped.
Mask policing is so 2020

I literally spend about half my walk in the street, trying to get a little distance from these people who are signalling that they're reckless and inconsiderate during a pandemic.

The anti-maskers have managed to make a walk be stressful. Stress is bad for you. Wearing a mask is no big deal by comparison.

Facemasks in the COVID-19 era: A health hypothesis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680614/

He's probably right, but I just don't trust people. I also find it much easier myself as someone who lives in the city to just wear a mask whenever I'm outside in public places. If I'm sitting somewhere away from other people where I know no one else is likely to walk by, only then will I sometimes take off my mask. Until the numbers are sufficiently down and the vast majority of people have been vaccinated who wished to be will I become less strict about this.

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I for one will be wearing a mask come winter next year on the T.

I LOVED LOVED LOVED LOVED LOVED that I didn't get my yearly

1) Head Cold
2) Flu like but not the flu

or any

Sniffling, sneezing, aching, coughing, stuffy-head, fever, thingy where i can't rest and need medicine.

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I actually hope that, like in Japan, it will be socially acceptable for people who choose to do so, to wear a mask on the T next winter. Also, I hope that people who are feeling a little ill (even if it's just a cold) will stay home and work there until they feel better.

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Of this pandemic. I will be joining you

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IMAGE(https://www.cdc.gov/flu/weekly/weeklyarchives2020-2021/images/ILI14_small.gif)

I guess that's one silver lining to 567,000+ people dying of COVID-19...

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My little two year old grandson came to us last week with the sniffles. (It was an emergency situation). The sniffles turned into the plague so I now have my first cold in a year. I did not miss it.

...me neither.

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Between you and the CDC I’ve been walking outside without a mask but always wearing one inside.

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epidemiologists you have cultivated in your commentariat. I had no idea the consistency of your reader base was 90% experts in infectious diseases.

Fully vaccinated and have been for months. I wear a mask indoors, on busy sidewalks (downtown/centre), drive thru windows, and for 8 hours a day at work. I don’t wear a mask when I’m walking my dog in my quiet neighborhood and when I’m walking in a place where I’m able to properly distance myself.

Many of the people who think everyone should be wearing a mask outside, no matter what, may be so on guard bc they having been working from home over a year and haven’t had as much exposure to the outside as people like me have. It’s the fear of the unknown which can sometimes teeter on paranoia. I get it, i was scared going into work last april too. Those of us who have been going into the workplace for the past year and aren’t living the “fully remote” lifestyle have a slightly better grasp on the reality (essentially “exposure therapy”).

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Magoo says...???

We can argue until the cows come home about whether or not outdoor spread is marginal at best, but I think all of us can acknowledge that there is a lot of low-key skepticism about the vaccines, let alone the severity of Covid all along. We have all heard this from our co-workers, our parents, our well-meaning but ignorant friends and family, and people from every walk of life, really. Messaging matters. Messaging that there are loopholes, exceptions, asterisks to the pandemic unfortunately is a slippery slope for the dumb masses. How many restaurants and businesses are *really* spacing out people six feet apart? How many venues have tents that are essentially an outdoor, enclosed room with not much air circulation? What about grocery stores that have removed their floor arrows, which most people weren't really paying attention to at any point anyways?

I'm sorry for those of you that feel tired and inconvenienced by wearing a mask in public, even if you did get a vaccine. We are all tired. We are all emotionally burnt out and want this to just be over. But one should know better than to trust other people to do "the right thing" by this point in time. After all, isn't that how we got to 13+ months of US pandemic with no clear end in sight, and the increasingly likely scenario that our country will NOT reach herd immunity due to vaccine hesitancy?