articles

Recently, I received the kind of invitation that many of us have been longing for, to an event the likes of which has been unthinkable for more than a year: the wedding of a beloved niece, and an opportunity to see friends and family. That I, an emergency physician, have hesitated so much in deciding whether to attend tells you all you need to know about the latest COVID instruction from the federal government.

The Centers for Disease Control and Prevention’s new guidance has indeed left people confused, uncomfortable or both. The CDC’s announcement that fully vaccinated individuals can ditch masks and relax social distancing measures in most settings has taken a beating from experts who wonder whether the decision was thoroughly considered. Local and state leaders, including New York’s Andrew Cuomo, have scrambled to revise their own directives.

With some 200 million of us still not fully vaccinated, some physicians believe the CDC’s new guidance arrived too soon and may prolong the pandemic. These critics point out that we have no formal process for knowing who is inoculated; how can we protect the unvaccinated if they’re also unmasked?Essential worker groups are asking the agency for clarification on how to perform their jobs safely when they don’t know who has received a dose.

The COVID vaccines are remarkable feats of science, but they’re not perfect. No vaccine is. In a large study conducted by the CDC, the Pfizer & Moderna vaccines were about 90% effective in preventing infection, regardless of symptoms. Further, evidence suggests that vaccinated individuals have a lower risk of transmitting virus to others, which may be part of the reason the CDC felt comfortable issuing these new recommendations.

But there are questions and complexities to all of this, especially since the right to be unmasked almost always relies on the honor system.

This past week, I competed in a national tennis tournament in La Jolla, Calif., that included about 100 onlookers seated in an outdoor but somewhat confined structure, with a roof and back and side walls. There was little air movement, and nearly everyone was unmasked. My assumption is that most of us were vaccinated because it was mostly an older group — but the reality was, no one knew.

“Personally, I am still not going to be comfortable going into a crowded space without a mask,” Dr. Robert Wachter, chair of the department of medicine at the University of California, San Francisco, told USA Today.

I have a history of a rare, oral salivary gland cancer. Do the complications of my prior treatments, including a hole in the roof of my mouth, put me at greater risk? I exercise daily, I’m strong and I certainly don’t feel immunocompromised. But I’m not completely sure.

All of which brings me to my dilemma. My niece’s long-planned wedding is set for Dallas; it’s an indoor affair, followed by an indoor reception, and we know the risk of COVID exposure is higher indoors. Most of the 250 guests will not be masked. We believe a substantial number of them have been vaccinated — but which ones? Nobody is going to be checking.

I expect to catch up with a number of old acquaintances. What if 10% of them aren’t vaccinated? What if it’s closer to 40%? The recent case of the New York Yankees, with nine members of the team benched for COVID despite already having been fully vaccinated, is a stark reminder that we still don’t know what we don’t know.

In my case, my 25-year experience as an emergency physician tells me we should not yet be holding extremely large indoor gatherings, especially if people are flying in from various locales and congregating in one place with mixed vaccination status. On the other hand, my niece and her fiancé have waited months — and the CDC just took a huge step toward unmasking a massive number of Americans. Do I say I do, or I don’t?

If you’re faced with a similar decision soon, you have my empathy. The past year has been a sad blur: overflowing intensive care units, tragic family deaths, deep isolation. Many of us have experienced loss very personally. More than 580,000 Americans have perished.

Let’s exhibit grace and patience with those who may be a little slower to unmask, as we try to understand how to safely implement the CDC’s new mandate for all of us. None of us knows the steps others have walked during the pandemic. Our science is good — but it’s not perfect.

View Original Article