But What About the Most Vulnerable?

Some of our citizens are at greater risk under relaxed mask guidelines.

green surgical masks on green background
Covid-19 by Prachatai licensed under CC BY-NC-ND 2.0 via Flickr.

While most of us welcome the new CDC guidelines relaxing masking guidelines and tying them to the state of local hospitals than the spread of the virus, we’re left with the same dilemma I highlighted last May when the agency greenlighted vaccinated folks to get on with their lives:

The obvious question, then, is: What about the children?

Right now, my wife and I are fully vaccinated and the three over-16s in the house have had their first shot and should get their second within the week. So, by the end of May, all of them well be “fully vaccinated” as well. My 12-year-old should be able to get her first dose any day now. But, right now, my 9-year-old is ineligible for vaccination.

Unless stores, restaurants, and whatnot are going to check to see who’s fully vaccinated—and they’re not—this effectively makes things worse for the kids. Now, I can take them places knowing everyone will be masked. But, now, everyone is going to be maskless, vaccinated or not. Aside from the immuno-compromised, who are at high risk and can’t get the vaccine, adults who are unvaccinated are mostly people who simply choose not to do so. And now they’ll have permission to go around infecting those who can’t get vaccinated.

Obviously, much has changed since then. My now-13-year-old is not only vaccinated but boosted, as are my three older stepchildren. My now-10-year-old is fully vaccinated and not yet eligible for or in need of a booster. So me and mine are fine.

Still, those under 5 are still not eligible for vaccines. And, even among the vaccinated population, the elderly, immunocompromised, and other unhealthy individuals are now at much higher risk. And that’s to say nothing of the unvaccinated—including the minor children of parents who are vaccine resisters and themselves have no say in the matter.

A Marketplace report (“‘I won’t take off my mask indoors’: Some physicians worry that CDC’s new mask guidelines will leave ‘most vulnerable’ to fend for themselves“) highlights the issue:

‘Very concerned that this new guidance will essentially recommend “one-way masking” w/ the burden to protect themselves falling on the most vulnerable.’

That’s a tweet TWTR, +0.89% from Dr. Oni Blackstock, a primary-care and HIV physician in New York City, after early reports that the Centers for Disease Control and Prevention planned to loosen COVID-19 guidelines for wearing masks.

“We need equity-centered, data-driven guidance,” Blackstock wrote Thursday.

[…]

Still, Blackstock was not the only person to raise the alarm on social media about what loosening mask guidance might mean for vulnerable individuals, including people with compromised immune systems, who may not receive strong protection from COVID-19 vaccines, and children younger than 5, who still aren’t eligible for vaccination.

Millions of people in the U.S. have diseases that affect the immune system, and still more take drugs that suppress their immune system.

“I won’t take off my mask indoors no matter what the CDC says today,” Dr. Kim Sue, an addiction physician and anthropologist and the medical director of the National Harm Reduction Coalition, tweeted Friday morning. “This is not about me, it’s about all my neighbors, immunocompromised friends, children

More anecdotally, a local story (WTOP: “Manassas mom among challengers to Youngkin’s mask-optional law“) that predates the new national guidelines:

A Manassas mother has joined 11 other Virginia parents in a lawsuit to stop the implementation of a new state law making masks optional in Virginia public schools and roll back new mask-optional policies in area public schools.

[…]

One of the 12 plaintiffs is Tasha Nelson, the mother of a 10-year-old student at Jennie Dean Elementary School in Manassas. Jack, Nelson’s son, suffers from cystic fibrosis, a condition that can hinder breathing and make patients particularly susceptible to lung infections.

Nelson says that because of his condition, her son – referred to in the suit as J.N. – is at high risk of severe illness from COVID-19.

“If there is no longer a mask mandate in Manassas City Public Schools, J.N.’s parents will have to choose between sending J.N. to school, which puts J.N.’s health and safety at heightened risk, or withdrawing him from school and risking his educational progress.”

On Feb. 16, hours after Youngkin signed S.B. 739 into law, the Manassas school division announced that maskless students would be welcomed into classrooms without any additional mitigation efforts like separation.

According to Nelson, she and Jack were in the car when they heard about the new law last Wednesday.

“He turns to me and he had these big tears in his eyes, and he said ‘Mom, does that mean I can’t go to school?'” Nelson told InsideNoVa. “He asked me if there was a way to let the governor know about kids like him.”

Nelson says that she’s tried to work with the Dean Elementary and city school officials to find a workaround for Jack, by either distancing him from unmasked students or having everyone in his class wear masks. But as of March 1, MCPS and other school divisions will be bound by state law to welcome maskless students without additional mitigation strategies. Nelson says that Jack’s doctors have said he should only be in school while there’s high community transmission if everyone is masked.

[…]

Cystic fibrosis patients have been particularly susceptible to severe COVID cases, with a recent National Institutes of Health study finding that over 10% of CF patients require critical care within a month of a COVID diagnosis, though it was conducted prior to the rollout of vaccines.

“I go solely on the advice of his specialists. His disease is rare and complex and requires a great deal of knowledge and care, and so his whole life everything we’ve done regarding his health has been at the advice and recommendation of a doctor who specializes in cystic fibrosis and pulmonary,” Nelson said.

For now, Jack is staying home, with Tasha getting assignments from the school for him to complete, as if he himself had tested positive for COVID. But that’s forced Tasha to miss work as Jack misses the specialized instructional help he received in school for his learning disability.

“This situation is devastating [Jack]., who cries daily when his siblings are dropped off at school and he cannot go. [He] feels isolated, ostracized, and discriminated against, and is having feelings of regret, and even shame, about his disease,” the motion reads.

This is obviously heartwrenching.

By and large, our society—and most societies—have done very little to accommodate the needs of the most vulnerable. The elderly and those with cystic fibrosis are at much greater risk of seasonal flu, the common cold, and all manner of other ailments, too, and we’ve largely placed the burden to mitigate the risk on them. COVID is deadlier but only by degree.

In the case of Jack, one would think there would be a way to accommodate his ailment, just as we do children with all manner of other challenges. I think it’s more than reasonable, for example, to require employees and students at public schools to get vaccinated for COVID just as they are for so many other diseases. It’s probably not reasonable, though, to require them to wear masks to marginally decrease the risk to one kid.

Beyond that, Leana Wen (“The CDC’s new mask guidelines finally got it right“) observes,

[T]here are other ways to protect vulnerable populations. The Biden administration must commit to doing far more to make antiviral treatments and preventive antibodies available to them. The federal government should make N95s or their equivalent widely accessible and free of charge to all who want to keep masking. Businesses can also do their part, for example, by designating specific hours for shoppers during which everyone must don high-quality masks.

That seems more reasonable than requiring the vaccinated to wear masks indefinitely.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Sleeping Dog says:

    In a perfect world… That we will never achieve…

  2. Bob@Youngstown says:

    we’re left with the same dilemma I highlight last May when the agency greenlighted vaccinated folks to get on with their lives:

    Get on with their lives
    That the part I never was able to understand, my experience with masking for the past two years has not prevented me from “getting on with my life”.
    YMMV, but (for example) wearing a seatbelt has not prevented me from driving.

    I’d agree that masking is inconvient at times, but I’ve hardly been prevented for doing anything. (The only exception that required an time adjustment was swimming laps in a crowded indoor swimming pool)

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  3. James Joyner says:

    @Bob@Youngstown: It’s obviously the case that, for a lot of people, masking is a minor inconvenience. But it’s just as obvious that, for most people, it’s more than that. It’s uncomfortable and socially awkward.

    Did the mask requirement stop me from, say, going to the grocery store? No. But that’s a 20-minute trip. It would have stopped me from going to restaurants, except that we implemented it in the most pro forma manner possible, requiring them only while walking around the establishment but not while seated. I did stop me from going to the movie theater. I’m not going to pay to sit around in a mask for 2-plus hours when I’m supposed to be enjoying myself; I’ll just wait to watch it at home when it comes to streaming.

    Teaching a two-hour seminar in a mask sucks. It’s much harder for participants to pick up facial cues that others are about to talk or stop talking. It’s just not a normal condition for human beings.

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  4. Tony W says:

    I am always amazed at how the toxically-independent conservatives completely kowtow to the government when it comes to masking mandates.

    The moment the government tells them that they don’t have to wear a mask inside a grocery store or Home Depot, off goes the mask. Whatever happened to thinking for yourself? Why do they let the government tell them what to do with their body?

    As for me and my house – we will continue to mask indoors for the foreseeable future. Likewise, there will be no indoor dining or other dangerous behavior until this pandemic is well in hand.

    And we are NOT anywhere near “well in hand”. Our daily case numbers are essentially where they were a year ago, and daily deaths are still coming in with over 2000 Americans each day dying from COVID.

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  5. James Joyner says:

    @Tony W: Which is absolutely your choice. I live in a household of reasonably healthy, vaccinated individuals and work at a place where essentially everyone is vaccinated. I judge the risk of resuming normal activity worthwhile.

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  6. Kathy says:

    @James Joyner:

    Two hours?

    Wow.

    I wear a mask from 7 am when I leave for work to 7:30-8:00 pm when I get back. Now, I’m terrible at math, but I think that’s a bit more than two hours.

    BTW, I haven’t been to a restaurant or a movie theater since the pandemic started. Not because I’d need to wear a mask, but because staying two or more hours in a closed space with lots of people is a terrible idea, masks or no masks.

    Another thing, breakthrough infections show why those of us vaccinated and boosted should keep wearing masks.

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  7. Michael Reynolds says:

    CDC guidelines barely matter, people are dropping masks. I had to get out of the house for a couple hours yesterday (maid service) so I drove down to Santa Monica and had lunch at a downtown restaurant. Maybe 15% of people were masked. A week from now it’ll be 10%. Absent some new horror, the mask party is over.

    I’m sorry for the kid with CF, but I’d have been sorry for him during flu season, too. Three hundred million Americans are not going to conform their behavior to the needs of the immunocompromised. It does not matter what the guidance is, that is not how the world works.

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  8. James Joyner says:

    @Kathy: We’re required to wear masks in all public spaces on base. The only time I take mine off at work is alone in my office, which is a solo. I’m just referencing the specifics of teaching a two-hour seminar: it’s much, much different masked than not.

    Again, I get that some people are much less risk-tolerant than others. My risk of getting a debilitating case of COVID were low to begin with and they’re vanishingly small with three shots of Moderna in me. I’m not willing to give up normal human interactions in order to further minimize an already-minuscule risk.

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  9. Just nutha ignint cracker says:

    new mask guidelines will leave ‘most vulnerable’ to fend for themselves

    Hey! This is America we’re living in, not some nanny-state socialist sh!thole. Leaving everyone not named (fill in name here) to fend for themselves is as American as apple pie. When citizens at large rise up and start demanding that the government and society do things for “the most vulnerable” we can talk again.

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  10. Just nutha ignint cracker says:

    “in order to further minimize an already-minuscule to me risk.”

    FTFY.

    3
  11. James Joyner says:

    @Just nutha ignint cracker: Well, sure. The whole post is drawing attention to those not in my circumstance. But others in the thread are talking about activities they’re afraid to engage in while the pandemic is still ongoing and I’m saying that my personal risk assessment is different than theirs.

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  12. Bob@Youngstown says:

    I’m not willing to give up normal human interactions in order to further minimize an already-minuscule risk.

    The way I read that is: “I’m not willing to be inconvenienced to accommodate conditions caused by a communicable virus that has the potential to jeopardize those around me.

    We would all like to get back to life as we knew it in July 2019 ( some may even long to get back to 1950), but a squall in our collective lives has conspired to derail our smooth sailing.

    Maybe we should stop bitching about how inconvenient” and collectively work our way out of the storm as best as we can.

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  13. Gustopher says:

    @James Joyner:

    I’m not willing to give up normal human interactions in order to further minimize an already-minuscule risk.

    I dunno, man. This whole pandemic has shown me that a lot of the normal humans aren’t worth interacting with.

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  14. Just nutha ignint cracker says:

    @Bob@Youngstown: “collectively”

    You liberals just can’t get past needing to frame everything in Marxist terms can you? 😉

  15. James Joyner says:

    @Bob@Youngstown:

    The way I read that is: “I’m not willing to be inconvenienced to accommodate conditions caused by a communicable virus that has the potential to jeopardize those around me.

    Dude, I’ve been doing that for two years. The CDC says I don’t need to mask anymore and most people aren’t going to do so. So, it’s time for Plan B.

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  16. Michael Reynolds says:

    @Bob@Youngstown:

    The way I read that is: “I’m not willing to be inconvenienced to accommodate conditions caused by a communicable virus that has the potential to jeopardize those around me.

    Set aside Covid, any time I go out in public during flu season I’m creating a risk that I might unwittingly be a disease vector for a virus that may kill a susceptible person.

    Every time I get in the car I present a risk to others, yet, I sometimes drive around for no compelling reason, causing risk to others. If I order DoorDash I’m creating a risk that the driver will run someone over. I’m also creating a health risk for the guy who cooks my DoorDash order – he might chop off a finger.

    Life is a balancing act. We rightly try to minimize the problems we create for other people, but only up to a point. Risk can never be zero, so we have to find a level that is sustainable and which accepts the reality of risk. We are not going to be masked forever, so whenever we decide to unmask, today – a week from now or a year from now – given that Covid is not simply going to disappear, we are accepting a slightly higher degree of risk to ourselves and others. There is no zero risk strategy.

    But this is an academic discussion because absent some new threat, masking is over. The tipping point has been tipped.

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  17. Just nutha ignint cracker says:

    @James Joyner: I think “afraid of” may be a little hyperbolic, but I also don’t see people expressing fear of doing things. Then again “unwilling to embrace risk X” (that someone else is willing to embrace) =/= “fear” in my lexicon.

  18. Andy says:

    The obvious question, then, is: What about the children?

    What about them? We’ve known for a long time now that Covid really is like the flu for kids, that kids do not spread it as much as adults do.

    @Bob@Youngstown:

    The way I read that is: “I’m not willing to be inconvenienced to accommodate conditions caused by a communicable virus that has the potential to jeopardize those around me.

    We would all like to get back to life as we knew it in July 2019 ( some may even long to get back to 1950), but a squall in our collective lives has conspired to derail our smooth sailing.

    Maybe we should stop bitching about how inconvenient” and collectively work our way out of the storm as best as we can.

    So what do you suggest? Because it sounds like you want people to mask always and forever and the reality is that the vast majority of people aren’t on board with that. At some point, tradeoffs must be made.

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  19. de stijl says:

    I have had two cancer scares – prostate and a melanoma on my right cheekbone. Both are cool now. Had to take righteous drugs that collapse your immune system for the prostrate. Had to get a major portion of my face sliced off for the melanoma. (A half inch by one inch swatch seems small, but looks huge in a mirror. It is shiny and weird and too pink.)

    The melanoma is a bit of a red herring. You can’t catch skin cancer. And you don’t get chemo for it. But, during the prostate process I was weak as a kitten and extremely vulnerable to random viruses. I was temporarily immunocompromised during that process.

    I am not going to take risks with randos shedding random viruses at the grocery store. Gonna mask up indoors for public spaces for the foreseeable future. If people have a problem with that, fuck them.

    @Reynolds seems convinced people like me will bow to to public pressure and accede. Lol.

    My whole life disproves that notion. I could not give a crap what people think. That is not going to happen.

    2
  20. Bob@Youngstown says:

    @Andy: @Andy:

    So what do you suggest? Because it sounds like you want people to mask always and forever

    Oh No… I don’t want people to mask always and forever. I’d just like people to stop with the big crocodile tears that their life has some how turned to sh*t, their wife divorced them, their dog bit them, they got herpes or they were unable to perform their job because they wore a mask when asked (or required) to do so.

    I’m tired of masks, you may be tired of masks, but…. for me and my household, being asked to wear a mask in the presence of potential virus transmitters or potentially vulnerable people has not been much more than a inconvenience that I’ve patiently endured. Changed my life? – No, but YMMV.

    And I do look forward to the day that medical guidance informs us that the transmission rate is so low that virus precautions are unnecessary.

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  21. Kathy says:

    @Bob@Youngstown:

    And I do look forward to the day that medical guidance informs us that the transmission rate is so low that virus precautions are unnecessary.

    Likewise.

    Because we know there won’t be a revolutionary medical discovery of 24 months as SARS-CoV-2’s expiration date.

    Cases right now are far higher than they were in the summer of 2021, when it looked we were at last beating the trump virus back. If it was premature to drop masking for vaccinated people then, it still is now, regardless of what the CDC says.

    We may be lucky and not get hit by yet another hypercontagious variant that slips past the vaccine’s defenses. Or maybe the second or third generation vaccines will offer protection broad enough to defeat all or most variants.

    Until then, we all remain vulnerable and should keep wearing masks to keep from spreading this pathogen around.

    1
  22. JKB says:

    This has all been run through the Democrat political science experts and they have advised.

    Impact Research, a Columbia, Maryland, political science laboratory, sent a memo to Democrats: “After two years that necessitated lockdowns, travel bans, school closures, mask mandates, and nearly a million deaths, nearly every American finally has the tools to protect themselves from this virus. It’s time for Democrats to take credit for ending the COVID crisis phase of the COVID war, point to important victories like vaccine distribution and providing economic stability to Americans, and fully enter the rebuilding phase that comes after any war.”

  23. Franklin says:

    Geez, the righteousness here makes it hard. You are perfectly free to wear a mask. Not one person has said otherwise.

    But you continue to pooh-pooh any hint that a mask might be more than an “inconvenience.” I wear hearing aids, and they help me obtain a modest level of communication. Masks significantly degrade that ability. Not just the muffled sound, but lack of facial cues. Do I need to detail how miscommunication with fellow humans can go beyond mere awkwardness and embarrassment to potentially causing critical mistakes? Luckily, the people I surround myself with are largely understanding, unlike some of you.

    My daughter also has a minor speech impediment where part of the correction is therapy where she can see how other people make the sound with their mouths. Yes, her therapist has a special clear mask to help her, but it might also help to see other people make those sounds.

    I’ve dutifully worn my mask for two years, have fully vaccinated myself and my family, and empathize with the immunocompromised and overworked healthcare workers. We still wear masks more than what is required. Now it’s time for you to accept that there’s another side to the argument.

    This will be my last post regarding mask wearing. I’ve heard your positions, and understand and acknowledge the truths behind them. You’re welcome to do the same for me, but there’s no point in repeating my arguments anymore.