Why Masking Matters Even With COVID-19 Vaccines

While many people may yearn to jettison their face masks after being fully vaccinated against SARS-CoV-2, masks likely will remain important for the foreseeable future. A recent Infectious Diseases Society of America (IDSA) press briefing highlighted the ongoing need to stay vigilant against the virus by wearing masks in public and with others outside our immediate households.

More than 43 million Americans have received at least 1 dose of vaccine, but that’s still a fraction of the population. “As vaccines and vaccination efforts are being rolled out across the country, the message I want to put out today is that it remains important to practice well-established, evidence-based prevention measures,” said IDSA member Joshua Barocas, MD, assistant professor of medicine at the Boston University School of Medicine and infectious diseases physician at Boston Medical Center. While COVID-19 vaccines prevent severe disease and death, he said, there are holes in our current knowledge when it comes to whether the vaccines can prevent inoculated people from spreading viral particles to others. “Although data that’s emerging is quite positive when it comes to transmission, we still don’t have very clear answers.”

Because the majority of Americans have not been vaccinated yet, and because we’re dealing with new variants of the virus that appear to be more transmissible than the wild-type virus and may be more adept at infecting those who have antibodies, Barocas maintains that masks still have a big role to play. “We don’t know who’s unvaccinated,” he said. “We don’t wear it like a badge on our coat. We don’t wear our immune function; we don’t show our risk factors on our shirts, and so we need a continued multilayered approach.” This is particularly important in public and with non-household members, he said, and includes social distancing, frequent hand washing, and good ventilation indoors. “If we do all of these measures together, then we’re avoiding placing all of our eggs in one vaccine basket.”

Barocas also described “existing and growing inequalities” when it comes to inoculation rates in the Black and Latino communities, which have been decimated by the virus but whose members are significantly less likely to be vaccinated. The reasons for this disparity are varied and include difficulties navigating computer-based sign-up systems, language barriers, transportation obstacles, and mistrust of the vaccine. “People with the greatest need for protection have not been, actually, at the front of the line,” Barocas emphasized.

For those who may be skeptical that mask wearing offers protection, Barocas mentioned studies conducted of airplane passengers and hospital patients demonstrating that mask mandates and mask wearing have decreased viral transmission. He allowed that mask wearing is not a completely foolproof way to avoid catching and spreading the virus, but likened it to the armor donned by medieval knights and the helmets and pads worn by football players: “Masks may not be 100% effective at preventing the infection, but neither a medieval knight [n]or a football player would enter their competition without their proper protection.”

Asked about the utility of wearing 2 masks at once, Barocas echoed other experts in his assessment: “We haven’t seen studies yet of how effective double-masking is. I think the message I want to put out there is, any mask is a good mask. Anything is better than nothing.”

The Centers for Disease Control and Prevention (CDC) just weighed in on this topic offering guidance on double-masking.

Masking plays an even more important role now that we have new COVID-19 variants from South Africa, the UK, and Brazil ricocheting around the globe. “These variants [are] capable of spreading with greater efficiency, causing alarming case number spikes and overwhelming, yet again, healthcare infrastructures,” said Ricardo Franco, MD assistant professor of medicine and associate scientist in the Center for AIDS Research at the University of Alabama at Birmingham. In vitro, these variants have shown that they can evade antibodies generated by people who’ve had COVID-19. To a lesser extent, he said, they may also be able to evade antibodies generated by vaccination, particularly the South African mutation.

Because of the greater transmissibility of these variants, Franco asserted that we might need to wear masks for a longer period than we had initially anticipated—but there is a light at the end of the tunnel. “The good news is that the status quo of mask wearing won’t last forever, it seems,” he said. “It seems like we’re in a promising place. We need to remain committed to us[ing] all the tools we have.”