SVMC's Mask Recommendations

Many states eliminated masking requirements in advance of the Centers for Disease Control and Prevention’s (CDC) highly anticipated and nuanced masking guidelines update last week. The update is based on the COVID-19 Community Level, which is determined using three measures: the COVID-19 hospital admissions per 100,000 population in the past 7 days, the percent of staffed inpatient beds occupied by COVID-19 patients, and the total COVID-19 cases per 100,000 population in the past 7 days. Yesterday, the state of Vermont also announced a more “across the board” removal of masking requirements beginning March 14th. While the differences in these plans may be confusing, both move toward more individual decisions about when to mask.

At the current time, the prevalence of COVID has declined, the rate of vaccination is high, and treatments are readily available. In addition, it is possible for those at higher risk of a serious case of COVID to take actions sufficient to protect themselves. (When the prevalence is high, by contrast, one person’s actions can affect others, which is why masking requirements are so important during those times.) For all of these reasons, it is OK to move towards more individual decisions about when to mask.

Everyone, regardless of the COVID-19 Community Level, should stay up to date with their COVID vaccines and get tested if they have COVID-like symptoms. Also, anyone with symptoms should wear a mask and test. Those who test positive should isolate. With that said, I developed a chart for helping you decide when a mask might make sense.

There is a difference between a requirement and a recommendation. Anyone who would like to go on wearing a mask should. We need to ensure wearing a mask is not stigmatized.

Even beyond the chart, there are additional factors to consider. Someone at high risk could run unmasked into a coffee shop for a minute or two without raising their risk of COVID in any measurable way. The same person would likely want to wear a mask if they were spending 2 hours in a crowded theater. Another person, up to date with vaccines and at no increased risk, may want to wear a mask for the week before competing in a major sporting event or visiting an elderly relative.

Also, it's likely that cases will rise again in the fall or if a new variant emerges. We may need to reinstitute mask requirements in some places to protect vulnerable people and hospital capacity. Doing so will not be an indication of an overreaction to the virus. It will be a reasonable response to increased risk.

Masks were absolutely crucial at the beginning of the pandemic, when vaccines and treatments were not available. They continue to be important for many people who are at increased risk of a serious case of COVID. They are very important when prevalence is high, even when vaccines and treatments are widespread, and will likely be important for limiting COVID illness in the future.

Trey Dobson, MD, is the chief medical officer at Southwestern Vermont Medical Center in Bennington and an emergency medicine physician at Dartmouth-Hitchcock Health.