4 Reasons I’m Wearing a Mask Again: Our vaccines are extraordinary, but right now they need all the help they can get. (The Atlantic)

 4 Reasons I’m Wearing a Mask Again

Our vaccines are extraordinary, but right now they need all the help they can get.

By Katherine J. Wu

The Atlantic Monthly

JULY 22, 2021

Earlier this month, I pulled a mask out of the bin of hats, scarves, and gloves I keep by the door; strapped it on; and choked. I had inhaled a mouthful of cat hair—several weeks’ worth, left by my gray tabby, Calvin, who has been napping on a nest of face coverings since I largely dispensed with them in May.

I’ve been fully vaccinated for two months. I spent the end of spring weaning myself off of masking indoors, and exchanging, for the first time, visible smiles with neighbors in the lobby of our apartment building. I dined, for the first time in a year and a half, at a restaurant. I attended my first party at another (vaccinated) person’s home since the spring of 2020. I am, after all, now at very low risk of getting seriously sick should SARS-CoV-2 infect me, thanks to Pfizer’s vaccine.

But the pandemic is once again entering a new phase that feels more dangerous and more in flux, even for the people lucky enough to have received their lifesaving shots. A more transmissible variant—one that can discombobulate vaccine-trained antibodies—has flooded the world. It’s wreaking havoc among the uninoculated, a group that still includes almost half of Americans and most of the global population. After a prolonged lull, the pandemic’s outlook is grimmer than it’s been in months. I am, for the foreseeable future, back to wearing masks in indoor public places, and there are four big reasons why.

1. I don’t want to get COVID-19.

Let me be clear: My chances of getting sick are low, very low, especially if I’m thinking about the disease in its worst forms. The vaccines are spectacularly effective at blocking COVID-19, particularly cases that lead to hospitalization or death, even when squaring off with Delta and other antibody-dodging variants. I expect this to hold true for some time: These vaccines were tested primarily for their power to curb deadly illness, and that’s what they’re accomplishing against every version of the coronavirus they face.

But no vaccine is perfect. Some immunized people will end up infected with the virus; a small subset of this group will fall ill, occasionally severely so. The proportion of vaccinated people who catch the coronavirus might tick up in the presence of certain mutations that make the virus less recognizable to vaccinated immune systems, and thus harder to purge. The longer the virus sticks around in the body—the more opportunity it’s given to copy itself and mosey through our tissues—the more likely it is that symptoms will arise as immune defenders rally to fight. (Delta might be extra well equipped to accumulate in airways.) Most post-vaccination infections, or breakthroughs, appear to be asymptomatic or mild, a sign that the vaccines are doing their job. But mild illness still isn’t desirable illness, especially given the threat of long COVID, which reportedly can happen in vaccinated people, though researchers aren’t yet sure how widely.

Masks slash the risks of all these outcomes. Breakthroughs are more common when the immune system faces a ton of inbound virus—when there’s an ongoing outbreak, or when the people around me aren’t immune. A mask reduces my exposure every time I wear one. Some variants, including Delta, might be more transmissible, but they’re still thwarted by physical barriers such as cloth.

I’m not duping myself into thinking that I’ll stave off this virus forever; SARS-CoV-2 is here to stay. But as hospitals in several states once again start to fill up, I’m in no rush to rendezvous with the coronavirus, especially because …

2. I don’t want people around me to get COVID-19.

If I get infected, that affects more than just me. I worry about the strangers I encounter—many of them maskless—whose immune status I don’t know. I worry about the youngest kids in my social network, who aren’t yet eligible for shots, and the elderly and immunocompromised, whose defenses may be weaker than mine. I worry about the people in my community who have been structurally barred from accessing the vaccines, or who are reluctant to take the shots. My risk of getting COVID-19 is low. Theirs is very much not.

The COVID-19 vaccines come with the delightful perk of blocking some asymptomatic infection, but researchers are still figuring out how often vaccinated people can pass on the pathogen. The math gets all the messier with more contagious variants such as Delta. Inbound virus affects me directly, but it can also turn me into a pathogen pit stop, potentially allowing outbound virus to bop into someone with less immunological armor. “Masks protect both us and the people around us,” Krutika Kuppalli, an infectious-disease physician at the Medical University of South Carolina, told me. In the United States, inoculation rates have taken a serious dip. The proportion of vulnerable people is stagnant, yet still too high.

During a pandemic, personal safety can’t be the only consideration, as my colleague Ed Yong has written. The disease we’re dealing with is infectious; the repercussions of our behavior ripple to those around us. Many unvaccinated people belong to populations that have been marginalized by the country’s fractured health-care system. Saddling them with any increased COVID-19 risk, even indirectly, threatens to widen disparities. Going maskless indoors still feels like a gamble, especially because …

3. I trust the vaccines, but I understand their limits.

My pivot back to masks says nothing about my continued confidence in the vaccines and what they’re capable of. But although vaccines are an excellent tool, they are also an imperfect one, and they’ll perform differently depending on the context in which they’re used.

Consider, for example, the effectiveness of sunscreen, another stellar yet flawed preventive. Certain brands, including those with higher SPF, will be better than others at blocking burns and cancer. Mileage may vary even with the same tube of sunscreen, depending on who’s using it (how much melanin is in their skin?), how they’re behaving (are they dipping in and out of the shade, or spending all day soaking up rays?), and local conditions (is it a cloudy day in a wooded park, or a sunny day on a snow-speckled hill?). Vaccines are similar. Breakthroughs are more likely in people with a weakened immune system and those who mingle frequently with the virus; they may happen more often with certain variants.

Asking a vaccine to shoulder the entire burden of protection felt all right a month ago, when case rates were plunging. Now they’re ticking back up. The vaccines don’t feel different, but the conditions they’re working in do. Maybe now’s not the best time to rely on them alone. “That’s putting a lot of pressure on the vaccines,” Jason Kindrachuk, a virologist at the University of Manitoba, told me. The virus has upped the ante, and I feel the urge to match it. When it’s extra sunny out, I’m probably going to reach for sunscreen and a hat, especially because …

4. Wearing an accessory on my head doesn’t feel like a huge cost to me.

Don’t get me wrong. I don’t enjoy wearing a mask, and all else equal, I’d still prefer to keep it off. But for me, it’s not a big sacrifice to make for a bit more security: I’ll mainly be using one indoors when I’m around strangers, a situation in which the risk of spread is high. And I’ll keep checking pandemic conditions like I would a weather forecast—hospitalizations, variants, immunization rates, and the behaviors of people around me—and adjust as needed. The idea is that this state of affairs will be short-lived, until vaccinations climb and the virus retreats again.

I live in New England, where things are relatively calm. I could probably get away with resuming normal life, whatever that is. But the status quo feels tenuous. It will take work to maintain. As Delta dominates the nation and case rates rise, we may already be losing our grip. Kuppalli said that although she’s concerned about our current menagerie of variants, she’s also trying to ensure that more problematic versions of the virus don’t have the opportunity to arise. The stakes in her community are particularly high: In South Carolina, where vaccination rates are relatively low, “it’s a free-for-all,” she said. “When I walk into a supermarket, I’m the only one in a mask. People look at you like you’re crazy.”

Vaccines have sometimes been billed as an option to supplant the nuisance of masks. But making that trade-off at an individual level feels overly simplistic in a population where so many people are neither immune nor covered up. I also didn’t get vaccinated because I wanted to stop masking. I got vaccinated because I wanted to reduce my chances of getting sick with this virus and transmitting it to others. Masking is a complementary means to the same end. My return to it isn’t an indictment of vaccination. It’s an insurance policy. It’s a small price to pay for more protection, especially once I’ve washed the cat hair away.

The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.

Katherine J. Wu is a staff writer at The Atlantic, where she covers science.