Don’t want to wear a mask at stores? Just get vaccinated. That’s the goal of Oregon’s new COVID-19 mask exemption. Businesses can, if they choose, allow fully vaccinated individuals to shop, eat, and exercise bare-faced.
On paper, the idea seems sound: the more freedoms you grant to vaccinated people, the bigger the reason to get vaccinated. But in a pandemic, everything comes with some risk. And the risks people face, vaccinated or not, can change depending on age, individual health, and the amount of virus circulating in a community.
Local and national groups have questioned the wisdom of lifting the mask mandate for unvaccinated people, while others feel the new rules are needlessly draconian and could lead the way to unacceptable levels of surveillance. And it leaves individuals, both vaccinated and not, asking if it’s safe to take off their masks.
The question of safety is particularly pressing for Oregon seniors, many of whom saw their worlds shrink dramatically during the pandemic.
These vaccines — which by many measures are among the most effective ever created — are saving lives. But as the number of breakthrough cases show, no vaccine is perfect. And the most severe breakthrough infections have been among people middle-aged and older. Oregon has seen eight COVID-19 deaths in fully vaccinated people. All of them claimed the lives of people older than 50.
Immune systems get weaker with age. That’s one of the reasons fatalities have been so high among older people: their bodies aren’t as prepared for a long battle with a virus. Unfortunately, since vaccines work by harnessing our immune systems, they can also be less effective with age. That means that the group most likely to catch COVID-19 while vaccinated is also the group most at-risk of severe illness.
Chet Liebs, a 75-year-old Portland resident, is keeping his mask on for now.
“I trust the science of the vaccine,” Leibs said. So he’s changed his behavior — he’s going shopping in stores after a year of staying home.
“It was very nice, people were wearing masks and it seemed to be progressing very responsibly,” he said.
Liebs has started visiting with other vaccinated friends, and these days rarely wears a mask when exercising outside.
But in businesses, where the vaccination status of strangers is unknown, Liebs said there were still too many unanswered questions.
“It feels premature,” Liebs said. He’s concerned about the association between age and breakthrough cases. He’d also like to see more research on transmission in vaccinated people before he gives up his masks indoors entirely. And he certainly won’t while cases are still high.
Because that’s the other thing about vaccines: like seatbelts, they can dramatically reduce the risk of getting injured or dying. But seatbelts don’t protect you from accidents, they just minimize the impact. The more times you ride in a car, the higher your chances are of getting injured. And the more COVID-19 is spreading the community, the higher the chance of someone vaccinated catching the virus. Older Oregonians aren’t the only vaccinated people who might choose to keep their masks on. Those with underlying health conditions, who work with at-risk populations, or who live with unvaccinated children might choose to do so, as well.
It’s not over yet
Dr. Jeff Absalon, the chief physician executive of Bend-headquartered St. Charles Health System, says he believes the mask guidelines from Centers for Disease Control and Prevention and Oregon authorities are grounded in good science, but they will only work if people comply in an authentic way.
“One of the concerns that I have is that if unvaccinated people are dropping down their guard, or not masking to the extent they have been throughout the pandemic, I am concerned that we will see more spread,” he said.
That’s a big concern for Absalon. These steps towards reopening — and dropping masks — hit at a time when vaccination rates, the spread of the coronavirus and hospital capacity look different in different parts of the state.
Absalon works in Deschutes County, where vaccination rates are comparatively high, but so are COVID-19 hospitalizations. He said the local public health system is facing surging demand for care from both a fourth wave of COVID-19 patients and people who are no longer afraid to visit hospital emergency departments for other health complaints.
The number of hospitalized COVID-19 patients has climbed steadily from a low of four on March 25 to a high of 59 on May 17 in the area east of the Cascades designated by the state’s hospital preparedness program as Region 7
Of the region’s 46 intensive care unit beds, just one is unused, according to data published by OHA. More than 90% of non-ICU beds are also in use.
Yet again, St. Charles has taken steps to limit elective surgeries and shift emergency-room patients into overflow spaces.
“Unfortunately, this far into the pandemic, we’re still seeing a very significant amount of patients with severe disease. I recognize this seems to be different from many other places in the state and the country, but we’re really in a tight spot right now and have a lot of sick patients,” Absalon said.
The issue of noncompliance
The CDC and Oregon health officials hope that the new mask exemption will encourage people to get vaccinated. But others are concerned that it could provide a loophole for those who want to take off their masks.
If businesses want to let vaccinated people remove their masks, the Oregon Health Authority said they will need to screen customers upon entry to see if they have been vaccinated. But there’s nothing to stop an unvaccinated person from removing a mask once they’re already inside.
“I think, ultimately this becomes partly a matter of how much do we trust each other?” said Courtney Campbell, a medical ethicist at Oregon State University. “Now that we’re in a situation where some people may not be wearing masks, I think that’s a real central concern.”
Vaccinated people who choose to remove their masks are trusting that other unmasked people in the business are vaccinated. And although masks are good at stopping a person from catching a virus, they’re much better at stopping someone from spreading it. So those who, for whatever reason, are not vaccinated, have a valid reason to distrust the unmasked, too.
That’s because this policy’s effectiveness relies on its enforcement by businesses. But there are few ways to ensure masked people stay masked without resorting to unacceptable levels of surveillance, like constantly questioning someone’s status, Campbell said.
Campbell said that providing more concrete incentives for vaccinations — like a small financial incentive, or a free beer inside a venue, or discounted tickets to a game — would likely be a better motivator than allowing people to go unmasked.
The great unvaccinated
Herd immunity has not been achieved on a statewide level, or even a county-level — regardless of what state reopening guidelines may imply. It is reached on a community level and relies on you, and all the people you interact with, being vaccinated.
But vaccine distribution in Oregon hasn’t been equitable. Some groups have had easy access to the vaccines while others still face barriers that make access much more difficult. These challenges include a lack of childcare, employment that does not provide flexibility to leave work or take paid time off the job, language barriers, and long travel times to reach vaccination sites.
“Some people have access to the benefits of vaccination, while others will bear the burden,” Campbell said
Frontline workers and people of color have been disproportionately impacted by the pandemic. They are also among the groups least likely to be vaccinated and are also more likely to be exposed to the virus.
“They might not have insurance or access to paid sick leave,” said Daniel López-Cevallos, who studies health equity at Oregon State University.
In other words, It’s inaccurate and unfair to assume that everyone who wants a vaccine has one. López-Cevallos said these groups will be particularly at risk if people use the new mask exemption to flaunt the mask mandate. “This lifting may be premature, based on what we’ve seen in terms of community behavior.”
“And even if they do not get sick, you can also transmit the disease to your family and community,” he said. And that community also includes a very big group of unvaccinated individuals: every child under the age of 12, and many older children, too.
He’s worried that these new policies give the impression that vaccines are the sole ticket out of this pandemic.
“More immunity will help us be able to track and contain and monitor pockets of infection. We need to work to lower cases, until we are certain our infectious disease epidemiologists can trace infections to the actual sources,” López-Cevallos said. Once any outbreaks can be traced and contained, the pandemic will be close to over.
Vaccines are one way to lower cases — “They are a pillar,” he said, but they are not the sole pillar. “We still have community spread.”
Even as cases decrease, the adequate tracing and containing COVID-19 spread continues to elude Oregon health authorities. On May 5, the Oregon Health Authority announced the largest outbreak of COVID-19 this year, at a church in Salem. It took state investigators almost a month to declare that the cluster of 87 cases were related. Meanwhile, church services continued.
“That’s not happening three months ago, that’s happening right now,” López-Cevallos said.
In the meantime, López-Cevallos said, we have to remember the other pillars of pandemic response, which have protected many people for a year: masking and social distancing.