‘Delta is a game-changer’: We asked NC medical experts about masking up to stay safe

When the CDC revised its masking guidelines back in May — and North Carolina quickly followed suit — COVID case numbers were trending downward, and there was still hope the state would reach the desired 70% vaccination goal and that life would soon return to somewhat-normal.

But vaccine hesitancy has plagued North Carolina (about 56% of residents have been fully vaccinated as of July) and the delta variant is circulating. And now, just as we were starting to let our guards down a bit, hospitalizations and case numbers are once again on the rise.

The CDC says vaccinated people don’t need to mask, and North Carolina’s amended mask mandate — which only requires masks in schools and prisons, on public transit, and in childcare and health care settings — expires at the end of this month (Gov. Cooper and NCDHHS this week announced guidelines that recommend masking in public schools).

Some North Carolina businesses are still asking unvaccinated people to wear masks (on the honor system) but most businesses have now abandoned any sort of masking requirements at all.

But with the delta variant causing more new cases and more breakthrough infections for vaccinated people, should we still mask up in public?

‘Delta is a game-changer’

“We are now entering a challenging time,” Dr. David Alain Wohl, a professor at the Institute of Global Health and Infectious Diseases at UNC-Chapel Hill, told The News & Observer.

“People have pandemic fatigue and have also had a taste of life without the more rigorous infection prevention measures. Then, delta comes along and cases, hospitalizations and even deaths are climbing again.

“Delta is a game-changer. It is much more catchy, and data indicate that even fully vaccinated people can become infected with the virus, possibly shedding it for a time before beating it back,” Wohl said.

We asked Dr. Wohl and other respected medical professionals a few practical questions that have been plaguing us in recent weeks — not necessarily policy questions, but questions that get more at what they do to stay safe.

In addition to Dr. Wohl, we reached out to Dr. Anita Skariah, UNC Health internist and pediatrician; Dr. Amir Barzin, professor and director of UNC Family Medicine Center; and former Duke Health physician Dr. Sallie Permar, now Department Chair of Pediatrics and Pediatrician-in-Chief at Weill Cornell Medical School/NewYork Presbyterian.

Should vaccinated people still mask?

The question we posed: With the Delta variant becoming more and more of a problem, are you still wearing masks when you go out to stores and restaurants and other social gatherings, even though NCDHHS and CDC say vaccinated people don’t have to?

Wohl: “Yes, I do wear a mask when indoors in public places where unvaccinated people may be. I strongly believe that masks should be worn indoors by the fully vaccinated when outside their bubble and unvaccinated people may be present. ... It’s a no-brainer that the unvaccinated should be wearing masks when indoors and around people outside their bubble.”

“I am perplexed by why the CDC and NCDHHS do not move to respond to this new threat and push for masking when inside public spaces.”

Permar: “Yes, even though I am fully vaccinated, I am still wearing masks in indoor places outside my home for a couple reasons. First, the new delta variant is fueling an increase in cases and hospitalizations, but mostly among unvaccinated. Some infections are being detected in vaccinated individuals, but these individuals are mostly not getting very sick. Wearing a mask ensures that I am not part of a chain of transmission to others who are still at risk of getting sick from this virus.

“Secondly, my daughter is currently too young to be vaccinated. We have left children under 12 in a tough spot by leaving them unprotected, so I wear a mask in solidarity and to continue to model masking for her.”

Skariah: “I am most definitely wearing masks still when out and about in stores, restaurants and at larger indoor social gatherings. The problem is that we do not know who is and who is not vaccinated and could be asymptomatically infected.

“This delta variant is more easily transmissible than the original or ancestor strain. It’s more efficient in producing higher concentrations of virus in people and evading their immune system, so spreads quickly. The vaccine definitely protects me from serious infection/hospitalization but there is still risk of breakthrough infection with this mutation.

“Although I am vaccinated, I most certainly do not want to bring this home to my unvaccinated children. We have been careful for so long. I do not want to lower my guard as we get into the home stretch of this pandemic.”

Barzin: “I have continued to limit large gatherings in indoor settings. I still have not ventured to many indoor dining spaces, but would likely ask to be seated outside.”

What would you tell your grandmother?

The question we posed: What would you tell your vaccinated elderly parent/neighbor/patient (or person with serious medical conditions) right now about being around unvaccinated people?

Wohl: “We have to return to a level of vigilance and caution that we hoped we would leave behind. My advice is start thinking again about reducing your risk of exposure to the virus by wearing a mask in public indoor spaces, socializing with those who are vaccinated, and avoiding crowds. As hard as it is, I would mask around unvaccinated young children, like the grandkids.”

Permar: “I tell family/friends who are at risk for severe COVID, which essentially includes every age group and medical background, to first and foremost: Get vaccinated. COVID is now a vaccine-preventable disease for all 12 years and above, don’t miss out on this privilege!

“If you are vaccinated but plan to be around unvaccinated people, I would recommend insisting on masking to avoid being part of any ‘cluster’ of cases, and if there will be close interactions over a number of days such as vacationing together, you could even request that unvaccinated individuals undergo testing before that time together — a strategy that seems to be working well for settings like summer camps.”

Skariah: “I recommend that all of my vaccinated patients and especially those who have underlying chronic conditions continue to wear masks if potentially around unvaccinated people, especially indoors. The vaccines are effective against the delta variant but not as effective as against the original strain.

“The more folks are unvaccinated, the greater the chance for newer strains to mutate and develop in those not protected by the vaccine. There will likely be more variants in the future if our vaccination rates do not improve.”

Barzin: “I would say: ‘You have done a really important thing in protecting yourself by being vaccinated. We know that breakthrough cases will happen. But it appears as though those who are vaccinated do much better clinically and do not end up having severe disease or serious complications resulting hospitalizations. This can change in the future, but the vaccine really does help protect people.’

“It is also not a one-size-fits-all solution. If vaccinated people have family members or others they take care of needing attention that cannot get the vaccine, I would ask that they do what they think is right for them. If they feel more comfortable in settings wearing masks, I would encourage that.”

How do we keep our kids safe?

The question we posed: What advice do you give to parents of kids under 12 to keep them safe in social situations and for in-person school?

Wohl: “Research demonstrates that in-school transmission among younger kids is minimal, but only if protective measures are in place. Masks work, even for children. It is a simple barrier that cuts down on the amount of virus being shed from a person toward others, and can help further limit infection by reducing the number of those viruses that make it into the nose or mouth.

“The American Academy of Pediatrics just came out with a clear recommendation for masking in schools for all over age 2 regardless of vaccine status. This makes total sense if we want to reduce the risk of shutdowns.

“We are in a pandemic and to get out of it we need to put our heads into masks — and not in the sand.”

Permar: “I am a parent of a child under 12, so I know it is difficult to continue to be vigilant when the rest of the family are enjoying the confidence of immunity. I recommend to be sure your child is continuing masking indoors for areas outside the home. I always choose outdoor eating when we go out, even when my child would prefer the A/C!

“We learned this year that in-person school is so important to children’s learning and well-being — so to preserve the in-person school setting for children under 12, continue to be sure your child is a good masker and hand washer, and understands distancing. And support school staff in implementing these measures until all school children can be vaccinated — hopefully by mid-fall.”

Skariah: “First of all, as parents/guardians, we need to model behavior for them. If you have kids who are not vaccinated, wear your mask in solidarity with them so they do not feel singled out. It has been a trying 18 months for all. Support them if they must continue to mask.

“As far as school, I recommend continuing to mask indoors regardless of being vaccinated or not. It is a layered approach to protection with masking, distancing and hand hygiene. It is so great to have these kids back in school but there will be a mix of vaccinated and unvaccinated people, so the risk of further mutations is present. These layers of protection have worked well to this point, worldwide.

“The other benefit is that the risk of other infections such as flu will likely decrease with masking during the fall into winter with kids masking at school.

“Give them breaks from masking when outside where, so far, it is less transmissible. This of course may change as new mutations arise.”

Barzin: “I would recommend that they listen to their kids and help teach them the importance of keeping distance when possible, hand-washing, and masking if they like. We know that the social interactions for children are really important. And we want to promote that in the safest way. If that means your child wears a mask until they can be vaccinated, we should be supportive of that as a society.”