Dr. Fauci, Tear Off These Masks If the epidemic continues on its current course, it will be safe to uncover your face by Memorial Day. By Nicole Saphier
https://www.wsj.com/articles/dr-fauci-tear-off-these-masks-11617387381?mod=opinion_lead_pos6
When will it be safe to shop at a grocery store or show up at the office without wearing a mask? Sooner than most experts are willing to admit. If the coronavirus epidemic in the U.S. continues on its current trajectory, the need for masks outside particular local outbreak areas will pass in a matter of weeks.
One way to think about the problem is by analogy to seasonal influenza. Hardly anybody wears a mask in ordinary settings to protect against the flu, and no one is required to do so. The worst flu seasons of recent years saw an average of 220 deaths a day nationwide. The seven-day moving average for Covid-19 daily deaths hovers around 900, still considerably worse. But that’s a 78% reduction since January, and the trends are favorable almost everywhere in the country. When the 14-day rolling average of daily Covid deaths has come down below flu level, which may happen within the next month or two, we should adjust our thinking about the coronavirus accordingly.
Vaccination is the main reason for the sharp decline in Covid cases and deaths. Some three million shots are being administered each day, and once immunity has kicked in, the vaccinated are at negligible risk of being infected, never mind spreading infection. If you’ve been vaccinated, there’s almost no direct safety benefit—to yourself or others—of wearing a mask. You still have to do so only because immunity is invisible. The expectation or requirement of mask-wearing is impracticable to impose only on those who are vulnerable or may be dangerous.
At some point, however, herd immunity is achieved: Enough of the population is immune to make the risk of infection minimal in the population as a whole. Anthony Fauci puts the threshold for herd immunity at full vaccination of 85% of the U.S. population, including children. Since the vaccine has been authorized only for patients 16 and older and not all adults are willing to accept it, Dr. Fauci’s goal almost certainly won’t be reached for another year, if ever. The current figure is only 17% of total population.
Dr. Fauci’s benchmark is unreasonably high. He ignores that many unvaccinated Americans—perhaps as many as 120 million, as seroprevalence studies suggest true incidence levels to be three to 20 times captured infections—have immunity owing to prior infection. A recent large-scale Danish study finds that prior infection provides approximately 80% protection to patients younger than 65 and 47% protection to those older. That difference is why it’s important to prioritize the elderly for vaccination, as U.S. authorities have done. Because of this combination of factors, we will likely surpass 50% combined immunity within the next week or two.
A single dose of either the Pfizer or Moderna mRNA vaccine has been shown to confer 80% immunity after two weeks according to recent Centers for Disease Control and Prevention data on healthcare workers. A British study showed people who were immunized after infection had 99% protection after a single dose. This means any of the 99 million Americans—38% of adults—who have received at least one dose may be sufficiently protected. At the current pace, 50% of the entire population could receive a single shot by the third week of April if efforts focus on the unvaccinated instead of those who’ve already had one shot. If combined with continued lower rates of infection and death, I believe that would be enough to justify an end to mask-wearing outside high-risk settings.
We are much closer to protective immunity than some public-health officials acknowledge—or perhaps want to acknowledge. Precisely how close is impossible to tell, in part because officials have recommended getting the vaccine regardless of prior immunity and haven’t kept track of whether people receiving the vaccine already had a documented infection or presence of antibodies conferring probable natural immunity. They also are administering second doses rather than maximizing the number of people vaccinated, despite the data showing the efficacy of a single dose and the U.K.’s impressive success with the delayed-booster approach.
A final factor is the supply of vaccines. In addition to protecting the vulnerable, universal masking salves the fears of those who are at risk of infection. Once vaccines are plentiful enough that any adult who wants one can easily get it, the calculus changes. If you’re unable to get vaccinated, it’s reasonable to expect others to accept infringements on their freedom as a precaution. Not if you refuse to get vaccinated.
Public-health officials and politicians risk a public rebellion if they don’t start taking common sense into account and instead persist in labeling anyone who questions their decrees “antiscience.” After more than a year of restrictions, they should prioritize getting back to normal. That means public-health agencies need to generate accurate benchmarks of progress—including natural immunity as well as vaccinations—and to be open to modifying their approach, including by relaxing restrictions that have proved ineffective or outlived their usefulness.
Universal masking isn’t in that category yet, but it will be soon. I believe it will probably be safe to end mask mandates by the end of April, but Memorial Day weekend is a more realistic target. Until then, even if you’ve been vaccinated, you’ll have to wear a mask when you’re indoors in public.
Dr. Saphier is a physician at Memorial Sloan Kettering Cancer Center, an assistant professor at Weill Cornell Medical College, and author of “Panic Attack.”
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