By KAREN JOHNSON and WHITNEY THURMAN
One current Friday evening, we huddled with our colleagues within the pouring rain at a movie show parking zone– our vehicles full of provides for our cellular vaccine clinic— looking for somebody who wished an additional dose of Pfizer’s COVID-19 vaccine earlier than it expired. 5 months in the past, we’d have been inundated with folks determined for that additional dose. However that has modified now that probably the most prepared and in a position segments of the inhabitants have largely been vaccinated.
Amidst this backdrop of slowing vaccination charges within the U.S. and lots of miles to go earlier than reaching all of these prepared to be vaccinated, the CDC has launched up to date suggestions for masks carrying that we imagine to be untimely and opposite to the ethic and mindset of public well being. Buoyed by mounting proof supporting the effectiveness of vaccines, the CDC— cheered by the Biden administration— gave totally vaccinated Individuals the inexperienced mild to ditch their masks. As totally vaccinated public well being nurses who’re as excited as anybody concerning the vaccines’ real-world effectiveness, we nonetheless discover ourselves once more asking: what are they considering?
To be clear, we don’t query the proof exhibiting that every one COVID-19 vaccines presently authorised within the U.S. are protected and efficient. We additionally crave excellent news, hope, and permitting the underside half of our faces to see the sunshine of day. We’ve got additionally appreciated the Biden administration’s dedication to “following the [biomedical] science” in pandemic policymaking. Our considerations lie with the timing of the advice; the shortage of regard for social science demonstrating the significance of public coverage in influencing neighborhood norms and human conduct; and the blatant disregard for well being fairness. That the nation’s preeminent public well being establishment has fallen prey to the individualistic mindset that typifies American society, as CDC director Dr. Rochelle Walensky acknowledged herself on Sunday relating to this “science-driven particular person evaluation” of danger, is irritating, to say the least.
At present, solely one-third of the U.S. has been totally vaccinated. The information media has been stuffed with accounts of many sub-groups who stubbornly defend their proper to refuse a COVID vaccine, however the majority of these within the U.S. who stay unvaccinated belong to communities which were unable to entry a vaccine because of problem navigating on-line appointment scheduling, lack of ability to take day without work of labor, poorly translated informational sources, or being ineligible because of age restrictions or different medical contraindications. Common mask-wearing has been a crucial stopgap measure to guard these at-risk populations till the vast majority of Individuals are vaccinated. The CDC’s suggestion is due to this fact not solely untimely: it sends the message to people and different governmental entities alike that we don’t must care about our neighbors.
Along with slowing the unfold of COVID-19, masks are a visual signal of neighborhood solidarity and take the burden of fear off unvaccinated people and oldsters of unvaccinated children. In a nation the place primary an infection management rules have in some way turn into political, the CDC’s suggestion to determine a two-tiered method to public well being appears woefully misguided. Encouraging the third of Individuals who’ve been totally vaccinated to go maskless whereas encouraging those that stay to be vaccinated to masks up will complicate unvaccinated people’ efforts to guard themselves whereas out in public and at work or faculty— locations that everybody has a proper to entry no matter their vaccination standing. Additional, the sort of coverage suggestion by the CDC is more likely to be interpreted as blanket permission for all to discard their masks. In truth, simply days after the announcement, the Texas Governor banned faculties and governmental entities from mandating masks. He even went as far to implement fines on establishments that try to take action, kneecapping any collective motion to guard communities, faculties, and workplaces. The sort of coverage determination is the precise purpose that we’d like the CDC to make public well being suggestions utilizing a public well being framework, not an individualized, biomedical evaluation: public well being insurance policies should defend probably the most susceptible amongst us who haven’t but been vaccinated, or for whom the vaccination is probably not as efficient.
Much more troubling, this method facilities the nice fortune of the predominately white, well-educated, and rich communities who’ve had best entry to the vaccine to this point. This newest suggestion from the CDC is one more instance of the burden of the pandemic falling disproportionately on communities with the least energy to guard themselves. They’re now pressured to marvel if the unmasked individual of their checkout line or eating of their part has been vaccinated with little recourse to guard themselves if they’ve been unable to be vaccinated earlier than the CDC’s newest suggestion.
Many will say that carrying a masks and getting vaccinated are particular person selections and that we must always dwell and let dwell. We don’t search to argue with the significance of acquiring particular person consent for medical care– this can be a primary moral precept that every one healthcare suppliers perceive and honor. However our code of ethics additionally calls for that we consider the larger good. Not like nurses, infectious ailments don’t respect the bounds of particular person autonomy. That is why we’d like public well being leaders who use their energy to determine norms that emphasize the well being and security of the entire neighborhood, with probably the most susceptible serving as our widespread denominator somewhat than being tossed from the equation completely. The CDC has the authority, means, and, in our estimation, duty to set a unique tone about public well being practices: we put on masks to guard and respect one another, not simply ourselves.
So the place does this go away us? The CDC might rescind the advice, thus inflicting additional confusion and frustration. However, as with the proverbial can of worms, this new steering won’t be simply re-bottled. As an alternative, Individuals should select to proceed to masks up till extra are vaccinated. We as nurses can use our affect as trusted suppliers to set an instance by masking up and inspiring our sufferers to do the identical. Lastly, the Biden administration should conduct an in-depth analysis of our public well being response to the pandemic, together with what proof has been used to make suggestions and the way such selections are being communicated to the general public. When contemplating pandemic policymaking, it’s crucial that we observe the entire science–not simply the science that provides us efficient vaccines. This consists of the science of particular person and collective conduct and the science of danger communication. We should emerge from the pandemic with a strong, fully-funded public well being infrastructure able to performing its important duties, together with selling— somewhat than minimizing— our interconnectedness as the best way by means of a collective disaster.
Karen Johnson, PhD, RN, FSAHM, FAAN and Whitney Thurman, PhD, RN are public well being nurses and college members on the College of Texas at Austin College of Nursing.