Mighty Well’s masking guidelines amid CDC confusion

by Ariela Paulsen
Mighty Well Co-Founders Yousef Emily Maria in Mighty Well Masks

CDC Director Dr. Rochelle Walensky announced drastic changes, yesterday, following criticism of the CDC’s response to the COVID-19 pandemic.  She acknowledged the vague and confusing guidance, as well as the recent overly-simplified recommendations that left out nuances necessary to keep our most vulnerable community members safe.  The CDC is also releasing, today, newly clarified recommendations.  We highly recommend you check them out here!

For those of us at Mighty Well, this acknowledgment of harm from the CDC carries significant weight.  We are a team of immunocompromised, chronically ill, disabled individuals and their loved ones.  We have felt the growing concern in our larger community of Friends in the Fight as the country became more confused and, frighteningly, more complacent in the face of a continuing pandemic.  

With this statement from the CDC comes the public acknowledgment of the complicated role the CDC plays.  We touched on this briefly in our blog “5 Things About COVID Anxiety That Patients Wish Friends, Family, and Colleagues Understood.”

In short: the CDC is a government agency.  Sure, it is tasked with some of the science behind pandemic response, but it is also trying to balance other factors such as the economy, supply chains, public education, and the overall wellbeing (happiness, income, freedoms, etc) of the country as a whole. 

CDC return to work guidelines

In addition to covering too many bases, the CDC is attempting harm reduction.  This is a practice of providing wiggle room instead of demanding perfection, with the understanding that people will not follow rules 100%, especially if they do not feel the expectations are reachable.  

The CDC offers guidelines but then considers what people are actually doing.  If a significant number of people are returning to work before their two-week quarantine is over, perhaps this rule is too unwieldy and should be changed to five days off, but returning with a mask.  By following the actual actions of the masses, the CDC hopes to encourage precautions that folks will actually take, rather than becoming an agency that everyone simply ignores.

An unfortunate number of these changes to policies have also been based on factors like the economy, rather than the realities of health and infectious disease.  As cynical as it may seem, the CDC does need to weigh these pieces when determining what will reduce the most overall harm to the country.  This can mean large-scale capitalism-preserving motivations, but also individual realities like working parents who don’t have childcare if their kid stays home from school, or people who can’t afford to take two unpaid weeks off from work.

immunocompromised and COVID

Finally, the CDC is weighing the risks for the general public, not individual needs.  They are not geared towards those of us with compromised immune systems, the more than 1 in 4 Americans who identify as living with a disability, or other risk factors.  For those who are young, healthy, and vaccinated, COVID may not pose much risk at the moment.  But actions we take outside of our private spaces can impact others who may not have this privilege of health and safety.  The new recommendations today begin to address this by offering nuanced differences based on a number of factors:

  • Vaccination status
  • Severity of symptoms 
  • Risk factors like compromised immune systems
  • Proximity to others who may be at risk due to age, immune status, or other disability

They also doubled down on the importance of vaccination and masking, that returning to work after exposure or illness is actually not ok unless wearing a high-quality mask.  (We recommend an N-95/KN-95 or medical mask under a well-fitted mask, per the CDC’s double-masking guidance).

guidelines, not mandates

We should also note here that the CDC recommendations are just that – recommendations.  They are not mandates, laws, rules, or even instructions for how every business, community, or individual should operate.  

Press Secretary Karine Jean-Pierre came under fire recently for stating that federal employees are required to stay home until a negative COVID test – in contrast to the CDC saying it’s ok to return after five days.  Yes, this may seem like hypocrisy, but it is also a reminder to workplaces around the US that they should be using their own judgment, based on science and their specific employees’ needs – not just general CDC recommendations – to inform their policies.  

We know that COVID can still be transmitted after five days.  Just because there are no mandates to stay home does not mean that businesses and individuals can’t still take precautions.  In addition to the new recommendations, the CDC is hoping to overhaul how they make scientific studies public.  Perhaps these changes will encourage individuals, businesses, schools, and other entities to understand the bare minimum recommendations, but also be informed about other measures they may want to take to protect their communities.  

Recommendations are helpful, but it is up to us to know the risks, have empathy for the different needs in our communities, and make informed decisions.

For example, the CDC’s previous recommendations for those who have had a direct exposure – that they can go about their business unless they test positive – was highly criticized as too lenient.  With this rule as a bare minimum, what do we know the risks might be?

  • Asymptomatic cases – someone may not think they have COVID because they feel fine
  • Lack of testing – people are no longer testing regularly as a screening tool, so they may not know they are positive
  • False negatives – rapid tests are increasingly less reliable as the virus mutates.  Someone may assume they have “just a cold” because they tested and it was negative, but could still have COVID.  This is especially common in the first day or two of symptoms, when the virus is active enough to be contagious, but not plentiful enough to show on a test

Given these risks, the CDC now recommends wearing a high-quality mask and testing five days after the exposure.  If that doesn’t feel safe enough, what other procedures could we create for ourselves?  We could ask folks to test daily for a week after exposure and stay home if they notice any symptoms.

we are not “post-COVID”

The reality is that COVID is not going away.  There will be new variants, waning immunity from shots, and the natural (sometimes unexplained) fluctuations and spikes.  Outside of COVID, there will be other diseases that come our way (looking at you, monkeypox!) as our climate changes and the world grapples with the effects of globalization.  Let’s decide now how we want to live in this world!  Happiness and financial stability are important.  Life must go on for the vast majority of citizens in our country.  We must be able to socialize, gather in person, earn a living, and otherwise care for ourselves and our loved ones.  Masks are wonderful, life-saving tools, but some people do find them restrictive, especially those with hearing impairment or neurodivergence (hence the importance of sensory-friendly masks).  

And yet… the rest of us, labeled as “high risk,” must also be able to live our lives.  We must be able to use public transportation without fearing for our lives.  We must have the option to work either remotely or safely in person.  Our nervous systems need a break from being on constant high alert as the only masked individuals in every space we enter.  Just as important, we need to feel that our very lives are valued by the people we encounter.  

Click here for what we wish our friends understood about COVID anxiety.

So, what can we do to balance these two often-competing needs?  Talk to one another, kindly, and communicate our needs!  We recommend you read the new CDC recommendations and then spend the time to create COVID guidelines at your workplace, home, school, or community.  Not sure where to start?

Here’s what we’ve come up with at Mighty Well:

1. Know the CDC guidelines for high-risk individuals and use them when in contact with people you know to be high-risk.

2. Wear a well-fitted mask in busy indoor spaces, especially around others who are masked. 

3. When possible, keep distanced or move outdoors.

4. Ask everyone to test before large indoor gatherings.

5. Test daily and mask for a week after direct exposures and stay home if any symptoms come up.  (Ask your doctor/insurance about getting free tests!)

6. If someone gets COVID, return to work after ten days, or after five days if symptom-free and testing negative.

7. Offer remote or mask-required options – for meetings, celebrations, transportation, etc.

8. Provide opportunities for individuals to express concerns if they do not feel safe. 

9. Prioritize mental health – America is struggling with more than just infectious disease.  People are suffering from depression, anxiety, addiction, and more.  Encourage self care throughout the day.  Offer coverage for counseling or a space for meditation and movement.

Whatever you choose, thank you for thinking through these challenging nuances.  We are Mightier Together!

Do you have a practice in your workplace, household, or community that you’ve found helpful?  We’d love to hear it!  Join the conversation on Facebook, Twitter, Instagram, or join our Friends in the Fight Facebook group.

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