CDC eases mask recommendations, other restrictions, for most Americans

The new guidelines, which took effect Friday, reflect the administration’s view that the United States has entered a different, potentially less dangerous phase of the pandemic. The change follows a relaxation of restrictions by most Democratic governors responding to nosediving case counts and public pressure. CDC officials said the shift reflects the reality that after more than two years of living with the virus, most communities have greater protection against severe disease because of widespread immunity gained from both vaccinations and infections, as well as the increased availability of treatments, testing and higher-quality masks.

Officials said the guidelines will not immediately affect mask orders on public transportation. Americans will still be required to wear face coverings on buses, trains and planes until a decision is made closer to March 18, when the order is set to expire.

But schools are included in public settings where masking and testing may not be necessary if the covid-19 disease risk is low based on the new metrics.

CDC Director Rochelle Walensky said the new guidelines, which classify the country into low, medium and high levels of disease, provide individuals with an understanding of what precautions they should consider based on the level of disease in their community, their underlying risk, and their own risk tolerance.

She stressed the new approach could be dialed up or down if an unpredictable virus should pose new challenges.

None of us knows what the future may hold for us and for this virus,” she said. “We need to be prepared and ready for whatever comes next. We want to give people a break from things like mask-wearing, when levels are low, and then have the ability to reach for them again, should things get worse in the future.”

The new approach is expected to be less disruptive to daily life at a time when cases and hospitalizations across the United States have plummeted, with the seven-day average of newly reported cases now near 70,000 a day, the lowest since late October and a drop of more than 85 percent from the end of January. Hospitalizations have dropped by nearly two-thirds, with under 55,000 covid patients.

The framework incorporates new metrics such as the number of new hospital admissions with covid-19, and the number of hospitalized covid-19 patients, as well as case counts, to assess levels of covid-19 disease in every county. Instead of focusing on eliminating transmission of the virus, it is aimed at preventing hospitals and health-care systems from being overwhelmed and protecting people at high risk for severe illness, officials said.

Under the approach, many parts of the country that were previously considered to have high or substantial levels of the virus are now reclassified as having low to medium levels of covid-19 disease.

People in communities with high levels of disease, including schools, are still urged to wear masks in indoor public places — but there are far fewer of them.

In communities with medium levels of disease, the guidance recommends that those at high risk for illness — including those who are immunocompromised or have underlying medical conditions — consult with their health-care providers and consider wearing masks.

In communities with low levels of disease, high-risk individuals can consult with their providers and wear masks as needed.

Regardless of the level of disease in a community, “people may choose to wear a mask at anytime, based on personal preference,” said Greta Massetti, a CDC official leading the agency’s covid response.

It’s also important for people to always wear a mask if they have symptoms, if they have tested positive, or if they have been exposed to someone with covid-19, officials said.

The country’s two large teachers unions welcomed the new guidance recommending universal masking in schools located in communities with high levels of disease, saying it was based on science, not politics — a swipe at those who argued mask requirements should be lifted because the public was tired of them. The American Federation of Teachers and the National Education Association had asked the CDC for metrics to guide the lifting of mask mandates.

NEA President Becky Pringle said she was optimistic that the virus was in retreat but said schools should be ready to reverse policies if the situation worsens again.

“School districts should act cautiously in response to today’s announcement, with the health and safety of students, educators, and their families always in mind,” she said in a statement.

The updated metrics change the U.S. map from what was almost exclusively red and orange — signifying substantial or high transmission risk — to one that will show green, yellow and orange, signifying states and counties with low, medium and high levels of disease. With omicron cases continuing to drop sharply, officials expect fewer communities to be facing high levels of covid-19 in the weeks ahead.

CDC had previously recommended masking in areas with substantial or high transmission, a category that applied to about 98 percent of counties, representing about 327 million people. Only 91,000 people were in low transmission level areas.

Under the new standards, only about 28 percent of people live in high-level disease areas, with 240 million living in medium and low areas.

Case counts provide a partial picture of the virus’s reach. But the number of hospitalized covid patients reflects the disease’s impact on a community — and its ability to respond to other emergencies. If hospitals or emergency rooms are filled with covid patients, people seeking treatment for heart attacks and strokes may have care delayed or even denied.

While not saying so explicitly, the new guidance provides a framework for living safely with a virus that is expected to remain at endemic levels for the foreseeable future — a goal that was out of reach for most of the last two years amid recurring surges and the arrival new variants when far fewer people had gained immunity from vaccinations or infections.

Using metrics that measure the burden of disease in a community can better identify places where surges in ICU admissions and deaths may overwhelm hospitals. CDC officials said communities can also use additional metrics, such as wastewater surveillance, to provide more tailored information.

Although surveillance of virus levels in wastewater can be an early warning sign for covid-19, CDC’s current system does not yet cover every U.S. county.

While some experts and average Americans have criticized the CDC for being too slow to update guidance, many public health experts have expressed uncertainty about what comes next. They worry that political pressure to return to normalcy will heighten risks for the immunocompromised, elderly and young children not yet eligible for vaccines.

State health officials applauded the framework, saying they wanted better barometers of covid’s impact in their communities.

The new metrics are “a timely step in the right direction,” said Nirav Shah, president of the Association of State and Territorial Health Officials and director of Maine’s Center for Disease Control and Prevention.

A focus on hospitalization rates gives states a benchmark to better understand covid-19′s medical severity and its impact on the health-care system, he said in a statement. It also recognizes the declining importance of daily cases, given the wider use of at-home tests, he said.

Several officials noted that while case counts and hospitalizations are declining, but they are still at elevated levels. They also expressed concern that less than two-thirds of Americans are fully vaccinated, defined as two doses of Pfizer-BioNTech or Moderna or one dose of Johnson & Johnson. Only about half of Americans have received a booster dose, which provides the highest level of protection against infection, hospitalization and death.

The federal government’s messaging about masks has drawn criticism since the pandemic began. The Trump White House delayed initial guidance on wearing masks in April 2020 to preserve enough of the higher-quality N95 masks for front-line health-care workers. Some political advisers also worried that widespread mask use might cause panic. The CDC reversed itself one year later recommending nearly universal masking but many Republican officials pushed back on the advice and declined to mandate the practice.

Laura Meckler and Jacqueline Dupree contributed to this report.

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