CDC’s Mask Guidance Confuses Even The Experts

Don’t wear a mask. Wear a mask. In fact, wear two masks. Now take your masks off (once you get your shots). Keep the mask on, though, if you’re in stores — well, some of them.

The CDC’s latest change in guidelines, announcing that vaccinated people can stop wearing masks in most places, has governors complaining, scientists unhappy, and people confused.

Rochelle Walensky, director of the CDC, has defended the new guidelines, saying the agency was simply “following the science.” The goal, she said, was to clearly declare that vaccines were effective and, amid declining vaccination rates, convince more people to get their shots.

But health communication experts who spoke with BuzzFeed News said that, even armed with new data, the way the CDC announced the change went against everything that’s known about how to clearly inform the public. Governors, and even the White House, were given little advance notice to prepare for a change that left store owners, parents of unvaccinated kids, and people with compromised immune systems relying on the honesty of strangers to tell who is vaccinated or not. In response, some states have ignored the guidelines, setting their own benchmarks to relax masking requirements.

Still recovering from its reputation for political interference under the Trump administration, and continuing to battle rampant misinformation about COVID-19, the CDC abruptly releasing the new guidelines undercut public confidence not only in masks but in public health advice overall, the experts warned.

“It’s not simple. There’s not just one way to send public health messages — but there are better ways than this,” said health communication expert Elisia Cohen of the University of Minnesota.

For starters, the shift in CDC guidance came without the warm-up that the public needs to understand changes in public health advisories. News of the change was delivered during three minutes of one of the White House’s twice-weekly COVID-19 updates. Walensky ran through results from two new studies showing vaccines were effective against variants and then announced the change: “Anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physical distancing.”

One problem: The public, unlike the CDC, is not aware of each incremental update in the science, said Rebekah Nagler, also a health communication scholar at the University of Minnesota. “The public may struggle to reconcile and make sense of seemingly conflicting research findings, or seemingly ever-shifting advice, but an organization like CDC does not anticipate that,” said Nagler. “I think in this case it just doesn’t think about what people were thinking about.”

Sudden switches in advice simply cross people’s wires without warning, said Matthew Seeger, a health and risk communication scholar at Wayne State University. You have to lay the ground carefully before you change guidance so people can understand where it is coming from.

“We spent a year trying very hard to get people to wear masks,” Seeger said. “This kind of sudden, abrupt change, without any kind of signaling that it’s coming, will leave people feeling blindsided.”

Another oversight was that the guidance was aimed at vaccinated people — but unvaccinated people could leave with the same takeaway. Population-specific recommendations might work for the agency’s announcements aimed at medical professionals, Cohen said, “but changes in [pandemic] guidance are going to be viewed by everyone, vaccinated or not, and they are going to be asking, ‘What does it mean for me?’” People who feel like their situation isn’t addressed, like bar owners or parents of unvaccinated children, may end up feeling slighted.

The CDC’s change in tone was also jarring because it went from a past focus on protecting others to a new focus on personal freedom, Cohen said. “There were no cues as to what everyone else should do or what our responsibilities are to others.”

In general, people process health guidance as a story they are telling themselves about their lives, she added, not as a cost-benefit calculation based on the latest studies or case numbers.

“When you have a source that gives you conflicting information or that changes guidance over time, it makes it more difficult for you to be relied upon as a trustworthy source,” Cohen said. “People say, ‘I have trouble keeping the story straight.’” The real concern is that rather than going to their doctor to resolve the confusion, people might just tune out health advice altogether.

Lawmakers raised this concern with Walensky on Wednesday morning during her Senate testimony on the CDC budget. “There’s just too much coming at you for families to be able to think, number one, that their child is safe,” said Sen. Shelley Moore Capito of West Virginia, adding that the guidance could inadvertently cause more people to ignore calls to get the vaccine.

Confronted with this confusion, governors have set hard dates, like June 15 for California, or hard numbers, like a 70% vaccinated population in Washington state, as a threshold for relaxing restrictions. New York, which changed its guidance to match the CDC’s, is requiring proof of vaccination for people in some venues.

And some state officials — including New York Gov. Andrew Cuomo and California Gov. Gavin Newsom — have even suggested that the CDC’s change led to an immediate decline in overall vaccinations.

In public comments, Walensky has stuck to saying the agency puts science first to come up with guidance. But the CDC may be right on the science and still wrong on the communication, said Cynthia Baur, a health literacy researcher at the University of Maryland School of Public Health and a 20-year veteran of federal health agencies, including the CDC. Normally, new guidance is extensively cross-checked with other agencies (such as the Occupational Safety and Health Administration, which is working on mask guidance for businesses) and states to make sure messages work, she said, not just dispensed without consultation at briefings.

“Even if the White House is providing more space for CDC’s independence, it’s hard to believe such an important set of scientific recommendations with major policy implications didn’t get review and clearance at other agencies,” Baur said. “Both the White House and CDC have experienced communication professionals, at least some of whom would have anticipated blowback and advised against the way CDC handled the announcement.”

The move is especially confusing, Seeger said, because the agency’s own guidance, some of which he helped write, has repeatedly stressed the importance of shaping health messages as policies are made, not coming up with a policy first and the public communications afterward.

“One thing I will say is CDC’s credibility has been damaged here, which is a very sad thing to say and I say it very reluctantly. But their ability to be persuasive has been reduced,” Seeger said. “This felt abrupt and not fully grounded in the reality that many people experience.”