MADISON (WKOW) -- Tuesday became another turning point in the fight against COVID-19 -- though this time, it was a turn backwards due to the enormous threat of the aggressive Delta variant.
Mask guidance mutates with virus
With new COVID-19 cases rising in every state -- and new research showing that in rare cases, vaccinated people can spread the Delta variant to unvaccinated people -- the Centers for Disease Control and Prevention changed its guidance on masks. The agency now recommends everyone in areas with high virus transmission should wear masks inside again -- whether they've been vaccinated or not.
"The Delta variant is showing every day its willingness to outsmart us and to be an opportunist in areas where we have not shown a fortified response against it," said CDC director Rochelle Walensky.
That began the domino effect to municipalities across the nation, including in Dane County, where hours after the CDC announcement, health officials were "strongly advising" anyone over the age of 2, whether vaccinated or not, wear a mask indoors.
"The Delta variant is spreading rapidly in our county and could increase severe outcomes in our country if left unchecked," said health director Janel Heinrich.
UW Health's Dr. Jeff Pothof says that new research shows how alarmingly that Delta variant spreads.
"We have studies that show in folks unvaccinated, their viral load can be 1,000 times greater than what we saw with normal COVID," he said.
Dr. Pothof says those numbers come from samples taken from deep within the nose of someone infected with the Delta variant. He says they performed the same tests on the initial strains of the virus previously.
"And the answer to that came back no, they don't have enough virus in the back of their nose where they would be a threat to anyone else," Dr. Pothof said. "And unfortunately, that's not holding true with the Delta variant."
Dr. Pothof says the risk to the unvaccinated becomes quite high if you're somewhere where there's high virus transmission and low vaccination rates.
"In that scenario, not only should the unvaccinated be masked up, but we probably have to mask up the vaccinated people so that they can't harm the unvaccinated," he said.
But those masks, in this instance, are more than just protecting the unvaccinated, according to Dr. Pothof.
"'Why should I go out of my way to protect you?' It would be nice if life was that simple, but it's not," Dr. Pothof said. "Because every time we allow this virus to replicate, especially the Delta variant, in vaccinated and more likely unvaccinated people, we give that virus a chance to mutate and create a variant that defeats all our immunities."
Dr. Pothof says that could lead to viruses that eventually are resistant to vaccines.
"Boy, that would just really ruin your day," he said.
Dane County guidance errs on the side of caution
27 News spoke to Dr. Jeff Pothof before Dane County issued its mask guidance.
In Dane County, 70 percent of all people have received at least one dose of a coronavirus shot -- one of the highest vaccination rates of any county in the country. Dr. Pothof's interpretation of the CDC mask guidance was such that areas where there were vaccination rates much lower, in the 30-45 percent range, should be the ones who need to mask up to prevent this type of spread.
"The important thing from the CDC recommendation today is this is not a carte blanche recommendation," he said. "Not every vaccinated person needs to be wearing a mask in indoor spaces. It is really based on where you live, what cases are doing in your area, and how many of you in your community are already vaccinated."
So with Dane County's vaccination rate far higher than would need to be concerned, we must look at what the cases are doing in our area.
According to the CDC, Dane County has a "moderate" level of community transmission. The CDC's new guidance was for masks to be worn in areas where there is a "substantial" or "high" level of community transmission.
Dane County health officials, including Heinrich, are standing by their decision to issue an indoor mask recommendation early.
"We're watching those numbers grow fairly quickly in this community," Heinrich said. "We'd like to prevent getting to an area of higher transmission."
Dane County Executive Joe Parisi emphasized that the new recommendation is just an advisory.
"It's not a mandate," he said. "But we're hoping that people will heed this advisory. And we know that people in Dane County, in our region, have heeded this in the past. This is the way we prevent further mandates is by people voluntarily stepping forward, whether it's individuals or businesses who would like to require masking in their establishments."
During a virtual press conference Tuesday, Dane County leaders were asked if a mask mandate would come back in the event that our COVID-19 situation gets significantly worse.
"I think we would love to not have to do that," Heinrich said. "We've done it in the past. We are very committed to using all the tools in our toolbox. But let's, let's not get there."
Schools take center stage, as new spreading mechanism emphasizes importance of masks
Both the new guidance from the CDC and Public Health Madison & Dane County emphasize the need for everyone in schools, regardless of whether they are vaccinated, to remain masked.
"Similar to the CDC, we are strongly recommending that all schools universally mask inside," Heinrich said. "We've been working and talking with our schools here locally and will continue to support them and making the decisions that they need to do to keep our kids safe, and our school community safe in those environments."
Last week, MMSD announced all students will be required to wear masks indoors this fall.
With the new research showing the fully-vaccinated people can now spread the Delta variant, Dr. Pothof says it's even more important that there is extra caution to make sure that those kids under 12 don't catch the virus -- since there's not yet a vaccine approved for them.
Even for kids over 12, however, he says the masks remain a good idea.
"Looking at vaccination rates between you know that 12-15, 12-18 range group, we're seeing some good variability here in Dane County," he said. "I think we're in the 60 percent range. But you know, you move up just a little bit to the right to Dodge County, they're not at 20% yet. So it's hard to say that folks in the 12 to 15 age range can have optional masking when only one in five at most has received the vaccine."
Data from the Wisconsin Department of Health Services shows that statewide, only around 32 percent of kids 12-15 have had at least one shot, and 42 percent of 16-17-year-olds have had one shot.
Keeping track of all the changes, and continuing to trust the science
If you're unvaccinated, you should have never taken off your mask. But if you are vaccinated -- and confused or even angry about all the changes -- it's understandable.
"We're really being asked to develop a change tolerance," said UW Health Psychologist Dr. Shilagh Mirgain.
27 News spoke to Dr. Mirgain back in May when the mask mandate was set to expire in Dane County. Back then, we talked about "no-mask anxiety" and the fears some people might have taking off their masks after having them on for so long.
Now, that anxiety may be entering a new stage.
Dr. Mirgain describes a psychological cycle that develops during pandemics, as evidenced by new research.
"After the initial impact -- the kind of 'heroism' phase where we celebrated the health care workers, first responders -- then we got to a honeymoon phase that I think happened when the vaccine rolled out," she said. "People were getting vaccinated, cases were going down, warmer weather happened, things were opening up and we felt like we're on the other side of this pandemic."
Dr. Mirgain said that's not where the cycle actually ends.
"There's actually another phase that happens before that 'new beginning' and reconstruction, and that has a phase called, 'Dissolution," she said. "And we're in that phase now."
In that phase, Dr. Mirgain says it's important for people to prioritize self-care, but also to continue to trust in the science.
For those in public health, she says the onus is on incredibly clear messaging that explains very specifically why each recommendation is being made based on the available evidence.
"That there's just clear and consistent messaging and the rationale behind it," she explained. "That there is a science behind the change."
Moving forward after moving backwards
While these new recommendations are certainly a step back, Dr. Pothof says they're not surprising.
"These kinds of recommendations will slide around as we see increases in cases, variants and different rates of vaccination versus cases," he said.
Dr. Pothof says he doesn't expect the move backward to degrade confidence in the vaccine necessarily, but it could increase vaccine hesitancy.
"Because people are like, 'Well, if I don't get to do whatever I want if I get a vaccine, maybe I'm not so interested in getting it,'" he said.
Dr. Pothof says that is certainly the wrong mindset.
"It's a little bit short sighted in the sense that the big benefit of the vaccine is that I don't have to admit you to the hospital," he said. "If you get COVID, you're not going to die of COVID. That's the 'money-money' when it comes to vaccine."