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Perspective on the changing CDC guidance

Doctors in Colorado know that CDC guidance on masking has confused a lot of people.

DENVER — Doctors in Colorado know the changing mask guidance from the Centers for Disease Control and Prevention (CDC) has confused people, so they answered some of our questions about the science and what habits people should change.

What is the driving force behind the changes?

Dr. Comilla Sasson, an emergency room doctor with Kaiser Permanente who's treated COVID patients across the country, acknowledged that people have a lot of questions. 

"CDC guidance was really confusing for a lot of folks," she said. "In May, we very strongly said, 'look, if you are vaccinated you don't have to wear a mask anymore.' Now all of a sudden, what we're starting to do is we have the delta variant, which is a game-changer."

When it comes to vulnerable populations, including those with cancer, lupus or who have had transplants, doctors have cautioned them to keep following COVID precautions the entire time. This is because some people who are immunocompromised don't have as robust of a response to the vaccines as those with an intact immune system. 

"We've been aware of the risks before the CDC came out with the recommendations," said Dr. Peter McSweeney, a primary transplant physician with the Colorado Blood Cancer Institute. 

Now doctors are reinforcing that COVID precautions, including masking, are particularly important with the delta variant circulating and as the vaccination process continues. 

"Higher vaccination levels in the community are safer for the immunocompromised patients," said McSweeney. "It's as simple as that."

What do we know about breakthrough cases and transmission?

This is another area where doctors say science is evolving.

"Now -- starting to change guidance even if you are vaccinated, you should get tested if your symptomatic and tested if you are exposed," said Sasson. "That's different for a lot of people. A lot of folks saying this doesn't make sense. The reason is now we're seeing more data that virus can live in noses and be potentially contagious, as well."

She said, at this point, it's not clear if the viral load varies in these situations between asymptomatic and symptomatic cases. 

"We don't know yet," said Sasson. "That's where it's really hard." 

"Intuitively, it's more likely if you have symptoms more likely to spread it to others," added Dr. Amy Duckro, the lead infectious disease specialist with Kaiser Permanente. 

What is the recommendation?

Duckro said the new indoor masking guidance applies to the community at large. 

"The risk we see -- if the virus is not contained, if people are not vaccinated and if not following public health measures, then the virus continues to be present... Inevitably it mutates -- the Delta variant will not be the last stop for us," she said.

"In the past, it was a blanket 'got your vaccination, let's do it, we can hang out again,'" said Sasson. "I think what we're saying now is we need to be a little more cautious. You're vaccinated and I'm vaccinated, but maybe we still need to wear masks in poorly ventilated indoor spaces. We may have to wear masks when we go out to see friends we haven't seen a long time, but we are in an area with there's a lot of community spread." 

 "It's wearing a mask," she added. "It's still getting to do things you want to do. See people you want to see. We just have to be careful again."

The doctors said a priority is to get more unvaccinated folks vaccinated. They also said their understanding of the vaccines still stands -- that it prevents a high percentage of people from getting the virus, and importantly, from getting so sick they have to be hospitalized and die from COVID. However, the vaccines are not a hundred percent. 

The doctors we talked to Thursday also said that a majority of patients being admitted to their hospitals are unvaccinated. 

The state health department shared: 

"Science shows that vaccines are safe and still very effective against preventing infections, and even more importantly at preventing the worst outcomes for those who do get infected, even infection from the delta variant. Because of the vaccine effectiveness and because over 70% of adults in Colorado have been vaccinated, we are in a much better place than the deadly fall wave from last year. Despite all this progress, this is a novel virus and we are still learning new information every day about its ability to change. The CDC announced it has new information about how the delta variant spreads; we have requested a  briefing on the science behind their guidance changes.  In the meantime, we are updating our public health order for our most vulnerable population in long term care facilities to follow CDC guidance."

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