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Do you have to stop using the mask? Dr. Leana Wen explains

Who can stop using a mask? 1:04

(CNN) – Can you stop using the mask or not? The U.S. Centers for Disease Control and Prevention (CDC) released new guidelines on May 13 that fully vaccinated people can stop wearing the masks in almost all settings.

Not so fast. Many people are deciding for themselves which environments they feel comfortable taking off. What if you have small children at home? What if you have an underlying medical condition that results in you being immunosuppressed? What if you still don’t feel comfortable doing it? Are there situations where you would still use a double mask?

We turned to CNN Medical Analyst Dr. Leana Wen for her advice. Wen is an emergency room physician and visiting professor of health policy and management at the Milken Institute School of Public Health at George Washington University. She is also the author of the upcoming book “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Could you explain the new CDC guidelines on mask use?

Dr. Leana Wen: The new CDC guidelines say that if you are fully vaccinated, which means it has been two weeks since your second dose of the Pfizer-BioNTech or Moderna vaccine, or since your one-dose Johnson & Johnson vaccine, you do not need to use a mask in most settings.

There are a few exceptions – you must still wear a mask on airplanes, trains, hospitals, nursing homes, and if a business requires it. The guidelines are also governed by state and local laws, so there will be some variations. My state of Maryland has removed the indoor mask mandates, but where I live, in Baltimore, we still have these mandates in effect.

To be clear, these guidelines do not apply to people who are not vaccinated. They should still have their masks on. That guide is to protect themselves, as those who are not vaccinated are still at high risk of contracting COVID-19. It is also to protect those around them, especially those who are also not vaccinated and therefore at risk.

CNN: If someone is vaccinated, do they have to stop wearing a mask?

Wen: No. Just because you can do it now doesn’t mean you have to. It is a personal decision and everyone must figure out what is best for them.

There are some vaccinated people who still need to take precautions and keep their masks on. This is particularly true for those with severe immunosuppression. If you are a transplant patient taking immunosuppressive drugs or have cancer and are undergoing chemotherapy, you should still keep your mask on and keep your distance in public places where people around you might be unvaccinated and unmasked.

People with other forms of immunosuppression should consult with their doctor. For example, patients on dialysis or who have lupus or rheumatoid arthritis and are taking milder immunosuppressive medications may also need to take extra precautions.

Others may be generally healthy, but still want to take extra precautions. It’s okay. You must proceed at your own pace. The vaccine protects you very well from contracting covid-19 and from spreading it to other people, but not 100%.

If the small possibility is something you are concerned about, you could continue to wear masks in higher risk settings.

CNN: How do you think about where you go based on risk? For example, how about going to the supermarket instead of going to a restaurant or gym?

Wen: Any outdoor activity will be safer than the equivalent indoor activity. If you are vaccinated and you are outdoors, it will be very safe. If you are thinking of taking your mask off with other people, I think this is the first area to do it. When you go for a walk or have a picnic in the park, you can remove the mask.

Another very safe environment is that of other people who you know are fully vaccinated. A dinner with vaccinated friends or sharing a workspace with other people who you also trust have been vaccinated, are good places to remove your mask and enjoy the company of others as you did before the pandemic.

If there is a company that is checking the vaccination in some way, for example some gyms and sports venues are doing it, it is also safer than if the vaccination status is not checked.

There will be an increased risk in indoor settings with people who may not be vaccinated. Again, the risk to you is much lower now that you are vaccinated. The level of risk depends on the environment and the community transmission rate.

Any environment where you are in crowds and cannot physically distance yourself is at increased risk, and if your community remains a hotspot, that also increases the risk. This is why some vaccinated people may still decide to keep wearing a mask in, say, a supermarket where there are many people around them, but they are fine taking off their mask to eat in a restaurant where there is good space between tables.

They may decide to remove the mask when they are in the gym on a treadmill and no one is around them, but they may not want to be in an indoor exercise class with lots of gasping people, no mask and no vaccines. These are personal decisions that people must make based on their own tolerance for risk.

CNN: Are there circumstances in which vaccinated people still need to wear a double mask?

Wen: Again, this is up to you and your tolerance for risk. Previously, the double mask was due to the fact that all the tools we had to avoid contracting covid-19 were the masks and the distancing. Now we also have the vaccines. For most routine settings, such as supermarkets, you might consider swapping out the N95 or KN95 for a normal cloth or surgical mask, and if you were using a double mask, switch to a single mask.

This is really a personal decision. Some people do not find wearing a double mask or an N95 or KN95 uncomfortable and may wish to continue to do so. That may be advisable in some cases, especially if they have an underlying medical condition that causes immunosuppression. Others found this type of mask wearing uncomfortable and may switch to a more comfortable single layer mask.

CNN: What about transportation? Should people wear masks on buses, planes, and trains? What should they do if someone around them does not wear a mask?

Wen: Yes, people should wear masks on public transport, airplanes and trains because this is still the law and is required. If someone is not wearing their mask in this environment, they are going against the law. If you feel uncomfortable, you can approach someone in charge for help or move away from the person who is not wearing a mask.

How and where to stop wearing a mask in the USA? 2:23

CNN: What about those who live with unvaccinated children or immunosuppressed people? Should they keep wearing masks?

Wen: That depends on your tolerance for risk. The probability that you, as a vaccinated person, will contract COVID-19 and transmit it to other people is very low, but it is not zero. Some may decide that very low risk is enough to return to pre-pandemic normality and not wear masks. Others may decide that a mask is not a huge inconvenience and still continue to use it in some settings.

For my family, with 1 and 3 year old children, my husband and I no longer wear masks in outdoor settings or indoors with other vaccinated people. But we will wear masks if we are in the supermarket, in church and in other places where there are potentially unvaccinated people without a mask. That is a personal decision that works for us and our tolerance for risk; others will make different decisions.

CNN: Let’s say you have young children or immunosuppressed people at home. Should everyone who visits you wear masks?

Wen: If people who come to visit young children are fully vaccinated, they are at very low risk. If you want to be absolutely sure, being outdoors is definitely the safest thing to do, but it’s probably still very safe to be indoors together, without masks. My husband and I are being very cautious, but even we thought this would be a low enough risk for us. If visitors are not vaccinated, they should see the other unvaccinated people only outdoors, or if they are indoors, with a mask and distancing.

The immunosuppressed person should consult their doctor, as I mentioned above, to find out what their risk is based on their medical condition and therefore how much precaution they should take.

CNN: What if someone wants to keep their mask on to show those around them that they care?

Wen: Some people may choose to do that, especially if they are indoors with a lot of people. We are in an in-between period, where the rules and regulations are changing rapidly. The bottom line is that people should do what is comfortable for them.

Decide, as a home and family, what level of risk you would like to take. Start removing the mask in some settings that you are most comfortable with and see how you feel. At this point in the pandemic, a lot is about personal decisions and your personal tolerance for risk.

Kobo Elipsa, for reading and writing

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