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To mask or not? Cook County’s medical expert weighs in on Lollapalooza, school and travel amid conflicting health guidelines as COVID cases rise.

Wednesday, July 21, 2021
Chicago Tribune

The decision to mask or go without has become increasingly confusing, as various government authorities offer conflicting COVID-19 pandemic guidelines and recommendations for the fully vaccinated.

Yet despite rising case counts, it remains pretty safe for most fully vaccinated people in the Chicago area to continue to go maskless in the majority of settings, said Dr. Rachel Rubin, co-lead of the Cook County Department of Public Health.


“What that means is if you’ve been vaccinated, generally, you’re good to go in terms of not having to wear a mask, except for certain circumstances,” she said, adding that this follows Centers for Disease Control and Prevention guidelines for those who’ve been fully inoculated against COVID-19.


She noted that some of those exceptions include settings like airports, buses, train terminals, nursing homes and crowded events, including those that are outdoors. Those at high-risk for the virus or underlying medical conditions might also need to continue masking even if they’ve been inoculated.

And anyone who is not fully vaccinated should keep wearing a mask, she added.

While cases have been increasing in the Chicago area, the level of community spread is still quite low compared with other points in the pandemic, Rubin said.


The most recent test positivity rate in Cook County was just over 1%, and Chicago’s was a little higher at 1.6%, according to state and city statistics.

If community spread seems to increase and cases surge, local officials might decide to either mandate or strongly urge masks indoors regardless of vaccination status, similar to some other states and cities in the nation, Rubin said.

Chicago officials earlier this week also warned that more COVID-19 restrictions might be on the horizon if cases surge.

“The next step might be that instead of making masks optional inside, making them required or highly recommended when inside,” Rubin said. “But we’re not at that point yet, because our new cases levels are still quite low, even though they are creeping up.”

Los Angeles County last week reinstated its mask mandate, hoping to reverse a recent spike in COVID-19 cases. San Francisco Bay Area health officials around the same time recommended residents mask indoors, regardless of their vaccination status.

Medical experts have become increasingly divided on masking guidelines for those who have been fully vaccinated, leaving many unsure about whether to wear a face covering or go without in various settings.

The World Health Organization in late June urged those fully vaccinated to continue masking as the highly infectious delta variant spread internationally. So far, just over 400 cases of the delta variant have been identified in Illinois, according to state health department data.

Yet local health officials have responded that wearing a mask isn’t necessary for most people who have been immunized given the low positivity rate and case counts in the Chicago area; the city and state continued to follow CDC guidance allowing the fully vaccinated to go maskless.

Former U.S. Surgeon General Jerome Adams on Twitter recently implored the CDC to revise its masking guidelines.

He recalled — and lamented — the nation’s misguided recommendations against widespread masking at the beginning of the pandemic.

“Instead of vax it OR mask it, the emerging data suggests CDC should be advising to vax it AND mask it in areas with (rising) cases and positivity — until we see numbers going back down again,” he tweeted.

The nation’s largest union of nurses also recently implored the CDC to reinstate its mask recommendations for everyone when in public or in proximity to others outside their household.

“The pandemic is not over, and the United States once again stands on the precipice of rising cases,” National Nurses United said in a July 12 letter to the CDC. “NNU strongly urges that the CDC strengthen and improve its guidance to protect nurses, our patients, and the public.”

The debate comes as Chicago prepares to host Lollapalooza at Grant Park later this month.

A large crowd walks away from the Bud Light stage after Migos' set ended on the first day of Lollapalooza in Chicago's Grant Park on Aug. 3, 2017.
A large crowd walks away from the Bud Light stage after Migos' set ended on the first day of Lollapalooza in Chicago's Grant Park on Aug. 3, 2017. (Alexandra Wimley/Chicago Tribune)

While Rubin said the four-day music festival isn’t under her jurisdiction, she would advise anyone attending to wear a mask while in a crowd or packed area, regardless of vaccination status.

“Am I going against the guidance if I take my mask off?” she said. “Probably not.”

But she noted that the CDC does recommend masking in crowded public spaces, which might include outdoor venues as well. She said this advice goes for any large event or crowded concert.

“Even in an outdoor concert, where I might be standing like sardines in a crowd, I might put my mask on, because that’s the safest thing to do,” she said.

Although large-scale public events of this kind are higher-risk, she noted that an attendee might be safer at Lollapalooza than many other public venues because attendance at the music festival has been so restricted: A printed copy of a vaccination card or a negative COVID-19 test within 72 hours is required for admittance; those who have not been vaccinated are told to wear a mask while on-site, according to the event’s entry requirements.

Similar confusion is burgeoning over school guidance as back-to-school season approaches, spurring anxiety for some educators and parents.

While the CDC earlier this month said masks aren’t necessary for vaccinated students and staff, the American Academy of Pediatrics offered conflicting recommendations this week, saying everyone over the age of 2 should wear a mask regardless of vaccination status.

Some local suburban districts have said they’re leaving the decision up to parents — even in the case of unvaccinated students, contrary to public health recommendations.

Rubin stressed that masks should generally be worn in schools unless everyone is vaccinated; some exceptions might be universities and colleges where the shots are mandated for attendance.

Another area that’s become increasingly tricky is travel, with cases rising in other parts of the country. Chicago’s travel advisory was recently expanded to include Florida, Arkansas, Missouri, Nevada, Louisiana and the U.S. Virgin Islands.

Rubin advised those who haven’t been vaccinated to avoid COVID-19 hot spots entirely; those who have been vaccinated and have unavoidable travel to places with surging case counts should take precautions, including masking in public.

One Chicago registered nurse who coordinates COVID-19 testing said she’s found different masking recommendations from various agencies to be confusing. Even she and her colleagues have gone back in forth about whether to mask in certain settings, although they’re fully vaccinated.

“I always err on the side of caution,” she said. “Everyone who is unvaccinated should be wearing one, but I think that’s a pipe dream.”


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