CDC unveils new masking guidance based on community-level hospital capacity, severe infection risk

The Centers for Disease Control and Prevention (CDC) has pulled back the curtain on new pandemic masking guidance reflecting community-level risk of severe infection and hospital capacity rather than new cases alone.

The public health agency said it will begin publicly reporting “COVID-19 community level,” a metric that divides individual communities into categories of “low,” “medium” or “high” risk, online and over its informational hotline beginning Friday.

Under the new approach, the CDC will no longer be recommending universal public mask-wearing indoors or in schools for the majority of U.S. counties, the agency said.

“With widespread population immunity, the overall risk of severe disease is now generally lower,” CDC Director Rochelle Walensky, M.D., said during a Friday afternoon tele-briefing. “Now, as the virus continues to circulate in our communities, we must focus our metrics beyond just cases in the community and direct our efforts toward protecting people at high risk for severe illness and preventing COVID-19 from overwhelming our hospitals and healthcare system. This new framework moves beyond just looking at cases and test positivity to evaluate factors that reflect the severity of disease.”

COVID-19 community level ratings will be informed by the agency’s data on new COVID-19 hospitalizations, the fraction of hospital beds occupied by COVID-19 patients and the number of new cases in a community, agency leaders said.

Communities will enter higher risk categories when these numbers exceed specific thresholds CDC said have shown to predict when intensive care unit space, hospitalizations and deaths will spike in the next three to six weeks, Walensky said.

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This new model was developed using current and historical COVID-19 case and hospitalization data and has so far demonstrated reliable predictive capabilities, she said. Walensky said the CDC plans to update these COVID-19 community levels on a weekly basis “for the foreseeable future,” Walensky said.

In “low” communities, the CDC recommends the public receive a vaccine and seek testing if sick, Greta Massetti, Ph.D., branch chief of the Field Epidemiology and Prevention Branch and part of the agency’s COVID-19 Response Incident Management Team, said Friday.

At “medium,” the agency recommends that individuals who are at risk, such as those who are immunocompromised, talk to their doctor about whether they should be taking additional measures to protect themselves such as wearing masks.

In “high” communities, where there is a substantial risk of hospitals being overwhelmed, the CDC recommends that everyone wear a mask indoors while in public and that masks remain on in schools.  

Regardless of risk level, the CDC recommends all individuals go get tested if sick and seek out a vaccine unless instructed otherwise by a medical professional. Additionally, those who are at higher personal risk or those who live with someone at higher risk may want to consider protective measures regardless of risk level, CDC said.

Under the new model, 23% of U.S. counties would be classified as “low,” 39.6% as “medium” and 37.3% as “high,” Massetti said. These levels are trending downward, she said, as about half of counties would have been classified as “high” just last week.

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Alongside the increased levels of protection across communities and greater access to testing and treatments, Walensky said the CDC wanted to relax its recommendations to “give people a break” from masks when the risk is low. The increased flexibility of the new model also gives CDC the means to return to mask recommendations should things worsen in the future.

“None of us know what the future may hold for us and for this virus, and we need to be prepared and we need to be ready for whatever comes next,” she said. “We at CDC will continue to follow the science and epidemiology to make public health recommendations and guidance based on the data.”

Walensky and other public health figures have signaled the shift to looser restrictions over the past couple of weeks as case counts declined across the nation. Several governors and local leaders have also announced an end to restrictions surrounding masks and vaccines that have either gone into effect or are scheduled to do so in the near future.

In a statement, American Medical Association President Gerald Harmon, M.D., called attention to the millions of Americans who are at risk of severe COVID-19 outcomes or are too young to be eligible for vaccination. Although masks in public are no longer recommended for many Americans, he said that he personally will elect to continue masking and urged others to voluntarily do the same. 

“Wearing a mask, physical distancing and staying home if you’re sick are small, but important protective measures that can help us all stay safe," he said. "While the omicron surge has declined, COVID-19 is not gone. We must remain adaptable and vigilant in confronting this unpredictable virus.”