Vivek Murthy does his best in the clip below to argue = there’s no contradiction since the CDC has always encouraged local governments to make their own decisions about precautions if they’re worried about rising cases. But we’ve all seen this graphic, which remains current at the CDC website. If fully vaccinated people don’t need to wear masks indoor then a county-wide indoor mask mandate for everyone in L.A. doesn’t add up.

I wonder how much longer public health authorities like Murthy will keep dancing around the truth instead of leveling with us. Watch, then read on.

When asked if the CDC should change its guidance on masks following new Los Angeles County mandate, Surgeon General Dr. Vivek Murthy tells @MarthaRaddatz that “counties certainly have the right to put mitigation measures back in place.” https://t.co/PXkOeejG49 pic.twitter.com/g6bjgTrDlM

— This Week (@ThisWeekABC) July 18, 2021

Here’s the truth that Murthy, Rochelle Walensky, and the CDC aren’t willing to say yet: The pre-Delta rules about precautions need to be rethought in a post-Delta world. The new variant is so contagious, possibly even to vaccinated people, that the “if you’re vaxxed you can get back to normal” guidance no longer applies to the same degree. Jerome Adams, Trump’s surgeon general, has already come around to that view and shared it yesterday on Twitter.

What Dr. Fauci and I said was based on the science & conditions at the time, and amounted to “save the medical masks (which were all that was available) for the medical workers.”

Both the conditions & the science changed, but what people heard and held to was masks don’t work…

— Jerome Adams (@JeromeAdamsMD) July 17, 2021

Now you have health officials, cities & counties (eg LA County), & likely soon states issuing guidance in direct conflict w/ the mask guidance @CDCgov issued a month ago. The sooner CDC says we were wrong, & hits the reset button, the better.

Trust me- I know more than anyone.

— Jerome Adams (@JeromeAdamsMD) July 17, 2021

Instead of vax it OR mask it, the emerging data suggests CDC should be advising to vax it AND mask it in areas with ⬆️ cases and positivity- until we see numbers going back down again.

CDC was well intended, but the message was misinterpreted, premature, & wrong. Let’s fix it.

— Jerome Adams (@JeromeAdamsMD) July 17, 2021

All the data we have confirms that the vaccines are very, very good at preventing severe illness from Delta. It’s not dumb luck that daily deaths in Israel are holding at an average of one or two a day while cases have surged from 20 per day to 800 in a month. Older people are immunized there and their immunity is keeping them out of the morgue. But there are two unknowns about the vaccine and Delta that are critical to deciding which precautions to take:

1. Are vaccinated people getting infected more frequently than they were before Delta?
2. Are infected vaccinated people passing the virus on to the unvaccinated more frequently than they did before Delta?

Those questions were also the subject of Saturday’s post about L.A. County’s sheriff saying he won’t enforce the mask mandate because it’s not backed by science. Is that still true in a world overrun by Delta, though? Murthy claimed yesterday that it is: “The good news is not only is the vaccine highly effective at preventing severe infection, like hospitalizations and deaths, but even if you do have a breakthrough infection, which, again, happens in a very small minority of people, it’s likely to be a mild or asymptomatic infection.” He may be right that the great majority of breakthrough infections have few or no symptoms. But is he right that they’re happening in “a very small minority of people” now that it’s Delta, rather than the original virus, that’s going around?

We don’t know (and he doesn’t either) because the CDC isn’t tracking breakthrough infections anymore unless they cause a severe case. To make matters worse, vaccinated people are probably getting tested at low rates even when they suspect they’ve been infected. They know they’re unlikely to have any major symptoms so they ride it out and don’t bother confirming that they have COVID. That leaves it an almost total mystery as to how many vaccinated people are walking around right now with the virus. But it’s not hard to find them in the media. Today Rep. Vern Buchanan of Florida announced he tested positive despite having had his shots months ago. Five of the Texas Democrats who fled their state for Washington D.C. last week have tested positive. They’re all vaccinated. The UK’s new health minister, also vaccinated of course, announced over the weekend that he’s positive:

This morning I tested positive for Covid. I’m waiting for my PCR result, but thankfully I have had my jabs and symptoms are mild.

Please make sure you come forward for your vaccine if you haven’t already. pic.twitter.com/NJYMg2VGzT

— Sajid Javid (@sajidjavid) July 17, 2021

None of these cases is a big deal. No one’s very sick and we’ve known from day one there’d be breakthrough infections even with the original virus. Israel’s data shows that Pfizer is still 64 percent effective at preventing infections by Delta, a solid result. But how many more of these breakthroughs are happening now than were happening two months ago, with the new variant burning through the country?

And are these breakthroughs capable of infecting the unvaccinated? Because if so, that’s when asking the vaccinated to mask up starts making sense again. Watch Scott Gottlieb raise that possibility on CNBC this morning. We don’t know yet whether Delta is more transmissible by vaccinated people than the original virus was, he says, but we urgently need to know.

"There are breakthrough infections occurring in vaccinated people. I don't think it's an overwhelming number. But we're not tracking it here in the US. That's the bottom line: we should be tracking it," says @ScottGottliebMD. pic.twitter.com/BcmSCSU6Ku

— Squawk Box (@SquawkCNBC) July 19, 2021

Assume the answer is yes, the vaxxed are contagious when infected by Delta and are infecting unvaccinated people. As a moral matter, should the vaccinated take any precautions to try to prevent those infections from happening? One possible answer is “No, f*** ’em. The unvaccinated had their opportunity to get the shot. If they want to take their chances with Delta, let them. Why should the vaccinated be inconvenienced to protect people who won’t protect themselves?” I think that logic will carry the day when it comes to more draconian precautions, like new capacity limits on businesses. It’s hard to justify putting a bar owner temporarily out of business — again — because the Tucker viewers in his neighborhood won’t take 10 minutes to run down to CVS and get a free shot.

But what about a minor precaution like wearing masks? (Which we should distinguish from mask mandates, which probably don’t increase compliance.) The vaccinated have more than just altruistic reasons for wanting to prevent the unvaccinated from getting infected. Each new infection raises the risk of a new mutation that might produce a vaccine-proof variant. Even if that doesn’t happen, a truly ferocious wave among the unvaccinated could overwhelm hospitals again, which means fewer available medical resources for the vaccinated too. And it’s possible that Delta is producing more severe breakthrough infections in the vaccinated than the original virus did, raising the risk of serious complications. Although, again, as Gottlieb says, we’d need much better data to confirm that.

In a sense, though, this whole debate is pointless. Obviously many vaccinated people who had stopped masking up are going to start again in response to the dire news about Delta, whether or not there’s a mandate in place. They’re risk-averse; that’s why they’re vaccinated. And the unvaccinated, who are in jeopardy but more risk-tolerant, probably won’t be terribly well protected from infection by a super-contagious virus like Delta if they’re wearing the standard cloth mask, assuming they choose to mask at all. The question of how common mask-wearing should be will be settled the way it usually is, by individual behavior. What Murthy and Walensky have to say about it is interesting but ultimately close to meaningless.

If you’re a parent in a blue state or county, though, I’d say now’s the time to worry about school closures again this fall. That’s the one aspect of the pandemic where the opinion of local authorities does matter. If the Delta wave ends up being as nasty as it’s shaping up to be, some skittish bureaucrats are going to want to shut classrooms again — no matter what the CDC says to the contrary.