"Friction": White House officials annoyed at CDC over new mask guidance

Stefani Reynolds/The New York Times via AP, Pool

Deep down they’re less annoyed at the CDC than they are at COVID for cursing them with a hyper-contagious variant that threatens to derail America’s economic recovery before the midterms. Team Biden essentially announced “mission accomplished” in May when the CDC told the vaccinated they could unmask. Reversing that guidance now broadcasts to the country that the mission hasn’t been accomplished after all. “President Biden absolutely declared a victory too soon,” said Dr. Leana Wen about the White House’s messaging in May.

Which hasn’t worked out well politically for U.S. presidents in the 21st century.

But partly this sounds like a bona fide disagreement on the scientific merits. The outbreak in Provincetown that inspired the new masking guidance wasn’t representative of how Americans typically interact, and the vaccinated who were infected there ended up with mild cases apart from a few exceptions. So what’s up with the doomsaying? Was it truly necessary to freak everyone out by undoing the “no masks if you’re vaxxed” rule?

It’s important to remember, though, that the new guidance wasn’t based on the Provincetown episode alone. If you missed this post from Saturday, read it now. There are at least three studies at this point showing that vaccinated people who get infected may carry the same viral load as the unvaccinated do, at least for a few days.

The revised mask mandate in particular has proved thorny. Officials in the White House and the Department of Health and Human Services questioned whether recommending Americans wear masks again would help with the pandemic fight, with some officials in meetings over the last week arguing that reversing guidelines could confuse people and spark political backlash.

Armed with analysis from within her department, CDC Director Rochelle Walensky argued otherwise. She lobbied Biden officials, including Biden’s Chief Medical Officer Anthony Fauci, to issue new recommendations urging fully vaccinated Americans to wear masks indoors, citing more recent data on the spread of the Delta variant, and virus levels in vaccinated and unvaccinated people. According to two senior officials familiar with the conversations, Walensky insisted that doing nothing wasn’t an option.

While Walensky has the backing of the president and other senior officials such as Fauci, both her office and the White House have privately expressed frustration with one another.

Those frustrations surfaced again when senior White House and health officials argued over data related to an outbreak of hundreds of vaccinated and unvaccinated individuals in Cape Cod. Though only a handful of those who were immunized and still got infected ended up in the hospital, the infection numbers among the immunized was alarming. Still, officials went back and forth on whether the administration had gathered enough data about asymptomatic spread of the Delta variant to call on Americans to wear masks indoors again and if Americans would adhere to the new guidelines.

If the CDC suppressed evidence that the vaccinated might be infecting the unvaccinated, and unvaxxed grandmas started getting infected by their vaxxed teenaged grandkids and dying, imagine the scandal once it leaked that the feds had reason to believe it was happening and didn’t tell Americans. I think Walensky took the same view of this as the FDA took with the Johnson & Johnson “pause” over blood clots: If they had tried to keep it a secret and the secret had gotten out, whatever public faith was left in the health bureaucracy would have shattered upon impact.

The White House is also peeved at the media for accentuating the negative in the Provincetown study, a common flaw in U.S. press coverage of COVID but one with especially high stakes right now. The more the unvaccinated come away from the new guidance believing that vaccines don’t work because they don’t prevent infection, the fewer of them will end up taking the plunge. White House COVID task force member Ben Wakana spent Friday spazzing out over news reports that didn’t focus on how few breakthrough infections there are nationally and how few result in vaccinated people needing hospital care:

The feds are trying to communicate the point that the vaccines don’t offer the same level of protection from infection in the age of Delta but do still offer basically the same degree of protection from serious illness and death as they did with prior strains. A nation of functioning adults would have no difficulty processing that, but, well, you know. “The media’s coverage doesn’t match the moment,” one Biden official complained to CNN. “It has been hyperbolic and frankly irresponsible in a way that hardens vaccine hesitancy. The biggest problem we have is unvaccinated people getting and spreading the virus.”

Did the CDC’s switch on masks for the vaccinated really discourage people from getting their shots, though? Or did it actually spook them into doing so?

The media’s bad-news bias may be helping, ironically. Public opinion on the state of the pandemic has soured over the past month as coverage of the new threat from Delta has exploded:

Predictably, those who are already vaccinated are more likely to say they’re worried about getting COVID (33 percent) than the unvaccinated are (20 percent), but the numbers are up in both groups since June. Some holdouts may have been scared straight by the variant and are finally being immunized, which is great. What’s less great is that the risk-averse segment of the population is destined to start hunkering down again as they perceive a rising threat from Delta, which means slower economic growth.

In fact, I wonder if that won’t be the main consequence of the CDC’s new masking rules for the vaccinated. It may be that the vaxxed still aren’t getting infected or passing along the virus much, even though it’s more common with Delta than it was before, and also that masking won’t do a lot to prevent the spread of a hyper-contagious strain. The new rules might matter only at the margins with respect to transmissions. But they could matter a lot to the economic recovery since the vaccinated fear COVID more than the unvaccinated do and will go the extra mile to limit their exposure. Hearing about hundreds of breakthrough infections in Provincetown last month might lead them to stay home, avoid crowds, and skip luxuries like dinner at restaurants again even though everyone in P-town ended up being fine.

In lieu of an exit question, read this thread from virologist Angela Rasmussen challenging the use of “Ct values” as a measure of viral load. Ct values were used in all three studies, including the one from Provincetown, that have been cited to support the CDC’s new masking guidance. Rasmussen argues that one can’t assume that the vaccinated have the same amount of infectious virus in their noses and throats as the unvaccinated after being infected just because they have the same amount of viral RNA. The antibodies in a vaxxed person’s system will kick in to start neutralizing the virus much sooner than they will in an unvaccinated person, who has yet to produce antibodies. Rasmussen thinks the CDC’s masking guidance was prudent under the circumstances, in an abundance-of-caution way, but she’s not sold that the vaccinated really are as contagious as the unvaccinated. The White House would be keen to know if that’s true.