“We’re not all in this together anymore”:
CDC’s unspoken adultifying message
re masks and social distancing

Before there were magnificently effective COVID-19 vaccines, “We’re all in this together” was a crucial pandemic message. The need to protect each other was at the heart of masks, social distancing, and other non-pharmaceutical interventions (NPIs).

Now, U.S. adults are divided into two cohorts: the vaccinated and the unvaccinated. The unvaccinated are a tiny threat to the vaccinated. The vaccinated are a tiny threat to the unvaccinated. The unvaccinated significantly threaten only each other. We’re not all in this together anymore.

This is the unspoken truth behind CDC’s announcement that vaccinated Americans no longer need to wear masks or maintain social distancing in most indoor spaces.

Unvaccinated American adults can respond to the announcement in any of three ways: (a) get vaccinated; (b) continue using NPIs in lieu of vaccination; or (c) stop using NPIs (if they were using them). Obviously, (c) is an undesirable effect and (a) is desirable. No one knows which one more unvaccinated people will choose.

The wonderful effect is on the vaccinated: freeing them from precautions that are no longer medically necessary. For a while, some vaccinated people will continue to wear masks and socially distance, for various reasons: caution, habit, mistrust, etc. Doctors Fauci and Walensky and White House administrator Slavitt all urged mutual tolerance between the masked and the unmasked.

In the absence of “vaccine passports,” it won’t be feasible for most third parties (stores, for example) to distinguish vaccinated from unvaccinated people, and thus to require NPIs of the latter but not the former. That may change if enough people want to be able to prove their vaccination status, but the new CDC recommendations don’t depend on the change.

That’s what makes the CDC announcement adultifying. Without vaccine passports, unvaccinated Americans are left in charge of their own and each other’s health. Vaccinated Americans have relatively little stake in what choice unvaccinated adults make, and should therefore avoid interfering or judging (out loud, anyway).

To reach this new set of recommendations, CDC needed to reach three conclusions:

• That the residual threat unvaccinated Americans pose to vaccinated Americans is small enough to be acceptable.
• That the amount of morbidity and mortality that will result when unvaccinated Americans (most of them young and healthy) are free to abandon NPIs without third-party policing will also be small enough to be acceptable. Widespread hospital overcrowding, for example, is not a likely outcome.
• That given the first two points, continuing to recommend NPIs for all Americans would unduly penalize those who are vaccinated and unduly infantilize those who are unvaccinated.

Given variants, waning, and other sources of uncertainty, these three conclusions may not be true forever.

That’s why CDC continues to recommend NPIs for venues where vulnerability is highest and largely involuntary (prisons, hospitals, mass transit – maybe even some communities with high viral spread and low vaccine uptake). And CDC wisely reserves the right to change its recommendations as the situation changes.

There are real downsides to the new recommendations, especially for people who cannot choose to get vaccinated or are not fully protected by COVID-19 vaccines, specifically children and the immunocompromised. These groups will be less protected when other people, some of them unvaccinated, stop using NPIs. CDC made the difficult decision not to ask all Americans to continue using NPIs to protect children and the immunocompromised.

Parents should strongly support unvaccinated children in continuing to use NPIs in crowded indoor venues.

We are not out of the pandemic woods. But we are in a clearing. Those of us who are vaccinated are in a very safe part of the clearing. And those of us who are unvaccinated have a well-marked path to that very safe part of the clearing, if and when they choose to take it.