A Largely Mask-Free Memorial Day Weekend: Reason for Concern?

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Do anecdotal reports of crowded stadiums, restaurants, and bars where almost no one was wearing a mask over the recent holiday weekend justify concerns about another jump in COVID-19 cases? Or does the newfound perception of normalcy just reflect how effectively vaccines and other protective measures worked?

Turns out, it depends on who you ask.

Vaccinated people not wearing a mask is “reasonable,” Ed of Aventura, FL said. “But how do you know who is and isn’t?”

Ed, who asked his last name not to be used, is vaccinated but continues to wear two masks.

He’s doing it, “not for me,” he says, but out of concern for others. He knows the risk of passing on an infection once a person is vaccinated is low, but he doesn’t want to risk it. When he sees someone outside without a mask, with their vaccination status unknown, ”my reaction is, they are entitled, inconsiderate and selfish.”

On the other hand, Sabina Stanislavsky, a magazine art director in Miami, is relieved. “I like to see people without a mask,” she says. “Without a mask, it’s back to normal. Our governor [Ron DeSantis] says we don’t need to wear masks anymore and that makes me happy. For me, I actually love it.”

An Uneven Landscape?

Dr Monica Gandhi

Infectious disease experts remain cautiously optimistic. “I do not expect to see an uptick in new COVID-19 cases in the coming weeks in places with high rates of vaccination,” Monica Gandhi, MD, MPH, told Medscape Medical News. “Moreover, I suspect a lot of people will still feel comfortable wearing masks — vaccinated or unvaccinated — in public places.”

“I suspect there may be an uptick only in some rural places without high rates of vaccination” that did not experience surges in the past, added Gandhi, professor of medicine and associate chief of the Division of HIV, Infectious Diseases, and Global Medicine at the University of California San Francisco.

Vaccinations are the essential factor, said Prathit Kulkarni, assistant professor of medicine in infectious diseases at Baylor College of Medicine in Houston, Texas. “The critical concept related to bringing the pandemic under further control is continued strong uptake of the COVID vaccine.”

“While it is possible that increased activity could cause a small increase in cases or hospitalizations, this can be countered by a strong vaccination campaign,” he added.

State of Variability

Dr Prathit Kulkarni

Different rates for new COVID-19 cases and hospitalizations remain throughout the United States. “Here in America, an example of this is the state of Vermont, where a large proportion of the population is vaccinated, and cases are down substantially,” Kulkarni said.

As of June 1, CDC figures show 123,218 total doses per 100,000 Vermont residents. Massachusetts is another state with a high vaccination rate (116,284 total doses administered per 100,000 residents).

“It is possible to see small clusters or outbreaks among groups of unvaccinated people in specific geographical areas,” Kulkarni said. “This is similar to what has been observed in the past with other vaccine-preventable illnesses.”

For example, Mississippi has administered 59,497 total doses per 100,000 residents. Alabama has administered 61,622 per 100,000 residents, the CDC reports.

“Mississippi, sadly, is at the bottom. But a number of other southern states have lower coverage,” Chris Beyrer, MD, told Medscape Medical News.

Dr Chris Beyrer

“I certainly think there is a potential for outbreaks where the vaccination rates are lower, and where mask wearing is low or absent,” added Beyrer, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

It’s an uneven playing field at many sporting events as well, with some stadiums enforcing mask mandates and others packed with no masks in sight.

Comedian Trevor Moore posted on Twitter: “It’s nice that sporting events are happening again — but weird to see everyone still enforcing masks. It’s like, you can bend the rules a little — this is a dog fight in the basement of an old Circuit City.”

For Some, It’s Situational

Some people are adjusting more quickly to seeing the mask-less masses, with some exceptions. “I am getting used to seeing people without masks and have no problem as long as they maintain good distance,” said Noelle Baker of Phoenix, Arizona.

Her comfort level depends on the situation where no masks are worn, she says. “Indoors and crowded, I’m not likely to go in.” She is fully vaccinated, still carries her mask and wears it when there are indoor crowds and also in restaurants, grocery stores, and elsewhere.

Perceptions shared on social media also vary. For example, Tim Amick Sr, who works at a school in southwestern Minnesota, says he is neither an ”anti-masker” or against the vaccine. He also doesn’t mask up all the time anymore, as he used to. He decides by the situation. “I go to some stores where employees are wearing masks and I put mine on out of empathy for them. I’m guessing a fair number of people not wearing masks are not vaccinated.”

He is not vaccinated, either. “I just don’t know if the vaccine will do that much for me at this point,” he says. He wrote on Twitter: “I am not anti Vax, but I am in that group that has not been vaccinated and over 40…do not see the need to at this point?”

Another unvaccinated person cited pandemic fatigue for not wearing a mask. “People are already done with this, they are already tired,” says Alex Sperisen, a Miami-area hair stylist. In the past, he wore a mask but just recently stopped, by and large. “I’m a healthy person and I know that people have died of COVID. The reality is, you are going to get what you are going to get and you just have to keep building your immune system. Even with the vaccine, you don’t have any guarantee.”

Sperisen has decided not to get vaccinated. However, if a client asks Sperisen to wear a mask because he or she feels more comfortable seeing the added protection, he will wear one, he says.

Think Globally, Act Locally

In areas of the world where vaccination has gone well, COVID cases and hospitalizations are down significantly, said Kulkarni. Although numbers are trending in a positive direction globally, concerns vary by location.

“In the past week, the number of new COVID-19 cases and deaths continues to decrease, with over 3.5 million new cases and 78,000 new deaths reported globally,” according to the World Health Organization Weekly Epidemiology Report released June 1.

Although cases worldwide dropped for 5 consecutive weeks and deaths decreased for 4 consecutive weeks, the WHO notes, “case and death incidences remain at high levels and significant increases have been reported in many countries in all regions.” India, for example, continues to face challenges with more than 27 million COVID-19 cases reported as of May 26.

“It’s too early to give up the mask, says Bhramar Mukherjee, PhD, professor of epidemiology and chair of biostatistics at the University of Michigan, Ann Arbor. “I will always err on the side of caution,” she says.

“They are making a choice that I understand,” she says of those who have discarded their masks. “I am making mine.” In her university town, there are many travelers from abroad, too, ”so until the globe is vaccinated, I will continue to wear masks in public.” 

The Wild Card

New variants may affect vaccine effectiveness, she says, so that also plays into her decision to stay masked, Mukherjee said. “I will get there [unmasked] if things go in the right direction, but [I’m] not there yet.”

“In this whole conversation there certainly is a wild card in the deck. And the wild card is the variants,” Beyrer said. For now, the vaccines have shown very robust protection against the variants circulating in the UK, South Africa and Brazil. “That’s very encouraging.”

“But at the same time, most of the world is not immunized. There are enormous numbers of new infections in so many regions,” Beyrer added. “If we have new variants of concern that we are not protected against by the latest generation of vaccines — we are going to have no choice but to go back to social distancing and other public health measures.

“It’s going to be very, very hard. People are very tired of this,” he said.

Some Reasons for Optimism

In the US, cases are coming down nationwide, even without mask mandates in some states, Gandhi said. A combination of natural immunity from previous COVID-19 infection plus COVID-19 vaccinations are likely behind this trend.

“For instance, Texas withdrew its mask mandate in March but didn’t see an uptick in cases after that,” she said.

“I’m very optimistic about vaccinating 12- to 15-year-olds. That’s an important change,” Beyrer said. “Kids really need a summer. They need to see their friends for their mental health, their well-being and emotional growth.”

At a popular beach bar near her New Jersey home, Caitlin Donovan says the line to get in over the holiday was two blocks long, mostly including young people and many unmasked. She has definitely noticed a drop in mask wearing. As the mother of three children under age 7, ”we get nervous about letting our unvaccinated children be around people who aren’t vaccinated.”

Of course, there is no way to know if people not wearing masks are vaccinated or not. She does understand the decision to ditch the mask. “I know the urge is to get back to normal. With every fiber of my being, I want to be there, too. I don’t resent people who are not wearing a mask as much as I just stay aware of them. We can only hope that we can spread the word about vaccinations.”

Kathleen Doheny is a Los Angeles-based journalist specializing in health, fitness, and behavior topics. In addition to writing for WebMD, she contributes regularly to other web sites and to national magazines. Credits include the Los Angeles Times, Shape, Natural Health, Westways, Weight Watchers Magazine, Prevention magazine, Consumers Digest, cancerandcareers.org, and webvet.com.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter:  @MedReporter.

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