To Wear Masks or Not to Wear Masks After Vaccination: Will We Ever Find the Answer to the Question?

Every day as more and more individuals across the country get vaccinated against COVID-19, and as states ease or lift restrictions including mask mandates, there is still some level of uncertainty for many individuals as we all try to transition to some degree of normalcy. In May 2021, the CDC updated its guidelines and stated, “Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.” ¹ In spite of the CDC recommendations regarding masks, there is still hesitancy and great debate among health care providers and lay persons about continuing to wear masks once fully vaccinated. 

Some publications have referred to this as “mask anxiety,” and numerous individuals struggle with this issue—especially since masks provided many individuals with a sense of security during this uncertain time. 

In a recent report, the American Psychological Association's 2021 Stress in America report, health experts indicated that almost 50% of Americans stated that they were hesitant or uneasy thinking about in-person interaction once the pandemic ended, and that those who were vaccinated were just as likely as those who weren’t vaccinated to express uneasiness/anxiety.^2,3 Moreover, in an interview, Vaile Wright, senior director of health care innovation at the American Psychological Association stated, “It's pretty normal right now to feel that way. I do think there's this part of us that feels like, 'I've been wanting this for the last year and now it's here and I don't know how to handle it." ² 

To gain a better understanding on the topic of wearing masks after vaccination and the recent CDC updates regarding masks, several individuals including physicians, nurses, nurse practitioners, pharmacists and individuals including those with and without medical conditions were asked to provide their insights. Of the 30 participants, only a few indicated that they do not wear masks any more or will not wear masks once fully vaccinated. The vast majority plan to continue wearing masks and some will wear masks in certain settings such as crowded areas or for health reasons. Below are some examples of statements from participants:

Healthcare Providers

• Physician: My medical group is slowly trying to get back to some "sense of normalcy" post pandemic. We ask our patients to call us ahead of time if they are sick or have a fever, and we can either reschedule them or arrange a telemedicine visit. With regards to masks, for now we still ask all our patients to wear a mask while in the waiting room, however, if they have been vaccinated, then they can remove their mask while in the examining room and I also remove my mask. If not vaccinated, both patients and physician keep on their mask in the exam room. All the physicians and office staff in my practice have been fully vaccinated. 
• Physician: I have been vaccinated and will continue to wear masks until herd immunity is reached. The vaccine is a supplemental protection against COVID-19 not a substitute.
• Pharmacist: I have been fully vaccinated and will only wear masks in crowded areas. We must believe that the vaccinations will provide some protection and if exposed to the virus that our immune systems now have antibodies to fight it.
• Registered nurse: I plan to continue wearing my mask although I am fully vaccinated. My decision is purely based on the non-vaccinated that go to public places and cough and sneeze without covering their mouths. In Louisiana, only 32% of the state is fully immunized and it's hard to believe we will ever have herd immunity here.
• Registered nurse: I am fully vaccinated, and I leave my mask off whenever I can. 
• Nurse Practitioner: I am fully vaccinated and wear masks while working. I am comfortable without masks, but still wear them depending upon the setting like the grocery store.
• Registered nurse: I am deciding to wear my mask a little longer even though I am vaccinated. I am waiting to see if the COVID-19 cases will remain low. 
• Registered nurse: Mask wearing, and hand hygiene have been recognized as effective ways of mitigating the spread of COVID-19 and other viruses. While I feel comfortable not wearing a mask since I am fully vaccinated, I often continue to wear one. 

Individuals With and Without Medical Conditions

• I am fully vaccinated. The reason I will continue to wear a mask is I have rheumatoid arthritis and I feel protected wearing a mask from people who may not have been vaccinated.
• I have asthma and I will continue to wear my mask. Yes, I am fully vaccinated but this virus is especially hard on your lungs. I cannot answer when I will remove my mask. I know the pain and fear of being unable to breathe on my own.
• I was fully vaccinated in January. I will continue to wear a mask in all locations where they say mask are required. Even when they are no longer required in stores and restaurants, I think I will continue to wear one on through the end of the year because since March of 2020. I have not had a single cold or sniffle for that matter.
• I am fully vaccinated, and I remove my mask when I am outside or when inside with individuals that I know are fully vaccinated. 
• Already fully vaccinated and have not worn a mask since. Wore masks to protect the vulnerable around me, but now that they are vaccinated, I don’t worry anymore. 
• I have asthma. Fully vaccinated, so do not wear a mask in outdoor settings, but keep it handy in case I need to go indoors. Also, no mask in indoor settings with people who I can confirm are fully vaccinated. Still wear them in indoor settings in public places where I do not know the vaccination status of others I may come in close contact with (such as grocery store). 
• As someone with a medical condition and good sense, I believe that masks should still be worn. Just that simple fact that it's safe and protects those who have already been vaccinated, those that are planning to but have not or haven't received their second, and those that are nonbelievers and just don't want to do what is right.
• I removed my mask once I was fully vaccinated. I have high blood pressure and high cholesterol which puts me in a higher risk. If we are to trust the science available, we should be able to move forward without the mask and without the fear of contracting or spreading the virus.
• I will not be wearing a mask after being fully vaccinated except in crowded areas. I must believe that the vaccine is providing me with protection and that I will not be able to transmit it to others. 
• I am fully vaccinated and didn't wear one in two places last weekend. I felt fine. But I still wear it most of the time.
• After vaccinations are complete then I will stop using my mask. I'm going to trust that the health experts are saying that once you're vaccinated there is much less chance of getting the virus.
• Will continue to wear a mask for a while as I know that viruses have mutant forms, and we are still possibly vulnerable. Also, I haven't had a cold in 16 months, so I may wear a mask and make that a new way of life!!
• Working with school kids pre K-12th grade is challenging enough and adding pandemic restrictions, safety protocols like mask wearing, constant sanitizer use, wearing gloves, taking temperatures -all contributed to daily mental anxiety. From the perspective of a public school employee, masks served as a safety net against not only possible COVID-19 infection, but other common health issues seen in schools -common cold, flu, allergies. I did get fully vaccinated because over 60 years old and have cardiac health issues but will continue to wear a mask when in small, confined spaces or inside public places like grocery stores or retail stores. I do not feel comfortable dining in a restaurant.
• My view on this subject is to continue to wear the mask only indoors or in crowded areas whether inside or outside. But, for inside activities such as going to the grocery or gym etc., I will wear the mask for the purpose of protecting others who may not be vaccinated. I am exercising this practice and I have been vaccinated for quite some time.
• Though fully vaccinated since early March, I will continue to wear a mask in most cases around those I do not know. A large majority of people here have never followed guidelines, and many are unvaccinated and still unmasked. The vaccine is 95% protection at best and not 100% and COVID-19 is not the only thing out there. I am not able to get the flu vaccine and I usually wear a mask during flu season anyway.
• I am fully vaccinated and have no underlying medical conditions, but I am going to continue wearing my mask in all indoor gatherings and any outdoor gatherings where there are groups of people.

Conclusion

Since March 2020, all our lives have been turned upside down and transitioning to some degree of normalcy can be overwhelming for many individuals. Everyone should take their time and do what is comfortable for them. Clearly, the debate about masks after vaccination will continue and there will probably never be an exact answer. As vaccination rates continue to expand, maintaining the practice of universal infection control measures and getting vaccinated are our best tools to continue to defeat the virus.

To wear a mask or not to wear a mask if you are fully vaccinated is a question that only everyone can answer based upon their current health and level of comfort. In addition to that, one of the best things we can all do for our fellow human beings is to respect one another and practice kindness whenever we can

References:

1. Centers for Disease Control and Prevention. When you’ve been fully vaccinated. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html. Updated May 16, 2021. Accessed June 16, 2021.
2. USA Today. Why we’re scared for the pandemic to end. USA Today website. https://www.usatoday.com/story/life/health-wellness/2021/03/19/vaccinations-bring-post-pandemic-world-closer-why-we-anxious/4767642001/. Updated March 22, 2021. Accessed June 16, 2021.
3. American Psychological Association. Stress in America 2021: Pandemic stress one year on. American Psychological Association website. https://www.apa.org/news/press/releases/stress. Accessed June 16, 2021.