The After-Mask Aftermath: How to be Maskless Again

Now with vaccines widely available and changes in recommendations from the CDC and the NYS Department of Health, fully vaccinated people can be maskless in most places. But some aren’t ready to retire their masks – yet.

According to Thomas Russo, MD, division chief of Infectious Diseases at UBMD Internal Medicine and the Jacobs School of Medicine and Biomedical Sciences at UB, even if fully vaccinated there is science backing both choices: continuing to wear a mask and to stop wearing it.

“First, even if you are fully vaccinated it is ok to continue to wear a mask if it makes you feel more comfortable,” says Dr. Russo. “If you are not ready to ditch your mask, don’t! Continued mask use will also protect you against other respiratory viruses. Other reasons to continue to wear a mask even if vaccinated is if you are immunocompromised. You may not have optimal protection from vaccination; we are still learning about that. Lastly, if someone in your household is vulnerable and at risk, wearing a mask will help protect them.”

For those people who are fully vaccinated and no longer want to wear a mask, the decision is supported by the high efficacy of the vaccines approved in the United States and the plummeting incidence of COVID-19 infections in high-vaccination areas.

The mask has always been meant as a way to control how far respiratory droplets spread from breathing, sneezing or coughing. According to said Steven Dubovsky, MD, president of UBMD Psychiatry, “the point is to reduce the consequences of breathing on someone you are right next to.” If you have a fitted N95, all the better. N95 masks are designed to keep germs from moving in and out.”

“If your mask also makes a fashion statement, it’s an additional benefit,” Dr. Dubovsky jokes.

“Whenever people feel that they are in danger, it is natural to look to anything that offers protection,” Dubovsky said. “It is equally natural to want to hang on to something that symbolizes safety, like a mask.”

There are several reasons people may not want to put down the mask in spaces outside of their home that don’t have anything to do with post-pandemic anxiety.

• Keeping safe. While the vaccines are highly effective, some may be concerned that it is still not 100% effective, so wearing a mask can help increase their safety. (Note: Pfizer and Moderna are 95% effective against SARS-COV-2; the Johnson & Johnson vaccine is 60-70% effective.)
• Protecting their children. Children under 12 years of age are not yet able to be vaccinated. Children make up the largest percentage of those not vaccinated and may be vulnerable for getting COVID-19 from others, including those who may bring the virus home.
• Wary. Some may be concerned that not everyone going maskless is actually fully vaccinated. In most settings, there will not be a way to know everyone’s vaccine status. Wearing a mask may be comforting to those in situations where they are unsure.
• Protecting the immunocompromised. Some medications or conditions decrease the effectiveness of vaccines, so people falling into this category are not as protected. Because they take immunosuppressive drugs, transplant recipients may be more susceptible to getting sick.
• Avoiding judgement. “There is also the social pressure from other people who view not wearing a mask as a sign of disregard for society,” Dubovsky said. If that’s the case, the mask may be viewed as a sign of compliance and belonging, especially in settings in which people glare at you or even yell at you for not wearing a mask.

“The pandemic itself has been frightening to everyone,” said Dubovsky, psychiatry department chair at the Jacobs School. “The feeling of danger has been intensified by a combination of continual media coverage and fierce political debates about the consequences of straightforward behavior such as getting vaccinated or wearing a mask.”

Those fully vaccinated and still wearing masks because they are anxious to be without could be doing so for a few reasons.

• Sense of safety. The mask has been a first-line defense against COVID-19 if you needed to be around people. Even if you were alone and wearing a mask, it made you feel safer. This was something you could actively control in a time that felt very out of control.
• Not ready to let go. Dubovsky says some may think of a mask as a lucky rabbit’s foot. “We feel that it has protected us up to now, and we’d better not take any chances until we are definitely in the clear,” Dubovsky said. Others may not be as apprehensive.
• Phasing it out. If you’re letting go of other precautions, such as social distancing, seeing more people outside of your household or taking part in outdoor activities, keeping the mask might be part of a phased approach so as to keep some form of comfort or protection from COVID-19 that you can directly control.

Taking that first step to being maskless can be very uncomfortable. If you are fully vaccinated and continuing to wear a mask but would like to feel more comfortable without a mask, consider this: “If you have been wearing a mask all along and you have not gotten sick, you may naturally conclude that the mask kept you from getting sick, overlooking other things you might have done to protect yourself, such as not getting into crowded elevators or keeping physical distance between yourself and other people, let alone not going to malls and busy grocery stores,” Dubovsky said.

By reminding yourself of all the other ways you’ve kept yourself safe during the pandemic, that might make you feel more comfortable taking the next step. Depending on your current practices, try one of the below:

• If you are continuing to follow those other protocols, ask yourself if it would make sense to start going out a few times without your mask.
• If you no longer feel you need those other precautions, ask yourself why letting go of the mask would be any different than letting go of the other precautions?

Depending on your viewpoint and answers, you might get more insight into what about it is making you uncomfortable.

If anxiety around not wearing a mask still occurs, Dr. Dubovsky recommends:

• Try just going outside your home without a mask. Return home as soon as you start to feel worried.
• Gradually increase the time you spend outside without a mask until you feel reasonably comfortable outdoors.
• Then, start going into a public space in which going maskless is permitted. At first, go when the location is not likely to be crowded.
• Take a mask with you during these exercises so you can touch it or look at it and feel that it will be there if you need it.
• By gradually re-introducing yourself to settings in which you used to feel comfortable, you will desensitize yourself to the fear of not having a mask. At that point, you can discard the mask completely.
• Go out with one or more friends who feel comfortable without wearing a mask.

It’s important to move at your own pace. There is no timeline or right or wrong if you’re fully vaccinated.

Dr. Dubovsky wants people to remember that wearing or not wearing a mask does not have to be a political or cultural statement. “People who prefer not to wear a mask might consider not looking down on those who do, and people who want to wear a mask should do the same. The point is to not resent those who are handling the new recommendations differently.”

It’s also stressed that those who are not fully vaccinated continue to wear masks when inside or within 6 feet of others. Fully vaccinated is defined as either receiving the one (1) Johnson & Johnson shot more than two weeks ago, or the second Pfizer and Moderna shots more than two weeks ago. If you were just vaccinated, you will not be considered fully vaccinated until 14 days later and should still abide by the recommendations for those not vaccinated.

“Of course, if you are not vaccinated or fully vaccinated you should continue to wear a mask indoors in public and outdoors when is close proximity to other for a prolonged period of time,” Dr. Russo said. “This is especially important with the rise of the delta variant ,which is very infectious and is responsible for increased hospitalizations!”