A Front Line Covid ICU Doc & Virologist’s Thoughts On New CDC Mask Guidelines

Lissa Rankin, MD
4 min readMay 19, 2021

The CDC has announced that vaccinated folks are now free to be maskless- both indoors and outdoors, unless they’re in crowded spaces. I was wondering what Rick Loftus, MD, my most trusted source of Covid advice who is a front line Covid ICU doctor, virologist, immunologist, and public health expert who used to work for the CDC, thinks. Here’s Rick’s answer to my question if you’re curious:


“The mask advice: It’s a tad too early, IMHO. They are clearly trying to incentivize people to go get vaccinated, which I respect. But the sensible states are going to throttle back on the masking over a 2–3 months timeline, I suspect. In Israel, they started seeing virus levels plummet despite full re-opening when they hit 68% immune-58% vaccinated and 10% natural immunity. The US is conservatively around 54% at the present, at least (there’s wide discrepancies in the estimated total number of naturally immune folks, which of course will overlap a bit with the vaccinated), so we’re very close. Vaccinating the 12+ age group will firmly get us to herd immunity territory. (People quibble over that term and split hairs, but as I use the term, I’m referring to conditions in which virus is not circulating enough to be able to attack an unvaccinated or vulnerable person.)

I’m quite optimistic about the US situation if the under 18s mostly get vaccinated (and I support institutions like colleges making vaccination a requirement for entrance- we need more of those rules). If I were head of CDC, I would have announced a “masks off for vaccinated” date of June 15, to give people a deadline for getting vaccinated, which would also let folks, states, and county DPH Depts. have time to wrap their heads around wide indoor masklessness and ask their questions. I think “masks off” on May 13 was premature, even if pretty safe for the vaccinated. The people who write and implement these policies, of course, are from functional cultures, not places like Iowa or South Dakota where many will remain vaccineless- and will have terrible surges and preventable death and disability this winter.

I told a townhall COVID update a few days ago that increasingly the big threat facing us won’t be the virus, but disinformation. For those who quibble about getting Pfizer/ Moderna because they’re RNA, or Astra Zeneca or J&J because of the clots problem (which for J&J is 1–2 cases per million, vs. 160,000 clots per million cases in active COVID), the Novavax protein vaccine will debut very soon, and is completely different in mechanism and at least as effective as the RNA vaccines. It’s made in insect cells. Soon we’ll have enough different types of effective vaccines that anyone refusing to get one for “scientific” reasons will just start to seem unreasonable.

(That was my experience with AIDS denialist patients who refused medication. Every time I offered them something different that would also work, they found another excuse not to take it. It became clear after awhile that the refusal wasn’t really about reason; it was about emotion. All of those patients wound up dead, sadly. All preventable deaths.)

The CDC mask advice highlights a key question: Is our goal no infections, or no symptoms? Those are different goals. The Yankees just had 8 folks test positive- and they only knew they had COVID because they get tested automatically every week, most had no symptoms. BUT… Do they have a kid at home who could get infected and get MIS-C (Multisystem Inflammatory Syndrome in Children)? Is there a grandma with chronic leukaemia at home whose vaccination didn’t work and could get lethal COVID complications? We know that vaccinated folks- if they get COVID- will be a lot less contagious than unvaccinated, but even if transmitting is rare from the vaccinated-but-infected, if it’s your kid or grandma who winds up the statistic, the fact that it’s a rare problem doesn’t make you feel better.

As a primary care doc, I’ve always pointed out that making decisions for individuals and making decisions for populations are not at all the same thing.

Personally, while I’m not concerned that if I contract COVID I’ll wind up in the hospital or dead, I am still wondering if I could wind up with Long COVID. There’s been no data yet showing how common organ damage or Long COVID syndrome are in those who are vaccinated and still wind up getting COVID- and that matters, for obvious reasons. Many of the previously healthy 20–40 somethings at the Mt. Sinai Long COVID clinic had such mild COVID they didn’t even need an urgent care. Mild COVID doesn’t appear to mean you can’t get Long COVID. You don’t get a “do-over” once you have heart damage or chronic fatigue. That’s the last salient piece of data I’d like to see before I really let my guard down. Meanwhile, I’m still going to mask in indoor environments where I’m there for a prolonged period (more than 15 min), and I’m going to avoid unventilated places where people hang out, like bars, until 2022.”

So there you go, from the mouth of the smartest and my trustworthy, informed, and kind person I know in this territory.

How are you all feeling about these new guidelines? Curious to take your temperature…



Lissa Rankin, MD

Lissa Rankin, MD, New York Times bestselling author of Mind Over Medicine, The Fear Cure, and The Anatomy of a Calling.