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Despite the New CDC Guidance, Should I Still Wear a Mask?

Despite the New CDC Guidance, Should I Still Wear a Mask?

Published on June 25, 2021

People with Cancer Should Still be Cautious Despite Vaccination

This is the fifth in a multipart series exploring important questions about COVID-19 and its unique impact on cancer patients. In this series, Patient Power went to the experts to get the facts about COVID-19 and how it affects prevention, screening, treatment, and research.

Update: On July 27, the Centers for Disease Control and Prevention (CDC) announced a new recommendation that fully vaccinated people wear a mask indoors in public if in an area of substantial or high transmission, citing the risk of being infected with the Delta variant and possibly transmitting it to others. The CDC also noted that people with weakened immune systems and members of their households might choose to wear masks regardless of transmission in their area.

When the CDC issued new mask-wearing guidance in May 2021, it was met with jubilation. The new recommendations said that fully vaccinated people could resume pre-pandemic activities without wearing a mask or social distancing, except where required by state or local regulations.

But not everyone was celebrating. Because of limited data on how well vaccines work in those who are immunocompromised, the path back to normalcy for this group is not as clear. People with conditions such as cancer are more vulnerable to COVID-19, and they may suffer from more severe outcomes if they get sick. And to make things more worrisome, the vaccine may not work as well in immunocompromised people, so they may have less protection, even after being “fully vaccinated.”

Let’s back up a bit. When people have cancer, there are two main reasons why they have an increased risk: either the disease itself or the treatments may cause suppression of the immune system. This indicates that a person may be “immunocompromised.” One example is that patients on cytotoxic drugs, such as 5-fluorouracil, platinum drugs, or taxanes, may be less able to respond to the vaccine. People who have had solid organ transplants and are taking immunosuppressant drugs may also not have a full response to the COVID-19 vaccine.

What Should People With Cancer Do?

So, what are people with cancer to do? As described in the first part of this series, Shmuel Shoham, MD, an expert in infectious diseases and associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore, suggests that a “cloud of vaccination” should surround people with cancer. He explained further, “Make sure that everyone who lives or comes into close contact with a patient with cancer is vaccinated because the most common place to get COVID-19 is in the home.”

But what should the patient with cancer do when they leave their home and are not sure that everyone they come in contact with is vaccinated? A media briefing was held on May 20, 2021, by the Infectious Diseases Society of America (IDSA) to shed some light on this topic. During the briefing, Jeanne Marrazzo, MD, MPH, director of Infectious Diseases at the University of Alabama at Birmingham, started by saying that “The CDC guidance… is really directed at people who are fully vaccinated and who we know are likely to have a really solid response to the vaccine, meaning they make an adequate amount of antibody to protect themselves should they happen to be exposed.” People who are immunocompromised may not make adequate antibodies when exposed to COVID-19.

Dr. Marrazzo pointed out that it is not just people with cancer who may be immunocompromised. She explained that about 3% of Americans (roughly 10 million people) may be considered immunocompromised. This includes people who have had organ transplants, liver disease, are undergoing dialysis, or those who take certain drugs for arthritis or irritable bowel syndrome. “This is a real reason to be cautious and interpret the new guidelines carefully,” she said.

The Bottom Line

If you have cancer, and particularly if you are on drugs that may suppress your immune system, be sure you and your loved ones are vaccinated and be extra cautious in how you interpret the new guidelines on mask-wearing. “Masks are a pretty powerful weapon against respiratory illnesses,” Dr. Marrazzo explained.

Those who are especially vulnerable should likely continue to wear a mask anytime they are near people who may not be vaccinated. This is especially important indoors, in poorly ventilated or crowded settings, and also in places where people may be talking loudly, shouting, or singing.

~Susan Yox, RN, EdD

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