COVID, Quickly, Episode 12: Masking Up Again and Why People Refuse Shots

Tanya Lewis: Hi, and welcome to COVID, Quickly, a Scientific American podcast series!

Josh Fischman: This is your fast-track update on the COVID pandemic. We bring you up to speed on the science behind the most urgent questions about the virus and the disease. We demystify the research and help you understand what it really means.

Lewis: I’m Tanya Lewis.

Fischman: I’m Josh Fischman.

Lewis: And we’re Scientific American’s senior health editors. Today we’ll explain why the CDC now wants vaccinated people to wear masks indoors again.

Fischman: And we’ll discuss one big reason why some people still refuse to get vaccinated.

Just a few months ago, the CDC said vaccinated people didn’t have to wear masks in most settings. But this week the agency reversed course, saying vaccinated people should wear masks at times. What do the recommendations say? And why the sudden shift in position?

Lewis: In its latest guidance, the CDC says that vaccinated people should once again wear masks in public indoor settings under certain circumstances—for example, if you live in an area with high levels of COVID transmission. (This includes people who live in places with more than 50 cases per 100,000 people in the last week.) The agency also recommended universal masking in all K–12 schools, including all students, teachers and staff.

The CDC says the reason for the shift is new data about the Delta variant and breakthrough infections. Delta is known to be much more transmissible than previous strains and appears to produce about 1,000 times as much virus in the body as the original strain. There have been reports of breakthrough infections among fully vaccinated people, and in rare cases, they may be able to transmit it to others. So the reason behind vaccinated people wearing masks is to prevent them from transmitting the virus to people who cannot get vaccinated, such as children under 12 or those who are immunocompromised.

Breakthrough infections are expected, as no vaccine is 100 percent effective. And they may be more common than we thought with the Delta variant, according to data from the U.K. and Israel. Still, the vaccines are extremely good at preventing severe disease and death—the vast majority of those hospitalized with COVID right now are unvaccinated.

If you’re vaccinated, and you get COVID, it doesn’t mean the vaccine didn’t work. As former surgeon general Jerome Adams put it in a tweet, “Think of the virus like the ocean, the vaccine like a life vest…. You may still get wet…, but your life vest ([the] vaccine) significantly lessens the chance you’ll drown.  And getting wet doesn’t mean the life vest didn’t work.”

Over the past several weeks cases, deaths and hospitalizations have all been rising in the US. We have defenses against the disease, but some people won’t use them. Vaccinations have stalled, and some unvaccinated people still refuse to wear masks. Most of us are baffled by all this. Why are people so resistant?

Fischman: I think there are lots of reasons, but there is one big one: many people still do not think COVID is a serious and deadly disease. There are two factors that contribute to this. One has to do with numbers. The other has to do with who we listen to.

Let’s look at numbers first. We have 330 million people in this country. CDC data shows that during the 18 months of the pandemic, 2.3 million have been admitted to the hospital, an indication of serious illness.

Imagine a big bowl of 300 million marbles and then drop in two million more. They’d be hard to spot. So there’s a good chance that, out of hundreds of millions of Americans, somebody might not know another person who’s had a severe COVID bout. It’s easier to dismiss it as a mild illness if severe disease is not part of your personal experience.

That appears to be what unvaccinated people believe. In June the Kaiser Family Foundation polled people about getting the vaccine. Fifty-seven percent of unvaccinated adults said what’s in the news about COVID is generally exaggerated. Only 22 percent of vaccinated adults say this. And 71 percent of unvaccinated adults say they are not at all worried, or not too worried, about getting sick from the virus.

Lewis: That’s pretty mind-boggling. Who are they taking their cues from?

Fischman: That belief has been reinforced by a lot of people, over the past year and a half, who have said that COVID isn’t serious. Psychologist Robert Cialdini of Arizona State University studies how people form beliefs and what influences them, so he and I talked about this.

People pay a lot of attention to what others around them—friends, family, neighbors, political leaders—say or do, Cialdini says. If others who share your values have a particular attitude, that makes it more legit.

The local patterns of low vaccine rates—certain counties in Alabama or Missouri, for instance—are examples of neighbors influencing neighbors this way.

Then there are national influencers. We all heard Donald Trump say that COVID is not a big deal, no worse than the flu. A lot of Republican congresspeople and governors railed against mask wearing and refused to wear masks themselves. Cialdini points out these leaders were sowing uncertainty, and uncertainty about what to do amplified their social influence.

Now we’re seeing the results, as deaths and hospitalizations race higher and higher among unvaccinated people.

But attitudes can change, Cialdini says. Social disapproval changes them—not yelling or finger-pointing. But if local leaders say that shunning vaccines hurts the community, and hurts people themselves, that can be surprisingly effective. Those notions ripple around neighborhoods. The vaccines, he hopes, will follow those ripples.

Lewis: Now you’re up to speed. Thanks for joining us. It’s summer, and we’re about to leave on a short break.

Fischman: We’ll be back at the end of August. So come back then for more COVID, Quickly! And check out for updated and in-depth COVID news.

[The above text is a transcript of this podcast.]

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