If you’re fully vaccinated against COVID-19 (as in, you’ve gotten all your shots and waited two weeks) the U.S. Centers for Disease Control and Prevention announced Thursday you can mostly go ahead and stop wearing your mask and stop social distancing — inside and out.

“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,” the CDC now says. (There are some important exceptions we’ll get into below.)

The shift in guidance was a dramatic reversal from the country’s top public health agency, which has been criticized for being too conservative (and convoluted) in its earlier guidelines for those who are vaccinated. The latest changes have left a lot of people with a lot of questions, which NPR’s science, health and education reporters are here to answer.

Was this shift in the guidelines a surprise?

Yes, many leaders in the public health world say they didn’t see the loosening of recommended restrictions coming so quickly, and some were dismayed.

Dr. Leana Wen, an emergency physician and public health professor at George Washington University, called the change “stunning” in a Friday interview with NPR. “CDC seems to have gone from one extreme of overcaution, to another of basically throwing caution out the window.”

You’re Vaccinated. Congrats! Now What Can You Do Safely?
“If the United States had the vaccination rates of Black communities (about 27%) I don’t think the CDC would have changed the masking guidelines,” Dr. Rhea Boyd, a pediatrician and public health advocate in the Bay Area, wrote on Twitter. “We should change guidelines when it is reasonable and safe for the populations made MOST vulnerable, not for those who are the least.”

Others were more supportive. “All of us who work in public health and in medicine have a very high level of respect and confidence [in] the Centers for Disease Control,” Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, told NPR Friday. “So when they say ‘now’s the time’ and the data suggests that this is the safe and effective thing to do, that means a lot to many of us.”

– Selena Simmons-Duffin, health reporter

Was the change based on science?

CDC says that yes, this decision was based on the current state of the pandemic in the U.S., along with evidence that vaccines are extremely effective in the real world. “That science, in conjunction with all of the epidemiologic data that we have, really says now is the moment,” CDC Director Rochelle Walensky told NPR Thursday.

Walensky notes that the number of cases, hospitalizations and deaths in the United States have declined significantly in recent weeks. That suggests that, because of vaccination — and because some people are immune because of previous infection with the coronavirus — the pandemic is gradually coming under control.

Walensky has also cited several recent studies of health care workers as evidence that vaccines provide excellent protection against disease. One CDC study published Friday found that, across 33 sites, vaccinated health care personnel were much less likely to get sick with COVID-19 than those who were unvaccinated.

Another recent study conducted at a major medical center in Israel followed about 5,500 fully vaccinated workers for two months. Of those, just eight developed any COVID-19 symptoms, such as fevers or headaches. Another 19 tested positive for the virus even though they had no symptoms. This rate of infection was significantly higher for workers who did not choose to be vaccinated. It’s hard to compare that very low rate of infection directly with the risk to the general public. These workers were at much higher risk for infection because they worked in a hospital, but they also wore masks, which limited their exposure.

Most people who do get infected despite having been vaccinated are very unlikely to develop serious illness, the evidence suggests. Most have no symptoms at all, or milder symptoms. However, these so-called “breakthrough infections” have occasionally resulted in hospitalizations and deaths, so the risk is not zero.

“There are those people who don’t want to take that bit of a risk,” Dr. Anthony Fauci, President Biden’s chief medical adviser, said on Thursday in the press briefing announcing the new guidelines. Those people may decide to continue wearing masks, he said, “and there’s nothing wrong with that, and they shouldn’t be criticized.”

– Richard Harris, science correspondent

Does CDC’s announcement change my local rules?

Not automatically. The public health system in the United States is decentralized. CDC doesn’t run or oversee and can’t overrule your local or state health department — it just provides support, such as partial funding and guidance. You’ll still need to check the local rules where you live to see how they’ve changed (if they have) in response to this week’s shift in the CDC’s guidance — here is an NPR roundup of recent state responses to the news.

Plescia of the Association of State and Territorial Health Officials tells NPR that “in states or local situations where there are already laws or regulations about mask wearing, we’ll have to have a look at those laws and regulations and see how we might change them based on this new science and this new announcement.”

For now, when you leave home, it makes sense to bring a mask with you in case the place you’re going still has a “mask required” sign on the door.

– Selena Simmons-Duffin, health reporter

What about going to the grocery store? Or the office?

Whether you need to wear a mask indoors in public venues will depend on local mandates and guidelines, as well as businesses, which make their own operating decisions. CDC’s general guidance for businesses hasn’t yet been updated since this week’s change of recommendation regarding masking for people who have been vaccinated.

Most legal experts agree employers can require vaccination of their employees returning to the workplace. The Equal Employment Opportunity Commission reaffirmed that position. But the majority of employers aren’t going so far as to require shots. According to a February survey by the Society for Human Resource Management, 60% of employers are NOT considering a vaccine mandate (35% are still undecided). It is legal for employers to ask to verify vaccination by checking, for example, a worker’s vaccination card — so long as they are not requesting other medical information that may violate the employee’s privacy.

At the same time, employers also have an obligation to maintain a safe workplace, which can get especially tricky for those that interact with members of the public who may or may not be vaccinated. Whether employers will continue to require masking in their workplaces may depend on a range of factors like local public health regulations, whether that employer has a vaccine mandate (and therefore only vaccinated employees are on site), or whether they have enough space in the facility to distance those who are unvaccinated.

To make things more complicated: Because there are also anti-discrimination laws to take into consideration, employers will also need to accommodate workers who remain unvaccinated because of medical or religious reasons. That means employers need to enforce policies uniformly for all similarly situated employees.

Some settings should still require masks even for fully vaccinated people, according to the new guidelines, including correctional facilities, homeless shelters, and staff, patients and visitors in health care settings.

“Locations such as health care facilities will continue to follow their specific infection control recommendations,” CDC Director Walensky said when announcing the new guidelines.

– Yuki Noguchi, consumer health correspondent

What about schools?

Schools are a bit different from businesses, especially since kids under age 12 are not yet eligible to be vaccinated.

It is unclear what impact this will have on teachers, staff and students in the near term. CDC has not yet revised its K-12 schools safety guidance. “What we really need to do now as an agency is comb all of our guidance […] for schools and for camps and for child care centers and for all of the guidance that we have out there and apply the guidance that we have for individuals — vaccinated individuals to that,” Walensky told NPR.

At least one district did move quickly Thursday to announce changes to its own in-school safety policies. “In accordance with the new [CDC] guidance, Cobb Schools will no longer require fully vaccinated individuals to wear a mask,” wrote Chris Ragsdale, the superintendent of schools in Cobb County, Ga. “I would also like to make clear that any individual wishing to continue wearing a mask while attending school and/or school events should feel free to do so.”

In some states, masks in schools are already optional. “Whether a child wears a mask in school is a decision that should be left only to a student’s parents,” said South Carolina Gov. Henry McMaster earlier this week as he issued an executive order allowing parents to opt their children out of school-based mask requirements.

That move was excoriated by the Palmetto State Teachers Association. In a statement, the group said, “many families and staff no longer have a choice for in-person learning if those individuals desire to follow the clear instructions of our public health authorities.”

And Becky Pringle, president of the nation’s largest teachers union, the NEA, urged state and district leaders not to scrap in-school masking mandates.

“We know at this point that only a third of adults are vaccinated and no students younger than 16 are vaccinated,” Pringle said Friday in a written statement. “CDC’s key mitigation measures for safe in-person instruction, including wearing masks, should remain in place in schools and institutions of higher education to protect all students and others who are not vaccinated.”

How do I know people around me are fully vaccinated?

You don’t. The U.S. federal government has declined to pursue the idea of vaccine passports that would verify someone’s vaccination status as a way of allowing them to follow different sets of rules.

“The government is not now, nor will we be supporting a system that requires Americans to carry a credential,” White House Coronavirus Response Coordinator Jeffrey Zients said in an April press briefing. “There’ll be no federal vaccination database [and] no federal mandate requiring everyone to obtain a single vaccination credential.”