National Nurses United (NNU), the largest union of registered nurses, sent a letter to the Centers for Disease Control and Prevention (CDC) yesterday, urging the agency to update its Covid-19 guidance and reinstate “the recommendation for everyone to wear masks in public or in physical proximity to others outside their own household.”
 
“NNU strongly urges the CDC to reinstate universal masking, irrespective of vaccination status, to help reduce the spread of the virus, especially from infected individuals who do not have any symptoms,” wrote NNU Executive Director Bonnie Castillo, RN, in the letter. “SARS-CoV-2, the virus that causes Covid-19 disease, spreads easily from person to person via aerosol transmission when an infected person breathes, speaks, coughs, or sneezes.”
 
The letter noted that the “Covid-19 pandemic is far from over,” with a 16 percent increase in daily new cases over the previous week and more than 40 states seeing an increase in daily new cases over the previous two weeks as well as 25 states seeing an increase in hospitalizations.
 
NNU stated that the rise in cases is not surprising due to “the rapid reopening of many states and the removal of public health measures, including the CDC’s May 13, 2021 guidance update that told vaccinated individuals they no longer needed to wear masks, observe physical distancing, avoid crowds, or get tested or isolate after an exposure, within only a few exceptions.”  
 
Unfortunately, the “CDC’s guidance failed to account for the possibility—which preliminary data from the United Kingdom and Israel now indicates is likely—of infection and transmission of the virus, especially variants of concern, by fully vaccinated individuals,” the letter continued. The Delta SARS-CoV-2 variant is already dominant in the United States.
 
The CDC’s May 13 guidance “also failed to protect medically vulnerable patients, children, and infants who cannot be vaccinated, and immunocompromised individuals for whom vaccines may be less effective.” Asymptomatic or pre-symptomatic infected people “can spread infectious SARS-CoV-2 aerosols during breathing and speaking, without coughing or other respiratory symptoms,” the letter noted.
 
Covid-19 vaccines are an important public health tool, but multiple measures are necessary to protect public health, as NNU noted in a May 17, 2021 scientific brief. However, only 48 percent of the total U.S. population have been fully vaccinated as of July 11, 2021, according to the CDC. The vaccines are effective at preventing serious illness and death from the virus for vaccinated people. However, no vaccine is 100 percent effective and the emergence and spread of variants of concern may reduce vaccine effectiveness.
 
“Masks are a simple and effective tool, especially when used in combination with other measures to reduce the risk of Covid-19,” noted Castillo in the letter. On June 25, 2021, in response to the spread of the Delta variant, the World Health Organization urged fully vaccinated people to wear masks.

In the letter, NNU also called on the CDC to:

• update health care infection control and other Covid-19 guidance to fully recognize aerosol transmission,
• require tracking and transparent reporting of Covid infections among health care workers and other essential workers, and
• track infections in people who are fully vaccinated, including mild and asymptomatic infections.