Almost 600 colleges and universities have mandated COVID-19 vaccination for students attending classes in the fall semester. Most of these schools have also mandated vaccination for faculty and staff. They all say the objective is to provide a “safe” campus environment. The University of Notre Dame, for example, stated in a recent “Policy Update” that its “highest priority” is the “health, safety, and well-being of every member of this community.”
Most of these schools make exemptions available for medical or religious reasons. Along with that group, every campus population will include those who decline to be vaccinated for other reasons. On every campus there will be a substantial number of staff, faculty, and students who are not vaccinated when classes resume. What is to become of them?
Where the unvaccinated are permitted to remain on campus at all, they will be subject to a regimen of discriminatory burdens. These protocols might include social distancing or repeated surveillance testing, sometimes at considerable cost to the student. They will surely include masking in all indoor spaces and in certain circumstances outdoors.
Currently, due to the delta variant, mask requirements for the vaccinated are fluid. Because we are now seeing more breakthrough cases among the fully vaccinated, the latest recommendation from the CDC includes indoor masking even for the vaccinated, but this may continue to change as cases fluctuate.
Many campuses are still likely to subject the unvaccinated to dramatically different masking requirements than those incumbent on the vaccinated. Notre Dame, for example, makes masking indoors “optional” for anyone who is vaccinated. But “[u]nvaccinated faculty, staff and students must wear a mask indoors, except when alone in a private office.”
Does the relevant scientific evidence support this disparate treatment of unvaccinated campus residents and workers? Most certainly not, as we will explain.
Unvaccinated with Natural Immunity to COVID
To begin with, many of the unvaccinated students, staff, and faculty have already had COVID. Their immunity to the virus and their ability to transmit the virus are not proven to be different than that of the vaccinated. The scientific evidence establishes that the natural immunity carried by these COVID survivors is at least as effective and as durable as anything the vaccines deliver.
For example, this recent Centers for Disease Control study of a gamma variant outbreak among miners showed the attack rate was 60 percent among fully vaccinated miners and 75 percent among unvaccinated miners without a history of infection. By contrast, there were zero cases in those who were previously infected with COVID.
While vaccine efficacy may be waning with time and new variants, we have not seen natural immunity wane over time. Another recent CDC study of a July outbreak in Massachusetts found that 74 percent of COVID cases occurred in fully vaccinated persons. By contrast, there have not been recent reports of similar breakthrough cases in those with natural immunity.
But none of the college exemption protocols we have examined offer exemptions on the ground of prior infection. Insofar as a discriminatory mask regimen is meant to protect unvaccinated COVID survivors from getting the disease, the regimen is, literally, pointless – even more so, as mounting evidence, including the studies mentioned above, suggests that the duration of immunity from the vaccines is considerably shorter than that of natural immunity.
While vaccinating COVID-recovered patients might produce an antibody uptick, there is no epidemiological evidence that this improves relevant clinical outcomes like symptomatic reinfection. The data also show that those who possess this natural immunity present no greater risk of transmitting the virus to others than those who have been vaccinated and acquire breakthrough infections.
Vaccinating COVID-recovered individuals anyway adds nothing of clinical value. Here, too, discriminating against the unvaccinated who have recovered from COVID by making them wear masks is, as a matter of scientific fact, pointless.
Unvaccinated without Natural Immunity
Not all of the unvaccinated persons on campus will be naturally immune, though. One might quickly jump to the conclusion that requiring them to wear masks is justified because it protects the unvaccinated against infection. There are two reasons this justification fails.
One is the scientific evidence that masks do not prevent community transmission of respiratory viruses. Between 2008 and 2020, 12 consecutive randomized controlled trials of community masking (here, here, and here), conducted among approximately 18,000 persons worldwide, established that this intervention does not reduce community respiratory virus transmission, including COVID-19 transmission.
The second reason is the desire to protect the mask wearer from infection does nothing to justify discrimination: while reinfection for the naturally immune is exceedingly rare (Israel recently reported that 53 percent of new cases were in vaccinated individuals, 43 percent of cases were in unvaccinated individuals, while only 1 percent of cases were in individuals who had already recovered from the coronavirus), both the vaccinated and the unvaccinated are subject to COVID infection.
Reinfection for the naturally immune is comparatively much rarer than it is for those who are vaccinated. Another recent study from the Israeli Health Ministry examined a total of 835,792 Israelis known to have recovered from the virus. The 72 instances of reinfection counted were 0.0086 percent of people who were already infected with COVID.
By contrast, Israelis who were vaccinated were 6.72 times more likely to get infected after the shot than after natural infection, with more than 3,000 of the 5,193,499, or 0.0578 percent, of Israelis who were vaccinated getting infected in the latest wave. Unfortunately, breakthrough infections among the vaccinated are now increasingly common, as we learn that the vaccines’ effectiveness sharply diminishes with time since injection.
Besides, the vaccines never promised immunity from infection. All that their makers said was that they would prevent most people who get infected from developing serious symptoms. That’s all that the evidence shows that they do too. As mentioned already, natural immunity seems to offer more robust and longer-lasting protection.
Mistaken Rationales for Masking the Unvaccinated
Of course, one might say that the unvaccinated are at a singular risk of developing a serious symptomatic case of COVID. The way to protect the unvaccinated from the risk of serious COVID-related illness is not, however, to mask them. It would be to mask everyone else so that the unvaccinated do not get sick from the airborne germs of others, a burden that the colleges rightly do not impose.
Another possible justification for the colleges’ discriminatory mask rules is that they protect the vaccinated majority from risks presented to them by the unvaccinated minority. Keep in mind, however, that the vaccinated are now known to be at risk both of contracting the virus from others and of transmitting it to others once infected.
The CDC’s director recently acknowledged, when commenting on the increasing number of breakthrough infections among the vaccinated, that vaccinated people with breakthrough infections of the delta variant carry just as much virus in the nose and throat as unvaccinated people and may spread it just as readily. With the rise of breakthrough infections and the waning of vaccine efficacy over time, members of the unmasked vaccinated majority may present a more significant risk to each other of infection than would a minority of unvaccinated people, if only due to their far greater numbers among the campus. Thus, to be safe, it would make sense to require the larger group to mask up too, following the logic of reducing risk.
The last possible justification for these mask-the-unvaccinated rules is, perhaps, paradoxical: it is to protect the unvaccinated people on campus from each other. If it is true that masks impede the transmission of the disease, then masking them would indeed likely lower the incidence of infection and, in turn, of serious consequences.
But even supposing that masks work in this way does not justify the discriminatory rules in place on campus. Remember, we are not talking about segregating the unvaccinated, as if one could imagine all of them interacting only with each other while all masked. On the contrary: the colleges require masks of the unvaccinated precisely so that they can go about normal business, mixing at will with everyone else on campus. In these circumstances, the unvaccinated are at risk of infection from the majority of those they encounter who are vaccinated and unmasked, yet still possibly infectious.
Consider, for example, the CDC study of the Massachusetts outbreak in July in which 74 percent of those infected had been fully vaccinated. Requiring the minority of campus denizens who are unvaccinated to wear masks in such a setting makes less of a difference than would requiring the majority to wear masks. If protecting the unvaccinated from each other is the rationale, then the majority should be required to wear masks too.
Why Not Require Masks Just to be Safe?
Of course, one might say that masking the unvaccinated might yet do some good. Who knows? The science is always “evolving” some say. So go ahead and require it. Why not?
This casual reply is wrong in several important respects. It ignores the truth that the masking rules in place are arbitrarily discriminatory, and that is simply wrong.
Besides, masks are burdensome, and some evidence suggests they may harm people socially and psychologically. They are annoying for many to wear. They are medically contra-indicated for some. They typically impede conversation and generally reduce the quality of social interactions.
Most important, those wearing masks on campus this fall will thus be marked with a scarlet “A,” as persons who – according to the negative implication of everything the colleges say about masking them – have chosen not to make the “health, safety, and well-being of every member of this community” their “highest priority.” Those wearing masks will, in other words, stand out as unclean and dangerous – when in scientific fact they certainly are not.
Of course, we do not suggest that colleges should prohibit mask-wearing. We recognize that many people might feel more comfortable or secure wearing masks. We suggest the colleges say these people are welcome to do so, so long as the colleges also stipulate that mask-wearing is not mandatory.
This allows both the vaccinated and unvaccinated who are still concerned about infection to choose to mask. By making it a matter of personal choice, the colleges could accommodate everyone, and incidentally remove the unjust stigma and discrimination of the protocols now in place for the school year.
Andrew Bostom, MD, MS, is an associate professor of family medicine (research) at the Warren Alpert Medical School of Brown University. Gerard V. Bradley, JD, is a professor of law at the University of Notre Dame. Aaron Kheriaty, MD, is a professor of psychiatry at the University of California at Irvine School of Medicine and the director of the Medical Ethics Program at UCI Health. Harvey A. Risch, MD, PhD, is a professor of epidemiology at Yale School of Public Health.
Originally Posted on: https://thefederalist.com/2021/08/18/why-forcing-unvaccinated-students-to-wear-cloth-masks-is-anti-science/
By: Andrew Bostom, Gerard Bradley, Aaron Kheriaty, and Harvey Risch