The new guidelines, which took effect Friday, reflect the administration’s view that the United States has entered a different, potentially less dangerous phase of the pandemic. The change follows a relaxation of restrictions already made by most Democratic governors responding to declining case counts and public pressure. But top health officials said the shift reflects that after more than two years of living with the virus, many communities have greater protection against severe disease because of widespread vaccinations, treatments, better testing and higher-quality masks, among other improvements.
CDC Director Rochelle Walensky stressed the new approach could be dialed up or down if an unpredictable virus should morph again.
“None of us knows what the future may hold for us and for this virus,” Walenksy said. “We need to be prepared and ready for whatever comes next. We want to give people a break from things like mask-wearing, when levels are low, and then have the ability to reach for them again, should things get worse in the future.”
The approach is expected to be less disruptive to daily life. It incorporates new metrics such as the number of new hospital admissions with covid-19, and the number of hospitalized covid-19 patients, as well as case counts, to assess levels of covid-19 disease in every county. Instead of focusing on eliminating transmission of the virus, it is aimed at preventing hospitals and health-care systems from being overwhelmed and protecting people at high risk for severe illness, officials said.
Officials said the framework would also provide individuals with an understanding of what precautions they should consider based on the level of disease in their community, their underlying risk, and their own risk tolerance.
Under the new approach, many parts of the country that were previously considered to have high or substantial levels of the virus are now reclassified as having low to medium levels of covid-19 disease. CDC recommends mask-wearing for indoor public settings, including schools, only in communities with high levels of disease.
In communities with medium levels, CDC recommends people at high risk for illness — including those who are immunocompromised or have underlying medical conditions — consult with their health-care providers and consider wearing a mask.
In communities with low levels of disease, high-risk individuals can consult with their providers and wear masks as needed. Regardless of the level of disease in a community, “people may choose to wear a mask at anytime, based on personal preference,” said Greta Massetti, a CDC official leading the agency’s covid response.
It’s also important for people to always wear a mask if they have symptoms, if they have tested positive, or if they have been exposed to someone with covid-19, officials said.
CDC is also changing its school guidance based on the new metrics; it is recommending universal school masking only in communities with high levels of diseases. Its previous recommendation, dating to last July was for universal masking in schools no matter the level of covid-19.
The updated barometers change the U.S. map from what was almost exclusively red and orange — signifying substantial or high transmission risk — to one that will show green, yellow and orange, signifying states and counties with low, medium and high levels of disease. With omicron cases continuing to drop sharply, officials expect fewer communities to be facing high levels of covid-19 in the weeks ahead.
CDC had previously recommended masking in areas with substantial or high transmission, a category that applied to about 98 percent of counties, representing about 327 million people. Only 91,000 people were in “low” transmission level areas.
Under the new standards, only about 28 percent of people live in high-level areas, 42 percent in medium areas and 30 percent in low areas. About 98 million Americans are now in the “low” community level.
Case counts provide a partial picture of the virus’s reach. But the number of hospitalized covid patients reflects the disease’s impact on a community — and its ability to respond to other emergencies. If hospitals or emergency rooms are filled with covid patients, people seeking treatment for heart attacks and strokes may have care delayed or even denied.
The new guidance does not say it explicitly, but it provides a framework for living safely with a virus that is expected to remain at endemic levels for the foreseeable future — a goal that has remained out of reach for most of the last two years amid recurring surges and new variants and when far fewer people had been vaccinated or developed immunity from infections.
Using metrics that measure the burden of disease in a community can better identify places where surges in ICU admissions and deaths may overwhelm hospitals. CDC officials said communities can also use additional metrics, such as wastewater surveillance, to provide more tailored information.
Although surveillance of virus levels in wastewater can be an early warning sign for covid-19, CDC’s current system does not yet cover every U.S. county.
While some experts and average Americans have criticized the CDC for being too slow to update guidance, many public health experts have expressed uncertainty about what comes next. They worry that political pressure to return to normalcy will heighten risks for the immunocompromised, elderly and young children not yet eligible for vaccines.
The new federal guidelines are intended to support state and local officials in their decision-making.
Case counts and hospitalizations are declining, but they are still at elevated levels. Less than two-thirds of Americans are fully vaccinated, defined as two doses of Pfizer-BioNTech or Moderna or one dose of Johnson & Johnson. Only about half of Americans have received a booster dose, which provides the highest level of protection against infection, hospitalization and death.
The federal government’s messaging about masks has been among the most bungled since the pandemic began two years ago. The Trump White House delayed initial guidance on wearing masks in April 2020 because some political advisers were worried that widespread mask use might cause panic. Then the CDC reversed itself one year later to say fully vaccinated Americans recommend nearly universal masking.
Federal health officials had also advised against widespread mask use to preserve enough of the higher-quality N95 masks for front-line health-care workers.