Editorial: Trusting a mask ‘honor system’ for unvaccinated

By The Herald Editorial Board

Depending on the United States in which you live, the covid-19 pandemic’s daily case rate is either on a decided and encouraging slide toward zero or is raging as badly as it was during the most recent winter surge. But those two Americas aren’t a reflection of geographical regions, nor red states vs. blue, nor urban vs. rural; the split is revealed among the vaccinated and the unvaccinated.

A recent analysis by The Washington Post, one in which Washington state is cited as a particular — and particularly unfortunate — case study shows that while rates for the state’s and the nation’s overall covid-19 cases, deaths and hospitalizations are clearly on the decline, the story is different for those metrics among those who are not vaccinated.

Nationally, The Post report found, the seven-day average case rate is at its lowest point than at any point in the last 11 months, and while slightly higher than the national rate, Washington state’s rate has shown a similar encouraging trend. The national and Washington state trends diverge, however, when the case rates are adjusted to exclude the vaccinated population and show those rates among the unvaccinated.

At a time when the Centers for Disease Control and Prevention has eased its face mask and social distancing guidelines — for those who are fully vaccinated — the Post report estimates that the unvaccinated face a 69 percent higher risk of infection; while the death rate among the unvaccinated is as high as it was two months ago and has plateaued and the national hospitalization rate among the unvaccinated is as high as it was three months ago for the general population.

Washington state is one of four states — joining Maine, Colorado and Michigan — to show covid-19 case spikes among the unvaccinated that are above the national average.

As of May 19, the Washington state seven-day average case rate was measured at 13 daily cases per 100,000 residents; but, adjusted for the unvaccinated population, that case rate average was 24 per 100,000, a figure that matched the rate last seen in late January and had surpassed figures for the pandemic’s surge in the state in April and early May.

Similar trends are seen in the figures for deaths and hospitalizations. In fact, hospitalizations among the unvaccinated in Washington state — about 20 per 100,000 residents — exceed the overall hospitalization rate in the state at any time during the pandemic.

The risks for the unvaccinated are particularly keen for those 45 and older. The Washington state Department of Health says that unvaccinated seniors are 11 times more likely to be hospitalized as those who are fully vaccinated; while those ages 45 to 64, are 18 times more likely to be hospitalized.

“Things are getting safer for those who are vaccinated,” Washington state’s secretary of health, Umair A. Shah, told The Post. “For those who are unvaccinated, they remain at risk. We have to make sure that nuanced message is getting to our community.”

Yet, that nuanced message may be going unheard, especially as those fully vaccinated get the “all clear” from the CDC and others to begin enjoying a resumption of activities closer to our pre-pandemic experience.

Other than the vaccination record some carry with them, no state official has embraced a plan to offer credentials — either a physical card or a smartphone app — that would show a record of vaccination that could allow businesses and events to easily check that status, meaning that those who are not vaccinated are trusted to follow an “honor code” when it comes to using face masks in public indoor spaces or outdoors in close proximity to others.

And not all may be honoring that code.

The Conversation reported this week that a recent survey, conducted by Matt Motta, an assistant professor of political science at Oklahoma State University, found that 1 in 4 unvaccinated people may not comply with the CDC guidelines to wear masks indoors.

Motta’s survey found that 21 percent had not received the vaccine and did not plan to do so; of that group, 26 percent said they planned to ignore the mask and social distancing guidelines; representing about 5 percent of the total of those surveyed.

While a fraction of the population, it is among the unvaccinated and unmasked where covid-19 will have its best opportunity — if given enough time and bodies — to develop new and more virulent and transmissible strains and defenses against the vaccines now developed and protecting us.

Motta concludes that those fractions of the population — unwilling or unable to vaccinate and then declining to follow mask guidelines for the unvaccinated — may not be significant enough to have negative public health consequences, though he leaves that determination for epidemiologists and public health officials. Still Motta notes the asymmetry between the CDC recommendations and the actions of the unvaccinated who disregard its guidelines.

“An ‘honor system’ approach to mask-wearing may not ultimately prolong the pandemic,” Motta concludes. “But Americans may be right to doubt whether or not unvaccinated people follow CDC recommendations.”

Also must keep in mind that while vaccinations are progressing; a significant percentage of the population cannot yet be considered fully vaccinated, two weeks past their last dose.

Nationally, about 40 percent of the population is fully vaccinated and more than 287 million doses of the three approved vaccines have been received. In Washington state, about 44 percent are fully vaccinated; and in Snohomish County, nearly 40 percent are fully vaccinated.

That honor system may indeed be the best course, by respecting the rights of Americans to make their own decisions regarding their health and placing hope that the promise of a return to a more normal daily life will encourage more to get the vaccine.

But those who have chosen vaccination — and those who because of allergies, compromised immune systems or other health reasons are ineligible for the vaccine — are trusting the honor system to protect public health.