‘Focus on Getting the Unvaccinated Vaccinated’: UCSF’s Dr. Monica Gandhi on the Bay Area’s New Masking Recommendations

Health officials in seven Bay Area counties on Friday strongly urged all residents, regardless of vaccination status, to wear masks in public indoor spaces on Friday. These counties are urging businesses to adopt masking requirements for all indoor customers.

Though coronavirus cases have steeply declined in the last six months across the country, they're now on the rise — likely due to the highly contagious delta variant. The Centers for Disease Control and Prevention reported Friday that new cases were up by nearly 70% in just a week nationwide, with hospitalizations up by 36%. Statewide, new coronavirus cases saw a 90% increase from the previous week, according to end-of-day totals on Friday. Many Bay Area counties are also seeing an uptick in cases. And in Contra Costa County, cases have more than doubled in recent weeks.

With all Bay Area counties except Napa and Solano issuing the recommendation to resume masking in public spaces indoors, KQED’s Tara Siler spoke with Dr. Monica Gandhi, infectious disease expert and professor of medicine at UCSF, about the risks and rationale behind the recent announcement.

Tara Siler: Public health officials have said vaccines are very effective against contracting serious disease or death from COVID-19. Can you explain the reasoning behind recommending that vaccinated people wear masks?

Dr. Monica Gandhi: This is actually not something that is being endorsed by the California Department of Public Health, nor does the CDC endorse the strategy because — we are really trying to stress as public health officials the effectiveness of the vaccines.

Likely, the county representatives were doing this because they wanted unvaccinated people to mask. And they likely thought that this would be a way to get everyone to mask. The worry that I have about that is, we don't want to message that these vaccines aren't effective by saying that vaccinated people have to mask. It's kind of a tricky public health messaging thing to do.

Do you think it's going to be confusing to people?

It is confusing. I've been watching the White House task force briefings very carefully — watching the messaging on masks. This has been brought up now in the last three task force briefings.

They're very clear that they really want to provide confidence in the effectiveness of the vaccines by not putting back masks for the vaccinated. They have a very clear strategy for the next phase of the U.S. pandemic response, which is focusing on areas with increasing hospitalizations and cases.

Our main focus is getting the unvaccinated vaccinated, and that is the national strategy. So we [in the Bay Area] are doing things a little bit different than that.

Do you think this is a good idea?

I am worried about the psychology of it on unvaccinated people. I also don't actually think you'll make that much of a difference in terms of cases because vaccinated people masking will not change the equation. We're in a phase of this pandemic now that it's all about getting [the] unvaccinated vaccinated. I want us to think about public health messaging that strengthens what we know about the effectiveness of vaccines.

What about the idea that you can't identify who's vaccinated and who's not — will unvaccinated people wear a mask?

I think it has put a very difficult thing on businesses. It's a fair point that unvaccinated people may not be the ones that choose to mask. But I don't think this is going to change the equation. The people getting sick are not at risk from the vaccinated. They are at risk from the other unvaccinated people. And those [transmissions] aren't happening in public spaces at stores. It's happening in private gatherings, that's where these transmissions occur. And likely passing in the store is not giving an unvaccinated person the delta variant.

Many vaccinated people in the Bay Area have been masking all along, even with reopening and cases are rising. Do we know that the more contagious delta variant is behind most of these recent cases?

We don't know the answer to that question. Yes, many vaccinated people have been masking in the Bay Area. Cases are spread among the unvaccinated with the majority of our cases, hospitalizations and deaths across the United States being among the unvaccinated.

And it's why there's such a focus by the Biden administration on figuring out what it takes to message the community, to go door to door to help people get vaccinated. That's why I think it's unlikely to make a difference.

What do you think it's going to take to get more shots in arms?

Friday was an important White House task force briefing — which I really would encourage people to watch — because it was about disinformation and misinformation being propounded on the internet. Some of this misinformation is literally that the vaccines are dangerous. Misinformation has to be controlled.

Second, we need to get FDA approval on these vaccines. You have to sign a consent form to get a vaccine under the current process — that can be a barrier to someone when they're wondering if it is experimental.

Third is community-based messaging. That's what we're doing here in San Francisco. We have higher rates of the Latinx population being vaccinated than many other places, because of the wonderful work that communities have done.

Fourth is getting it into doctors' offices and having one-on-one conversations. I have changed seven people's minds in my own practice.

Then the final one, there are going to be mandates likely in some settings. San Francisco, for example, has mandated that city of San Francisco employees get vaccinated and those kinds of restricted and more selective mandates are going to be more and more part of the American landscape in the next couple of months.

This interview has been edited for length and clarity.