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The Centers for Disease Control and Prevention changed course Tuesday on masking guidelines, recommending that even vaccinated people return to wearing them indoors in parts of the country — including some counties in Iowa — where the Delta variant of the coronavirus is fueling surges.
Citing new information about the variant's ability to spread among vaccinated people, the CDC also recommended indoor masks for all teachers, staff, students and visitors at K-12 schools nationwide, regardless of vaccination status and regardless of the rate of community spread.
Republican Iowa Gov. Kim Reynolds rejected the guidance soon after it was issued, criticizing the Democratic Biden administration for confusing and unnecessary messages.
"The Biden Administration's new COVID-19 guidance telling fully vaccinated Iowans to now wear masks is not only counterproductive to our vaccination efforts, but also not grounded in reality or common sense," Reynolds said in a statement.
She did not explain how asking people to wear a mask discourages vaccinations. But she added she was concerned the federal guidance could result in mask mandates for schools. Reynolds signed a law in May that prohibits local officials from requiring masks be worn in schools or businesses.
"As I have throughout this pandemic, I trust Iowans to do the right thing," she said in the statement.
Iowa ranks lower than the national average when it comes to the rate of vaccinations, with about 47 percent of the population, or 1.47 million Iowans, fully vaccinated. Like many states, vaccination interest here has stagnated.
Yet Iowa's seven-day rolling average of new daily cases was 199 as of last week when last publicly updated by the state — the highest level since May 19. At least 6,170 Iowans have died as a result of contracting COVID-19.
President Joe Biden said Tuesday his administration was considering requiring all federal workers to get vaccinated. His comments came a day after the Department of Veterans Affairs became the first federal agency to require its health care workers get the shots.
Biden dismissed concerns that the new masking guidance could invite confusion, saying Americans who remain unvaccinated are the ones who are "sowing enormous confusion."
"The more we learn about this virus and the Delta variation, the more we have to be worried and concerned. And there's only one thing we know for sure if those other 100 million people got vaccinated, we'd be in a very different world," he said.
The CDC's new mask guidance follows recent decisions in Los Angeles and St. Louis to revert to indoor mask mandates amid the spike in infections. The nation is averaging more than 57,000 new cases a day and 24,000 COVID-19 hospitalizations.
The guidance on masks in indoor public places applies in parts of the United States with at least 50 new cases per 100,000 people in the last week — communities rated as “substantial” or “high” risk of transmission, the center said.
That includes 60 percent of U.S. counties, officials said. While Iowa is rated overall to be of “substantial” risk, not all of its counties are. For example, the CDC currently lists Linn and Johnson counties to both be of the lower “moderate” risk of transmission. However, many counties including Black Hawk around Waterloo and Story around Ames were rated at the highest transmission rate. Only 10 of Iowa’s 99 counties are rates by the CDC as low risk of transmission.
New case rates are particularly high in the South and Southwest, according to a CDC tracker. In Arkansas, Louisiana and Florida, every county currently has a high transmission rate.
Most new infections in the nation continue to be among unvaccinated people. So-called breakthrough infections, which generally cause milder illness, can occur in vaccinated people. When earlier strains of the virus predominated, infected vaccinated people were found to have low levels of virus and were deemed unlikely to spread the virus much, CDC Director Dr. Rochelle Walensky said.
But with the Delta variant, a mutated and more transmissible version of the virus, the level of virus in infected vaccinated people is "indistinguishable" from the level of virus in the noses and throats of unvaccinated people, Walensky said.
The data emerged over the last couple of days from over 100 samples from several states and one other country. It is unpublished, and the CDC has not released it. But "it is concerning enough that we feel like we have to act," Walensky said.
Vaccinated people "have the potential to spread that virus to others," she said.
For much of the pandemic, the CDC advised Americans to wear masks indoors and outdoors if they were within 6 feet of one another. Then in April, as vaccination rates rose sharply, the agency eased its guidelines on the wearing of masks outdoors, saying that fully vaccinated Americans no longer needed to cover their faces unless they were in a big crowd of strangers. In May, the guidance was eased further, allowing fully vaccinated people to stop wearing masks outdoors in crowds and in most indoor settings.
The guidance still called for masks in crowded indoor settings, like buses, planes, hospitals, prisons and homeless shelters, but it cleared the way for reopening workplaces and other venues.
Subsequent CDC guidance said fully vaccinated people no longer needed to wear masks at schools either.
For months, COVID cases, deaths and hospitalizations were falling steadily, but those trends began to change at the beginning of the summer as the variant began to spread.
Some public health experts said they thought the earlier CDC decision was based on good science. But those experts were also critical, noting that there was no call for Americans to document their vaccination status, which created an honor system. Unvaccinated people who did not want to wear masks in the first place saw it as an opportunity to do what they wanted, they said.
"If all the unvaccinated people were responsible and wore mask indoors, we would not be seeing this surge," said Dr. Ali Khan, a former CDC disease investigator and now dean of the University of Nebraska's College of Public Health.
Walensky said she is aware of the criticisms and concerns, and she acknowledged that many Americans are weary of the pandemic and do not want to return to prevention measures. But she said new scientific information forced the decision to change the guidance again.
"This is not something that I took lightly," she said.
The Associated Press and John McGlothlen of The Gazette contributed to this report.