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As Delta Variant Spreads, the “Honor System” for Masking Hasn’t Worked

The CDC has issued new guidelines suggesting that people resume wearing masks indoors as COVID cases rise worldwide.

The highly contagious Delta variant is causing a rise in cases around the world, from the Olympics in Tokyo to Russia, Indonesia and the U.S. The Centers for Disease Control and Prevention has issued new guidelines suggesting that people resume wearing masks indoors, but state and local officials are not legally required to implement CDC guidelines. Dr. Leana Wen, an emergency physician and former Baltimore health commissioner, says she supports the new CDC guidelines because an “honor system” of trusting people to wear masks unless they were vaccinated clearly did not work. “We know that we can’t trust the unvaccinated,” she says. She also discusses global vaccine inequity, how to overcome vaccine hesitancy, and her new memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health.


This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: Experts are warning vaccine inequality could lead to a prolonged COVID-19 pandemic, even as the World Trade Organization has failed again to agree on a proposal to temporarily waive intellectual property rights for coronavirus vaccines. This comes as a new study by the People’s Vaccine Alliance finds the cost of vaccinating the world would be five times cheaper if vaccine manufacturers were not making billions in profit.

Meanwhile, in Tokyo, where the Olympics are underway, Japanese officials have reported record-breaking coronavirus cases that set an all-time high since the pandemic began. In Indonesia, the new epicenter of the pandemic in Asia, officials have extended COVID-19 restrictions to August 2nd and stepped up vaccination drives.

Here in the United States, President Biden is formally announcing today that civilian federal employees must be vaccinated or face regular testing and follow social distancing guidelines. Google and Facebook have also announced vaccine mandates for workers, and more than 600 universities have announced mandates for students and employees. New York Governor Andrew Cuomo announced Wednesday all state hospital employees must be vaccinated, with no testing options for the unvaccinated.

GOV. ANDREW CUOMO: The court has upheld and Department of Justice just did a memo that says an employer can mandate an employee get vaccinated. We’re taking the first major step down this road. We’re saying, in state hospitals, where the state is the employer, the frontline workers must be vaccinated, period — not vaccinated or you have to have a test once a week. We’re taking that position like other state governments. The federal government is supposed to take that position for normal public employees. But for the public employees, the hospital workers who are front facing, we are mandating vaccinations, Bill.

AMY GOODMAN: On Tuesday, the CDC issued new mask guidelines that recommend even vaccinated people return to wearing masks. But state and local officials are not legally required to implement CDC guidelines. In Texas, Republican Governor Greg Abbott signed an executive order to bar local officials from requiring masks. Missouri’s Republican attorney general sued to halt a county mask mandate now in effect in St. Louis.

This comes as Mississippi top health officials say they’re seeing an “astounding” rise in COVID cases as the Delta variant spreads and threatens to overwhelm hospitals. As of last week, the CDC said 35% of U.S. counties are experiencing high levels of community transmission.

For more, we’re joined by Dr. Leana Wen, emergency room physician, former Baltimore health commissioner, also contributing columnist for The Washington Post and author of her memoir, just out, Lifelines: A Doctor’s Journey in the Fight for Public Health.

Dr. Wen, welcome back to Democracy Now! Let me start with this question. As President Biden is announcing today civilian federal health workers — this excludes Pentagon — will be required to be vaccinated, CDC saying you’ve got to wear masks once again — something you were opposed to when they changed a few weeks ago — in fact, the vaccines have not gotten full authorization. It’s still emergency use authorization. So, people who are concerned, they’re saying, “If the federal government hasn’t fully approved these, why should I risk my health?” Can you talk about what’s going on here? And what is your answer to them?

DR. LEANA WEN: Sure. And I just first want to clarify that. I was opposed to the CDC


DR. LEANA WEN: — back in May, when they lifted the indoor mask requirement. I thought that the honor code was never going to work, that when vaccinated and unvaccinated people are mixing, unless there is proof of vaccination, everybody should still be wearing masks. And so, I actually support what the CDC is now doing, which is going back to this indoor mask requirement, because, frankly, we know that we can’t trust the unvaccinated, that they have been walking around without masks, and, in fact, that’s what led to the surge that we’re seeing.

But to answer your question about what’s happening now with vaccine approval, I mean, I think it’s good that the FDA is making sure that we follow the right process. We don’t want for anything to be rushed. But, that said, whatever red-tape bureaucracy there is, we really should be cutting out, because full approval — I mean, at this point, hundreds of millions of people around the world have received these life-saving vaccines. We know, and it’s been proven, how safe and effective they are. So I’m not entirely sure what we’re waiting for. I do know that having full approval will really pave the way for a lot more employers and schools and other institutions to implement vaccine mandates, which I strongly believe is what we need at this point.

So I very much support what the Biden administration is doing with the federal government, with federal employees, saying that at this point we are in the middle of a national and international public health emergency; you have a right to stay unvaccinated if you want to, but if you want to be in public spaces, if you want to now be coming to work and be around other individuals, you don’t have a right to infect others with a potentially deadly disease. So, the idea of either testing or proving that you’re vaccinated, I think, is exactly the right one. And FDA approval in the near future, I hope, will be coming, as well.

NERMEEN SHAIKH: Well, Dr. Wen, I mean, one of the things that many people have been surprised by all over the world is that despite the fact that these vaccines have been available to Americans for several months now, only 50% of Americans are fully vaccinated. It’s a huge issue because, as you point out, now especially with the spread of the Delta variant, there have also been numerous incentives offered to Americans to take the vaccine, even as around the world people are desperate for this same vaccine. What do you think can be done, apart from, of course, the FDA granting full approval? What can be done to get people to take these vaccines, if they haven’t taken them ’til now? Is there any reason to think they’ll take them in the future?

DR. LEANA WEN: It’s a really good point that you’re making about American exceptionalism, which is that there are people around the world, who are even healthcare workers or vulnerable older individuals, who are so desperate to get the vaccine — and, frankly, some people are going to die because they don’t have access to the vaccine — and here we are in the U.S. sitting on this surplus, really having doses that are going to go to waste. We’re begging people to take the vaccine, when there are people around the world begging to get access to the vaccine. And I think that we should really be thinking about who we are as a country, what are the values that we have, and what is our obligation to people around the world, as well.

But to your point about what is it that can be done, I think that the Biden administration has done a great job in getting vaccine supply and initially working on the vaccine rollout. They, though, have hit a wall. There is really not much else that they can do, short of vaccine mandates, and that’s because you just can’t keep on doing more of the same at some point. You’ve got to admit that you’ve got to change tactics. I mean, you can’t keep on doing education and outreach. Yes, that’s really important, but that’s not going to get us over this hump. We are at less than 70% of all adult Americans having received at least one dose. We are at just about a third of teens, who are now eligible to get the vaccine, who have gotten vaccinated. And so, we really need to do something different.

In the past, we know that vaccine mandates are effective. And I think we really need to be reframing how we think about them. We should be thinking about this as we do drunk driving. You have a right, if you want to be intoxicated in your home or in some other setting, at a bar, let’s say. But you do not have the right to be intoxicated and then get behind the wheel of a car in a way that you could potentially endanger other people. And so, I think that the vaccine mandate concept is going to be increasingly important, because, for example, I have two unvaccinated young kids. I don’t know that someone has the freedom, so to speak, to transmit COVID-19 to my unvaccinated kids, or to somebody with immunocompromise or cancer and is on chemotherapy.

NERMEEN SHAIKH: Dr. Wen, I wanted to ask whether you think this has had any impact on people’s hesitancy or outright refusal to take the vaccine, that initially there were widespread reports that so-called healthcare workers were refusing the vaccine. Now the American Medical Association has said that 96% of physicians are fully vaccinated. But healthcare workers include a very large number of people. But I think, initially, many may have thought that doctors themselves are refusing this vaccine, so how do we know it’s safe? It seems it’s not safe if doctors aren’t taking it. But physicians have taken it, almost 100% of them. So, what effect do you think that’s had? And do you think that needs to be clarified further?

DR. LEANA WEN: That’s a really interesting point. And I think you’re right that at the very beginning, we were hearing a lot of reports of healthcare workers writ large, not physicians. I mean, perhaps there were some physicians who at the beginning said, “OK, I don’t want to be in the first week of getting the vaccine,” but you’d be very hard-pressed to find any physician in the U.S. now who’s not fully vaccinated and who isn’t extremely enthusiastic about recommending it to our patients and to all of our family members. It is true that, especially early on, nurses, home healthcare workers, the broader swath of people, as you mentioned, who constitute healthcare workers and the healthcare profession, there were people who were hesitant. But increasingly, this group is also getting vaccinated.

And we have now seen, I think, of last count, more than 800 hospitals and healthcare systems are implementing some type of vaccine mandate, because this is not new to us as healthcare workers. We are routinely required — every year, we have to get the flu vaccine. We’re required to have our MMR vaccines and our hepatitis vaccines, because it would just be irresponsible for us to pass on diseases to our patients, some of whom are among the most vulnerable. I mean, we have an obligation to care for our patients. This is another one where I really believe that mandates are important. We’ve seen all these medical associations get behind the idea of vaccine mandates for healthcare workers. And I think as more healthcare workers are vaccinated, it’s also important that we recognize that we are in a trusted position in our communities, and begin to tell our friends and relatives and colleagues in the community writ large about the importance of vaccination.

AMY GOODMAN: This week, President Biden responded to questions from reporters about the millions of Americans who are still unvaccinated.

PRESIDENT JOE BIDEN: We have a pandemic because of the unvaccinated, and they’re sowing enormous confusion. And the more we learn, the more we learn about this virus and the Delta variation, the more we have to be worried and concerned. And only one thing we know for sure: If those other hundred million people got vaccinated, we’d be in a very different world. So, get vaccinated. If you haven’t, you’re not nearly as smart as I said you were.

AMY GOODMAN: So, that’s President Biden. The virus now quicker, sicker, younger. Talk about who’s packing the hospitals, who’s getting intubated, people especially in their twenties, and long COVID, at this point what we understand about it, even if you’re not as sick, possibly being sicker for so much longer.

DR. LEANA WEN: Yeah, these are really good points. And I’d say two things about where we are and who’s getting sicker, based on the science and based on what we’re seeing. The first is that the good news is that older individuals, those who have chronic medical illnesses, tend to be the people who are vaccinated. And that’s why we are seeing a shift to younger groups. But it’s young people — I mean, we’re talking about people in their thirties and forties — who are becoming so ill that they’re dying and leaving behind their young children and families as orphans. We’re talking about people in their twenties who may think that they are invincible, but, exactly to your point, that they’re really not. I mean, they are also getting ill.

And even if they recover and leave the hospital, what ends up happening is that they have these long-haul COVID symptoms. I mean, I’ve seen patients, for example, who, even months after they get relatively mild symptoms, they are still so short of breath that they have trouble walking just a couple blocks. They’re so tired, they have difficulty concentrating at work, and some people have even had to take disability leave because of the symptoms that they’re having. Some people are also left with loss of hair, loss of smell or taste, and can’t now enjoy food, and they don’t know when this return to normal is going to be. And so, long COVID is a real problem.

I think something else that you mentioned about the younger, quicker, sicker, I think, is a really good point, that with the Delta variant that we now have, we know that a person infected with the Delta variant carries a thousand times the viral load than someone infected with the previous variants. And what that means is that that person can transmit a lot more virus. They also get ill a lot faster, and so potentially they could infect a lot more people, as well. And so I think people who are unvaccinated should really know that they are at high risk and also that this is not just — I mean, I agree with everything in the clip that you played from President Biden, but this is not just a pandemic of the unvaccinated. This is also spilling over to the vaccinated. And those who are vaccinated, we now know, based on the CDC, they are now able — but with the Delta variant, because they carry so much more virus, they could transmit it to their unvaccinated family members. And so, I, for example, even though I’m fully vaccinated, my children are not, because they’re too young to be vaccinated. So I need to be now careful for my children because of all the unvaccinated people around us.

AMY GOODMAN: Many countries have been unable to secure enough vaccines for their populations, and children and students in the United States and around the world have had their education disrupted for more than a year and a half. This is James Elder of the United Nations Children’s Fund speaking at a press briefing in Geneva yesterday.

JAMES ELDER: More than 600 million children who aren’t on an academic break remain affected by school closures — 600 million. … Schools need to open as soon as possible. Reopening schools cannot wait for all teachers and students to be vaccinated. Governments, at a time of great fiscal stress, need to protect those education budgets. We need to find new ways to try and — those children who were never in school, to get them back in amid COVID.

AMY GOODMAN: So, if you could talk about this issue of having vaccine accessibility around the world, and at the same time you have Pfizer in the United States saying people should get a third booster? They say they have evidence that it increases your ability to deal with the variant by something like five times, and if you’re older, far more than that. And you have companies, like Pfizer, making record profits, while what? Yesterday, Tanzania got their first vaccines. And they’re lucky. Some countries haven’t gotten any.

DR. LEANA WEN: Yeah, I mean, I think that this is a really tricky issue. Of course, global vaccine equity is a priority. As people have said, if we don’t share the vaccine with the world, the virus is going to share the world. I mean, we are going to get new variants that develop, that then impact us here, as well. So it’s a humanitarian issue, but it’s also a self-interest issue for us to share the vaccine and to figure out a better way of manufacturing the vaccines, scaling up production around the world.

I think this question of the booster shot, this is why we have federal regulatory agencies. This is the way it’s supposed to work, that the company produces data, they submit the data to the FDA and CDC, they then review the data and decide: Are booster shots needed at this time? Probably we’re going to find that the booster is necessary for some people, for example, those who are severely immunocompromised, maybe older individuals with chronic medical illnesses. But that is the way that this process is supposed to work.

I will go back to something you mentioned about children. You know, I just came out with my new book, Lifelines, and I talk a lot in the book about how we, as a country, have really failed our children here. I mean, we have consistently failed our children by not investing in early childhood education, in providing child care and so forth. But during the pandemic, we also prioritized opening bars and not schools. We also failed to invest in ventilation and other changes that could have allowed our schools to reopen safely much sooner. And I think that we are now making the same mistake. I mean, there are governors, for example, that have outlawed or banned school districts from even requiring masks, come the fall. And I really worry that we are just not prioritizing our children, their learning and their health once again. And, by the way, all those individuals who are not getting vaccinated right now by choice, they’re also impeding the ability of our kids to safely be back in school. They’re also directly exposing our children, who don’t have the choice to be vaccinated, to COVID-19 and to potential long-term consequences. And so, I hope that we, as a society, as I talk about a lot in Lifelines, take a hard look at who we are and what our values are when it comes to our children.

NERMEEN SHAIKH: Dr. Wen, we’re just going to get into your book, but could you talk about this? You’ve mentioned your children now, and many people are concerned. When is the vaccine likely to be available to them? And then, in your book, you speak at length about how the lack of access to public health impacts children, potentially for the rest of their lives. The absence of public health, poverty and other issues have a huge impact, not just in the moment, on children, but potentially for their whole lives.

DR. LEANA WEN: Right. With regard to FDA authorization, I would hope that for the 6-to-11-year-old group, that we’ll have vaccines sometime this fall, probably late fall; for the younger group, 3 to 5, maybe by winter — my hope is by this winter; and for the even younger group, 6 months to 2 years, probably at the beginning of 2022.

Now, I talk in Lifelines about my own story. I talk a lot about — the main portion of the book is talking about my experience leading Baltimore’s Health Department and the programs that we led, for example, B’more for Healthy Babies, that as a result of home visitation programs and partnerships across our city, we were able to reduce infant mortality by 38% in a seven-year period and also close the gap between Black and white infant mortality by over 50%.

But I saw, growing up as an immigrant, about how people go without access to care, and how, in this country, we do not treat healthcare as a fundamental human right, as the human right that it really is. I mean, I was, I think, about 10 years old when a neighbor child, who I — who was our neighbor, I knew well — he had a severe asthma attack, and his grandmother was too afraid to call for help because the family was undocumented. And she was afraid that their family would be deported and face immigration trouble if she called for help, and so she didn’t. And as a result, this boy died in front of me from an asthma attack. I mean, that’s something that is happening right now because we, as a country, just do not have a system where we value lives the same way, and where we are not prioritizing our children.

And so, throughout my career as an ER doc and working in public health, I’ve seen what the needs are when it comes to understanding, for example, that housing is also a health issue, that the food that we eat, the air that we breathe are also health issues. And I think we, as a society, really need to look post-COVID or at the learnings from COVID, even though we’re still very much in this pandemic. We need to see how can we really learn the lessons so that we are not failing our most vulnerable again.

NERMEEN SHAIKH: Dr. Wen, talk specifically about your own childhood — you came to the U.S. when you were 7 — and how that informed your decision to go into public health and, in particular, to focus on emergency medicine.

DR. LEANA WEN: Right. So, my parents and I immigrated from China. We were fortunate to be granted political asylum here in the U.S. My parents, though, like many immigrants, worked multiple jobs, but we still had trouble making ends meet. My father worked in a restaurant, delivering newspapers. My mother was working in a hotel, cleaning, while also getting her degree so that she could become a teacher, which she did. She ended up teaching second grade for many years in Los Angeles. But we went through many periods where we depended on SNAP, food stamps. We depended on public housing. At certain points, we were experiencing homelessness ourselves.

And that very much shaped who I am and why I wanted to specifically enter the ER. The experience that I mentioned of watching a child die in front of me when I was a child myself, I knew that I did not want to ever be in a position where I had to turn someone away because of inability to pay or because of their immigration status or because of health insurance or lack thereof. And so, that’s why I entered the ER.

But it was also in the ER that I saw how much what patients need isn’t just what we can do within the walls of the hospital. I mean, I had another patient who was a child with asthma, but he didn’t need new inhalers. He was living in an area where he was across the street from an incinerator, and there were row houses that were around where he lived that were full of mold, and that’s what was triggering his asthma. And so, that’s why I turned to public health and then had my dream job as Baltimore’s health commissioner, to lead the city to see what we can do about these social determinants of health, these other circumstances in people’s health that actually determine their well-being, and why public health can actually be a critical tool for social justice.

AMY GOODMAN: Dr. Wen, you also talk in your book about the fierce anti-Chinese backlash in this country. Do you find, as you push for mask mandates, something you have been saying consistently, whatever the federal government says — that when you push for vaccines, you get enormous pushback as a Chinese American woman? Are you receiving death threats now?

DR. LEANA WEN: You know, every time I appear on air and people see how I look, there’s something about being an Asian American person, a woman, talking about vaccines and masks, issues that have been so charged ideologically, that somehow sets people in a direction that’s extremely harmful. I mean, and it’s — you know what? It’s not really just about me. I mean, there are so many AAPIs here in the U.S. and Asians around the world who have been assaulted, who have been spat upon and blamed directly for the coronavirus. There have been shop owners whose shops have been destroyed and burned to the ground because people blame them for the virus.

I mean, there is a real consequence to the words that people use. When our former president, for example, and other allies used words like the “kung-flu” or the “China virus,” there was this insinuation that somehow people of Asian descent are to be blamed for this global pandemic that’s killed so many people. And then, understandably, some people then take out their anger — understandable anger and frustration, but they take it out on people who look like me. And this is a major problem that obviously we need everyone to help us to stop anti-AAPI hate, to start using the correct language, because language, in this case, really matters.

And I think we also need to take a stand when we’re talking about, for example, the lab leak theory, which is, obviously — the origin of coronavirus — something we need to investigate. But we need to be investigating this in a scientific way, not putting this into the political sphere, because when we do, when we make these issues partisan, there is a direct consequence on anti-Asian hate, assault and violence.

AMY GOODMAN: We want to thank you so much for being with us, Dr. Leana Wen, emergency physician, previously served as Baltimore’s health commissioner, contributing columnist for The Washington Post, author of a new book Lifelines: A Doctor’s Journey in the Fight for Public Health.

This is Democracy Now! Next up, the Senate has voted to open debate on a $1.2 trillion infrastructure bill that includes some new spending on climate and environment measures, but critics say it falls far short of what’s needed in this time of a climate catastrophe. Stay with us.

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