Question:
With the recent change in CDC recommendation to NOT wear masks if fully vaccinated unless there is an underlying health condition…what is your recommendation for vaccinated adults with DS. The only underlying conditions are age 60, beginning stages of dementia and sleep apnea?
Answer:
The COVID-19 vaccines that are authorized in the United States have been shown to be effective at preventing people from getting or becoming seriously ill from COVID-19 (the CDC provides information on the types of vaccines at this link and on COVID-19 vaccine effectiveness at this link). As a result, the list of activities that are thought to be quite safe for those who are fully vaccinated to participate in without wearing a mask has been expanded significantly in the recent CDC guidelines.
Does that include people with Down syndrome (DS)? There aren’t data regarding the effectiveness of the vaccines specifically in people with DS, yet. However, it is likely that the vaccines provide at least some protection for people with DS based on the overall effectiveness of the vaccines in a broad range of people. I shared information about the immune response of people with Down syndrome to COVID-19 vaccines in the article linked here. As noted in the article, studies on the efficacy of COVID-19 vaccines in people with DS are underway.
Until we have more data, here are some considerations based on the CDC guidelines:
- You can still wear a mask. “It’s never wrong to be more cautious.” That is what Dr. Robert Citronberg, Executive Medical Director of Infectious Disease and Prevention at Advocate Aurora Health, the health care organization at which I work, said when asked about the new CDC guidelines. While masks may not be required, ultimately, wearing masks is a personal decision based on factors such as your comfort with risk, the rate of infection in your community, and the risk of potentially bringing home the virus (especially if someone in the home is at increased risk for severe illness from COVID-19). I still recommend some caution. The data we have so far on COVID-19 infection in people with DS, indicate that those over age 40 and those with certain risk factors, including dementia, are at increased risk for severe illness from COVID-19.
- Small gatherings. Per the CDC guidelines, families who have all been fully vaccinated, can hold small outdoor or indoor family gatherings, without wearing masks. These gatherings can include families from multiple households if everyone is fully vaccinated. The risk of infection seems to be quite low in that situation. I recommend caution as those gatherings get larger and the knowledge of the behavior and vaccination status of the participants decreases, particularly for people with DS with risk factors that put them at increased risk for severe illness from COVID-19.
- Larger public places. Larger public places include concerts and sporting events as well as crowded stores and other congregate settings, especially those that are indoors. I recommend caution until we know more about the effectiveness of COVID-19 vaccines in people with DS. I recommend considering wearing a mask, performing hand hygiene, and practicing physical distancing as much as possible when in those settings. Others may decide that avoiding those settings altogether is prudent until we know more.
- Work and activities. Prior to the changes in the CDC’s mask guidelines but after receiving COVID-19 vaccines, quite a few individuals with DS served at the Adult Down Syndrome Center went back to work and/or activities safely. The physical and mental health benefits of returning to work and activities are significant. Even though the CDC has made changes to the mask guidelines, you may want to continue wearing masks and practicing physical distancing depending on factors such as the type of job or activity and the vaccination status of others at the job or activity. Businesses and organizations may also continue to enforce a mask requirement.
While it is anticipated that COVID-19 vaccines are effective for people with DS, we do not have data, yet. The impairment of the immune system often associated with DS may (or may not) reduce the effectiveness. In addition, there is potential risk for greater exposure to the COVID-19 virus as more people return to activities, particularly unmasked. In many settings, we may not know who is or is not vaccinated. I recommend a cautious, stepwise approach as we learn how the new guidelines work for all people and, more specifically, people with DS. Perhaps start with smaller family groups in which all the people are vaccinated. It is probably safe not to wear a mask in that setting but still acceptable to do so if desired. Perhaps consider still wearing a mask in stores, at work, and in similar settings. The CDC has given us more flexibility in their recommendation but, while we monitor the results of these new recommendations, it is reasonable to proceed forward with cautious optimism, particularly for those with additional risk factors.