Do vaccinated people in SC need to wear masks again? DHEC’s guidance has changed

Fully vaccinated South Carolinians living in areas with high COVID-19 activity should wear masks in indoor public spaces to stem the spread of the delta variant, state health officials said.

The state Department of Health and Environmental Control announced its revised guidance Tuesday at the recommendation of the U.S. Centers for Disease Control and Prevention.

“Today’s change in guidance from the CDC reflects the very concerning trends we are seeing nationally and here in South Carolina regarding increasing case rates and a stagnant vaccination rate,” DHEC public health director Brannon Traxler said in a statement. “We were hoping to reach herd immunity to stifle the spread of COVID-19 to prevent this scenario, but public health urgency now makes it necessary to return to recommending universal masking in public indoor settings.”

The CDC, which since mid-May had advised that fully vaccinated individuals need not wear masks indoors, reversed course Tuesday amid a sharp national spike in coronavirus cases driven by the highly infectious delta variant.

The federal agency now recommends that vaccinated people in counties with significant disease transmission — more than 50 cases per 100,000 people over the past seven days — wear masks in public indoor settings.

It also released guidance encouraging universal masking in schools, regardless of vaccination status.

DHEC said Tuesday it supports the CDC’s guidance and recommends all South Carolinians, including those who are fully vaccinated, wear face masks when indoors and in public settings. The health agency’s guidance is only advisory and does not constitute a mandate, it said.

The CDC’s updated masking guidance would apply to all but five counties in South Carolina, which currently have moderate COVID-19 spread, according to CDC data. Those five are Greenwood, Lee, Marlboro, Newberry and Saluda.

The shift comes as COVID-19 infections have increased more than sixfold in South Carolina over the past month, soaring from 1,132 in the last week of June to 6,850 this past week, according to DHEC data.

As a result, the number of COVID-19 patients in South Carolina hospitals has quadrupled since July 2. Far more of those patients are in intensive care units or on ventilators than were earlier this month, but thus far coronavirus deaths in the state have not spiked, public health data shows.

Unvaccinated or partially vaccinated individuals account for the vast majority of new coronavirus cases, hospitalizations and deaths, according to a recent DHEC analysis.

Among those patients for whom vaccination status could be determined, 93% of cases, 86% of hospitalizations and 90% of deaths in June were among those considered not fully vaccinated, state health officials said.

DHEC officials attribute the recent surge in cases to the extremely infectious delta variant, which likely makes up more than half of all cases in South Carolina and can spread rapidly through unvaccinated or partially vaccinated populations.

As of Tuesday, only 44.3% of eligible South Carolina residents were fully vaccinated, one of the lowest rates in the country.

“With the delta variant, vaccinating more Americans now is more urgent than ever,” CDC Director Rochelle Walensky said Tuesday. “The highest spread of cases and severe outcomes is happening in places with low vaccination rates and among unvaccinated people. This moment, and most importantly, the associated illness, suffering and death could have been avoided with higher vaccination coverage in this country.”

While vaccination is safe and highly effective, according to health officials, it does not offer guaranteed protection against COVID-19. As of Friday, South Carolina had identified 542 breakthrough cases in residents who were fully vaccinated, although most did not suffer severe symptoms, health officials said.

One of the primary reasons state and federal health officials are now encouraging fully vaccinated residents to mask up indoors in some situations is because of new data showing the viral load for people infected with delta remains the same regardless of vaccination status.

Walensky said that while unvaccinated people are responsible for the vast majority of COVID-19 transmission in the country, vaccinated people who contract the delta variant can still pass the virus.

“Information on the delta variant from several states and other countries indicate that in rare occasions some vaccinated people infected with the delta variant after vaccination may be contagious and spread the virus to others,” Walensky said. “This new science is worrisome and unfortunately warrants an update to our recommendation.”

The data on delta differs from research on the alpha variant, formerly the dominant strain in the country and in South Carolina, which scientists did not believe could be spread by vaccinated individuals.

Since vaccinated individuals can spread delta, they run the risk of infecting people who aren’t able to be fully vaccinated, like children under 12, or passing it to people who are vaccinated but not fully protected due to having weakened immune systems.

“Part of the reason for this guidance is to make sure that we can protect those,” Walensky said, “and that people who are seeing immunocompromised people, for example, know how to protect them even though they themselves may be fully vaccinated.”

Where in SC is COVID-19 spreading?

All but five South Carolina counties currently have substantial or high rates of COVID-19 disease activity, as defined by the CDC, and would therefore be subject to the agency’s indoor masking recommendation.

Between July 19 and July 25, 41 South Carolina counties, including Richland and Lexington, reported at least 50 cases per 100,000 people, according to the CDC.

Eighteen counties reported between 50 and 100 cases per 100,000 people, defined as substantial transmission, and 23 counties reported more than 100 cases per 100,000 people, defined as high transmission.

Both Richland and Lexington counties have high rates of coronavirus transmission, according to the CDC.

Only five counties — Greenwood, Lee, Marlboro, Newberry and Saluda — reported between 10 and 50 cases per 100,000 people over the last week, defined as moderate transmission, and would not be subject to the federal masking guidance, according to CDC data.