For the general vaccinated Californian, the lifting of the mask restrictions indoors on Tuesday is a cause for celebration. But for the immunocompromised, this can be a huge concern.
The order only requires masks for vaccinated individuals on public transit, in youth and healthcare settings, state/local correctional facilities, and emergency/homeless shelters. Masks are still required indoors for unvaccinated people. California decided to end the mask mandate after it administered 40 million vaccinations to state residents.
While this number of vaccinated individuals is promising and helps protect the immunocompromised, this population still remains at higher risk for a number of reasons.
Dr. Anna Liu, an immunologist and infectious disease physician at Stanford Medicine, said that not only do people who are immunocompromised often fail to gain the same level of protection as people who have normal immune systems from vaccines, they also contract the virus more easily and are at higher risk for developing a new COVID-19 variant.
"And there will probably be more such cases when the mask mandate is lifted if a lot of people start mixing and gathering and removing masks, particularly indoors," Dr. Liu said.
Orange County restaurant and bar owner Jennifer S., who asked to not include her last name, remains conflicted because she suffers from Multiple sclerosis. While lifting the mask mandate helps her business and employees, she feels uncomfortable with this decision not only because of her MS, but also because the vaccine is less effective for her.
"Unfortunately for me, the medication I take because of my MS also suppressed my immune system so that I don't have the antibodies I need to have in my system that anybody with the vaccine would normally have," she said. "But I'm also in touch with the fact that I'm in a unique situation and most people don't feel the same way because they don't have to feel the same way."
Palm Springs resident Kristin Barnes, who also has MS, had similar concerns.
"I think there is a little apprehension and anxiety [about the order] for anyone who might be compromised mainly as new variants come in and things like that, there is some anxiety the more populated an area might be," said Barnes.
Dr. Liu advises people who are immunocompromised to continue to behave as if they were never vaccinated and to be very cautious around others who are not fully vaccinated.
Unfortunately, Jennifer does not have that option.
"By necessity of what I do, I have to face the public every single day," she said, whether through her customers or her employees, both of whom she interacts with. And while she has anxiety about doing this with no masks in her restaurant, she feels she no longer has the credibility to enforce them.
"You cannot put a rule in place that you cannot enforce,” she continued. “And so how am I going to enforce this when the government is no longer saying it's necessary?"
There is also a concern in the health community that people will lie about their vaccination status.
"We assume that on the honor system,” Epidemiologist and University of Southern California Keck Professor of Preventive Medicine Rita Burke said. “So everyone who is not wearing a mask that we see out there, assuming that they are also fully vaccinated, that may or may not be the case."
Now that the mask mandate has ended, Barnes plans to be a bit more thoughtful in closed environments and will continue to prefer outdoor activities over indoor activities.
Dr. Liu recommends to the general public after mandates are dropped to not ask people why they are continuing to wear a mask.
"If somebody wants to wear a mask because they feel more comfortable, it's nobody's business why they are," she said.