As concerns mount over rising COVID-19 infection rates and the delta variant’s increased contagiousness, two state agencies on July 30 updated their recommendations on mask wearing.

The Department of Public Health is now recommending that fully vaccinated people wear masks or face coverings indoors if they have weakened immune systems, are at risk for severe COVID disease because of age or underlying health conditions, or have medically vulnerable or unvaccinated individuals living in their households.

The Department of Elementary and Secondary Education announced that it is strongly recommending that all students in kindergarten through sixth grade, except for those prevented by medical or behavioral needs, wear masks indoors this fall, given that younger children are not yet eligible to receive the COVID vaccine. The DESE said that individual school districts will be allowed to make masking decisions based on their specific circumstances. The DESE has not altered its policy of requiring all districts and schools to operate in person, full-time, five days a week, this fall.

The updated guidance came as the U.S. Centers for Disease Control and Prevention released new data indicating that, while vaccination strongly protects most individuals from severe illness, the delta variant can spread much more easily among the vaccinated than was previously understood.

DPH guidance
The state’s new advisory applies to indoor settings that aren’t people’s own homes. In particular, it aims to prevent “breakthrough” COVID vaccinations — infections in people who are already vaccinated — particularly in individuals who have weakened immune systems or other medical conditions, or whose age places them at greater risk for severe illness. The state advises that people consult with their doctor about whether they fall into a high-risk category, and directs residents to the CDC’s information page on high-risk conditions.

The DPH continues to urge people who aren’t fully vaccinated to keep wearing face coverings and masks indoors to avoid spreading COVID-19 to others.

The state dropped mask requirements for vaccinated individuals on May 29, though it has never stopped requiring masks for all people on public and private transportation systems (including ride shares, livery, taxi, ferries, MBTA, Commuter Rail and transportation stations), in health care facilities, and in other settings hosting vulnerable populations, such as congregate care settings.

Fall guidance for schools
In addition to recommending masks for students through sixth grade, the DESE also recommends that unvaccinated staff in all schools, and unvaccinated students in grades 7 and above, wear masks indoors.

The state recommends that vaccinated students remain unmasked, and the masking recommendation doesn’t apply outdoors, or when people are eating indoors. Individual who are at higher risk for severe COVID disease, and those who have a household member at high risk, are encouraged to wear a mask even if they are vaccinated. The advisory asks schools to support children’s voluntary decisions to wear masks.

Unvaccinated or not, all students and school staff must wear masks on school buses, and in school health offices. The DPH said it will provide additional guidance for school health professionals.

In addition, the state urges schools, particularly those with lower-than-average vaccination rates, to host on-site vaccination clinics during summer orientation events or at the start of classes. Schools can request that the DPH provide mobile-vaccination services, including staff and vaccination administrators, free of charge.

The state agencies said they will continue to consult with medical advisors and may update masking information as they receive more data.

Federal guidance
On July 27, the CDC issued updated recommendations advising indoor masking for vaccinated people who are at higher risk for severe illness and those who live with someone who is. In addition, the CDC recommended that vaccinated people wear masks in public indoor settings if they live in areas with “substantial or high transmission” of COVID-19.

According to the CDC’s website, two Massachusetts counties, Barnstable and Nantucket, fall into the “high” transmission category, while seven more counties — Bristol, Essex, Hampden, Middlesex, Plymouth, Suffolk and Worcester — are considered at “substantial” risk of transmission.

Both the DPH and DESE referenced updated CDC information in their announcements, but the state recommendations do not include a geographic component based on the CDC’s county-by-county findings. Though the number of COVID cases has been increasing in recent weeks, Massachusetts maintains one of the highest vaccination rates in the country.