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CDC eases summer camp guidance, saying children do not always need masks

Children as young as 12, including Wilson Moro, can receive coronavirus vaccine. Registered nurse Jennifer Reyes inoculates him May 14 in Freeport, N.Y. (Mary Altaffer/AP)
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The federal government relaxed its guidance Friday for summer camps, saying that vaccinated adolescents do not need to wear masks at camp and that even younger campers who have not been inoculated can generally shed face coverings when outdoors.

The updated guidelines from the Centers for Disease Control and Prevention remove some glaring inconsistencies between earlier camp recommendations that all staffers and campers wear masks and more recent general announcements that face coverings are rarely needed outdoors and that vaccinated people can often forgo masks entirely. Still, even the updated guidance comes with a complex set of considerations that may prompt camps to change policies just days before they open.

A CDC official said the agency wanted to provide more nuanced guidance for a camp season kicking off under starkly different conditions from last year. Not only have coronavirus case numbers plummeted, but older teens and camp staff also are eligible for vaccination — and so, too, since earlier this month, are campers ages 12 to 15.

About 2.5 million adolescents in that younger age group have had one dose of the Pfizer-BioNTech vaccine, said Erin Sauber-Schatz, team leader for the CDC’s Community Interventions and Critical Populations Task Force, which wrote the guidance.

“We have this whole group of adolescents who by mid- to late summer can be fully vaccinated. … Camps are at a point where they can offer an opportunity to have a camp setting where everyone is fully vaccinated,” Sauber-Schatz said, adding that such a scenario can enable a “pre-pandemic camp experience” with neither masking nor physical distancing.

Of course, many camps serve younger children who cannot yet be vaccinated, and for those settings, the guidance became somewhat more complicated. At camps where not everyone is vaccinated, the guidance says, vaccinated people do not need masks. But unvaccinated people are “strongly encouraged” to wear masks indoors, and they should wear masks outdoors in crowds or when close to others for prolonged periods.

But because it may not be possible for camp organizers to know who is vaccinated and who is not, the CDC notes that camps may simply choose to apply the agency’s previous guidance: masks for all.

“The staff is going to have to be the role model. I tell my camp directors, just because your staff can remove masks doesn’t mean they should,” said Tracey Gaslin, executive director of the Association of Camp Nursing, which advises camps on health matters. “Kids at a camp are going to follow the leader and do what the counselor does.”

The rapidly shifting public-health guidelines this spring have made it hard for camps to plan, because “there’s only so much flexibility everyone has,” Gaslin said. But she praised the new guidelines for acknowledging that local conditions — such as higher coronavirus transmission rates — may require camps to employ stronger safety strategies.

“It’s not just about the individuals; it is about the camp community and how we make it safe for everyone,” Gaslin said.

The CDC’s previous camp guidance, issued last month, was criticized by some public-health experts, politicians and parents as being too rigid, particularly when set against the backdrop of a nation that is quickly reopening and unmasking amid rising vaccination rates and falling coronavirus case numbers.

Some states, including Massachusetts, rejected elements of that guidance, saying they would not require children to wear masks outdoors at camps or schools. When New York this month said children ages 2 and older would be required to wear masks most of the day at camps, parents and local officials revolted, prompting the state to soften its language to “encourage” face coverings.

At a Senate hearing where CDC Director Rochelle Walensky spoke this month, Sen. Susan Collins (R-Maine) decried what she called “unworkable summer camp restrictions.”

The new guidelines urge camps to encourage staffers and campers to be vaccinated, and they emphasize that all camps should use multiple approaches to coronavirus prevention that include hand-washing, health checks, testing and cleaning. Unvaccinated campers should be grouped in cohorts and should remain at least three feet from other people in all settings, the guidelines say.

They also encourage camps to consider local and site-specific considerations, such as regional coronavirus rates and whether campers are coming from places where those rates are higher. In areas where transmission rates are high, camps should consider requiring masks indoors, the guidance says.

The updated guidelines “are way more reasonable,” said pediatrician Dimitri A. Christakis, editor of JAMA Pediatrics. He had criticized the previous guidelines as “draconian,” in part because they suggested that children wear masks in hot, humid summer weather despite the low risk of outdoor transmission of the coronavirus.

“It’s just disturbing that they do such a 180 in [a few] weeks, which I think undermines the trust that people have in public-health recommendations,” he said. “To me, it reiterates what has been disturbing to me about this pandemic from the beginning, which is that kids have been an afterthought.”

Emily D’Agostino, an assistant professor at Duke University who co-wrote a study that found layered mitigation protocols helped prevent coronavirus spread in North Carolina day camps last summer, said she thought the new guidance was sound, even if more complex. Camp directors know their own settings well, she said, and can best choose which strategies to apply.

D’Agostino said she would still advise that camps require masks for unvaccinated people indoors, not just “strongly encourage” them, as the CDC now does.

“This points to the fact that more and more people are vaccinated, and we know that vaccines work,” D’Agostino said. But, she added: “In settings where we don’t know if everyone is vaccinated, or it’s difficult to tell, or we can’t be assured, or they’re not eligible, we still need to have these multilayered strategies.”

The camp guidance comes two weeks after the CDC announced a significant shift in its guidance: that fully vaccinated people no longer needed to wear masks or physically distance in many cases, even when they are indoors or in large groups.

The announcement caught states, businesses, medical experts and senior White House and other administration officials by surprise.

Public-health experts have said that federal officials need to explain changes in guidance to the public and say clearly what circumstances, such as vaccination coverage, might lead to changes. That way, people can better prepare for possible changes and take steps to get vaccinated if they’ve been undecided.

CDC spokesman Benjamin Haynes said agency officials shared the guidance on camps with officials at the Department of Health and Human Services, the CDC’s parent agency, and the White House coronavirus response team earlier this week to ensure that the guidance “was clear and actionable.”