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

The federal government relaxed its guidance Friday for summer camps, saying vaccinated adolescents do not need to wear masks at camp, and even younger campers who have not been inoculated can usually 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 set camps scrambling just days before they launch.

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 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 already had one dose of the Pfizer-BioNTech vaccine, said Erin Sauber-Schatz, team lead for 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 complex. At camps where not everyone is vaccinated, the guidance says, vaccinated people do not need masks. But unvaccinated people are “strongly encouraged” - though not obligated - 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 its 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, Gaslin said.

“There’s only so much flexibility everyone has,” she said. “We know we’re headed back toward things being closer to normal, but at the same time, camps are at that crux of, OK, we have our policy set in March, and now all these changes are coming.”

The CDC’s previous camp guidance, issued last month, was sharply criticized by some public health experts, politicians and parents for being too rigid, particularly when set against the backdrop of a nation that is quickly reopening and unmasking amid rising vaccination 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 up 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 referred to as “unworkable summer camp restrictions.”

The new guidelines urge camps to encourage both staff 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, it says.

They also encourage camps to consider local and site-specific considerations, such as regional coronavirus rates and whether campers are coming from locations 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 Christakis, editor of JAMA Pediatrics. He had slammed the previous guidelines as “draconian,” in part because they suggested that children wear masks while playing sports in hot, humid summer weather despite the low risk of outdoor transmission.

“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-authored 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 administration officials by surprise.

Public health experts have said federal officials need to explain changes in guidance to the public and explain 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’re on the fence.

CDC spokesman Benjamin Haynes said agency officials shared the camps guidance with officials at the Department of Health and Human Services, CDC’s parent agency, and the White House covid-19 response team earlier this week to ensure the guidance “was clear and actionable,” he said.