‘Is it OK if we still wear masks?’ Why some vaccinated Kentuckians can’t let go yet.

Fully vaccinated, Kristinia Robinette understands that her risk of contracting COVID-19 is very low. But like many others who relied on masking to thwart spread of the virus for so long, she’s not yet comfortable without one.

Ratcheting up her anxiety is living in a place where she knows most people around her aren’t vaccinated. Robinette is a nursing supervisor for the Lawrence County Health Department in Louisa, where 32% of county residents have chosen to get the vaccine, according to data from the Kentucky Department for Public Health.

“If everyone had been vaccinated, I would feel more comfortable,” she said Tuesday. “I just think there’s people that are just not wearing [masks] and they’ve not been vaccinated. It’s just kinda scary.”

For nearly a year, masks were the most important tool people had to keep from catching and spreading coronavirus. Though the virus is now under control in Kentucky, thanks to use of a better tool — vaccines — some people are still clinging tightly to their masks, unsure of when they’ll let go.

In Kentucky, where there are no longer capacity restrictions and people can venture in public without facial coverings, unvaccinated people unequivocally face the greatest risk, especially if they’re unmasked. Robinette knows this. She trusts that the vaccine is overwhelmingly effective at fending off a severe coronavirus infection. But she’s also regularly in close contact with people who have vulnerable immune systems, like older adults, and those who aren’t eligible for a vaccine, like children.

“I know the vaccine’s 95% effective. But what if, for some reason, the vaccine didn’t fully cover me?” she said. “I wouldn’t want to be responsible for passing it to someone else.”

It’s not totally air-tight logic, she recognizes. But continuing to mask, which she says she’ll do indefinitely, makes her feel safer.

‘A mental shift’

Marcy Rein, Whitley County Public Health Director, has heard similar hesitations from some residents in her southeastern Kentucky county. For one, now that the mask mandate has been revoked, it’s harder to tell who takes the virus seriously.

“People are getting a little bit more, like, ‘Well, I don’t know if the person who’s not wearing a mask next to me has been vaccinated, or if they just don’t believe masks are necessary,’” she said.

A recent Axios/Ipsos poll published by the National Institute for Healthcare Management found that most Americans — 75% of those polled — do not trust strangers to be honest about their vaccination status. For some Kentuckians living in rural communities where so many of their neighbors aren’t vaccinated, deciding whether to continue wearing a mask is a tricky balance.

Last week, Rein fielded a call from an older woman who, along with her husband, was uncomfortable taking off her mask in public spaces, even though both are vaccinated. “They were concerned about the lower vaccination rate and the lifting of the mask guidelines. Essentially their question was, ‘Is it OK if we still wear masks?’”

Rein said yes, it was. In Whitley County, where, like Lawrence County, just over 30% of residents are vaccinated, several residents have called the health department to ask for advice. “That’s what I’m hearing: people who are just not sure when and if taking off a mask is appropriate for them.”

Rein, like Robinette, still wears her mask in many public settings, like when she shops for groceries. That’s partly to set a good example for her kids, who she encourages to wear masks because they’re not old enough to be vaccinated. Part of it, she acknowledges, is for comfort.

“To suddenly stop doing something that was so vitally important for so long is a mental shift that I think is a significant part of it,” she said.

On June 11, when Gov. Andy Beshear lifted the state’s mask mandate for all people, including roughly half of the population still not inoculated, he did so with some nuance aimed at vaccinated people: “Wear your mask until you’re comfortable taking it off,” he said.

He also encouraged business owners who feel they’re at high risk to continue enforcing their own mask guidelines. Some businesses are choosing to do this, but most aren’t, at least in the seven Eastern Kentucky counties in Scott Lockard’s Kentucky River District Health Department.

“Businesses are ready for the mask mandate to end,” he said last week.

Mask compliance remained a challenge throughout 2020 in his district, which covers Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe counties. “We’ve been talking [to businesses] about how they can still require it, but I’m not seeing any will to do that.” There’s too much financial insecurity at stake, he said.

“Before, you could blame [the mask mandate on] the governor, you could blame the health department. But now it puts a local business owner in that precarious situation of having to be the one, themselves, to declare, ‘No, I want the mask mandate,’” he said. “They’re afraid of losing customers.”

‘Identifying the real threat’

It makes sense to licensed clinical psychologist Dr. Shannon Sauer-Zavala that some fully-vaccinated Kentuckians aren’t comfortable forgoing masks just yet.

Anxiety is often borne out of uncertainty, “and the pandemic was predicated on uncertainty,” said Sauer-Zavala, who’s also an assistant professor of psychology at the University of Kentucky.

“When there’s uncertainty, your mind will try to find ways to bring some sense of control,” she said. “That can look like wiping down your groceries [before] we realized COVID-19 wasn’t spread from surface contact. It can look like isolating yourself. It can look like wearing a mask.”

So, while the evidence shows coronavirus vaccines are highly effective at staving off infection, there’s still some uncertainty in other areas: when will vaccinated people need a booster shot? How well, overall, does the vaccine limit transmission?

“When you don’t know what the right level to protect yourself is, people might err on the side of caution,” Sauer-Zavala said. “People differ in how good they are at identifying what is the real threat, and what is more a kind of perceived threat.”

That’s a sticking point for Sara Jo Best, director of the Lincoln Trail District Health Department, spanning Hardin, LaRue, Marion, Meade, Nelson and Washington counties.

Some members of her staff are hesitant to go without masks. “It had become such a habit,” she said this week.

But Best is trying to draw a hard line for herself in order to set a good example.

“As leaders in public health, we felt like, if we were recognized in public wearing masks, it may not convey the correct message about our faith in the efficacy of the vaccine,” she said. Best worries that wearing a mask now “could be incorrectly perceived by others that I’m not vaccinated or don’t trust in the vaccine effectiveness.”

So, she no longer masks in public, unless she goes into a business that requires it. But she gets the trepidation.

“We’ve been through a traumatic event, and there are psychological impacts from that,” she said. Masks were an “important component for our protection for quite a long time. There may be individuals who have a hard time letting go of that additional feeling of protection, even if it isn’t scientifically necessary.”