Like many North Texans, Sarah Watkins followed federal advice and stopped wearing her mask after getting her COVID-19 vaccine earlier this year.

But lately, as she watched the number of delta variant cases grow in the region, the 62-year-old retired Plano ISD principal started to have second thoughts.

“I made the decision a week or two ago that I’d mask up indoors, for the most part,” Watkins said. “Especially when you’re around people you don’t know, [it is] just an added layer of precaution.”

Vaccinated or not, the Centers for Disease Control and Prevention said Tuesday, people like Watkins should start masking indoors again.

The new guidance calls for wearing masks indoors and in public in areas with high or substantial community spread. That applies in areas with at least 50 new cases per 100,000 people in the past week, or if at least 8% of tests are positive in that period.

Dallas, Tarrant and Denton counties have high levels of coronavirus transmission, according to a CDC map. Collin County currently has a substantial level, the CDC says.

The CDC also recommended indoor masks for all teachers, staff, students and visitors to schools, regardless of vaccination status.

The reason for the new recommendations is the spiking of cases and hospitalizations alongside the rapidly spreading COVID-19 delta variant, especially among people who are unvaccinated.

Dallas County reported a three-day total of three COVID-19 deaths and 1,453 new coronavirus cases Tuesday. Only 52% of the county’s population over 12 years old has been fully vaccinated, according to county data.

Those numbers mean it is especially important for North Texans to mask up in public, said Dallas County Judge Clay Jenkins.

However, statewide rules from Gov. Greg Abbott limit any localities’ ability to reinforce the CDC’s recommendations with government-issued mandates.

“The scientists at the CDC are not running for election; their only interest is in keeping us safe,” Jenkins said Tuesday. “If they’re giving us advice, we need to follow it.”

Delta sparked change

In May, the CDC said vaccination rates and availability meant that those who got the shots would no longer need to wear masks indoors in most settings. The CDC’s guidance still called for wearing masks in crowded indoor places like buses, planes, hospitals, prisons and homeless shelters, but it cleared the way for reopening workplaces and other venues.

The new guidelines follow recent decisions in Los Angeles and St. Louis to revert to indoor mask mandates amid a spike in COVID-19 cases and hospitalizations that have been especially bad in the South. The country is averaging more than 57,000 COVID-19 cases a day and 24,000 hospitalizations.

Most new infections in the U.S. continue to be among unvaccinated people. But “breakthrough” infections, which generally cause milder illness, can occur in vaccinated people. When earlier strains of the virus predominated, infected vaccinated people were found to have low levels of the virus and were deemed unlikely to spread it much, said Dr. Rochelle Walensky, the CDC’s director.

But with the delta variant, the level of virus in infected vaccinated people is “indistinguishable” from the amount in the noses and throats of those who are unvaccinated, Walensky said.

Last week, Dallas County increased its COVID-19 threat level for unvaccinated people to orange, or “extreme caution,” after just over a month at a lower level. The move discourages indoor dining and recommends limiting nonessential travel and keeping outdoor gatherings to 10 people.

“We can keep frequenting our favorite businesses, but we can do it safely,” Jenkins said. “I know it’s hot out there, but we can choose the patio.”

John Wiley Price, a Dallas County commissioner, said he supported whatever new mask guidelines or vaccination requirements were necessary to stop the spread of the virus. He said he would back any new measures taken by the county to do so.

“Whatever we have to do to manage this situation, I am with it,” Price said. “You can’t depend on everyone to be responsible and accountable, and therefore we owe it to everyone else to try and manage them into some accountability.”

With regard to schools, Jenkins said, “It’s really up to parents to follow the advice of school districts and the CDC and get children to wear the mask.”

Abbott has insisted that masks will not be required in Texas schools and has recently reiterated that he will not allow other government entities to enforce mask mandates.

Last week, Abbott told KPRC-TV in Houston that it would be “inappropriate to require people who already have immunity to wear a mask.”

Vaccination rate key

Beyond masks, medical experts say, vaccines are the most surefire way to stop the spread of the disease. Nationally, many employers have begun considering vaccination mandates.

Vaccines are already required for employees of the Department of Veterans Affairs, the state of California, New York City and other groups. Last week, a federal court upheld a similar mandate for students at Indiana University, signaling that more such mandates may be permissible. President Joe Biden said Tuesday he’s considering a similar requirement for all federal workers.

Dallas County Commissioner J.J. Koch said he worries that more mask mandates would make people less likely to line up for the shot.

“We’ve had a hard enough time getting people vaccinated,” Koch said. “I do really have some deep, deep concern for any kind of mask mandates for anyone indoors.”

Koch said that because of Abbott’s strong position against masking requirements, the point is moot for the county. But he hopes the county will continue efforts to increase vaccination rates rather than the CDC’s masking guidance.

“If we require people to mask again, I guarantee that the adults who we need to get vaccinated are not going to do it,” he said. “I’m going to spend most of my time encouraging folks to get vaccinated.”

‘I don’t trust everybody else’

Leslie Kelly’s mental and emotional health have suffered over the past year as she has had to work from home and worry about loved ones.

Despite getting vaccinated and concern about getting back to normal life, Kelly, a 24-year-old Plano resident, has continued to wear her mask, no matter where she is.

“My motivation was never to chuck off the mask as soon as possible,” Kelly said. “With the way that other people are handling it, I’m not going to be comfortable with that for a long time still.”

Kelly said seeing rising cases of the delta strain while fewer than half of Americans are vaccinated validated her decision to stay masked.

“It’s not that I don’t trust the vaccine. I absolutely do, but I don’t trust everybody else.”

Jenkins said that although he encourages everyone to be vaccinated as soon as they’re able, he doesn’t blame people who haven’t gotten the shot yet.

“We can’t take the position that ‘I’m not going to do my part because I am angry’ and perceiving that someone else isn’t doing their part,” Jenkins said. “That’s not how you win a war.”

The Associated Press contributed to this report.