In this Feb. 15, 2022, file photo, a masked store clerk stands behind the counter at the Cumberland Farms store on Pine Street in Portland. Credit: Troy R. Bennett / BDN

New federal guidelines released last week suggested most Americans no longer need masks to protect against COVID-19, but it came with fine print that still recommends them for a large share of medically vulnerable Mainers.

Fewer Americans live in areas where mask-wearing is recommended under the new guidelines, which incorporate recent case counts and hospitalization rates. It is an example of changing messaging that emphasizes a need to return to a sense of normalcy with finer points often drowned out in public discussion.

Maine has not officially updated its masking guidance after adopting a previous federal recommendation last summer. Gov. Janet Mills said Friday that she had directed the Maine Center for Disease Control and Prevention to review its masking guidance in light of the new federal recommendations. Maine has not had a statewide mask mandate since May 2021.

“Before, we were asking people to wear masks both to protect themselves but also to not spread it,” said Dr. Robert Horsburgh, an epidemiology professor at Boston University. “And now, the [U.S.] CDC is saying, ‘There’s not that many people spreading it, so really, you just need to protect yourself.’”

Under the new federal guidelines, everyone should wear a mask in indoor public spaces in counties that are deemed “high risk.” As of Friday, that was 13 out of Maine’s 16 counties. For counties deemed “low risk” — no Maine counties as of Friday — mask-wearing is a matter of choice, the agency said.

But for counties at “medium risk” — which included three in Maine as of Friday — people who are immunocompromised or at high risk for severe illness should talk to their health care provider about precautions such as masks or respirators, the agency said. People who live or have contact with those at high risk of severe illness should consider testing or masking when together indoors.

That is notable because the U.S. CDC’s list of conditions that put someone at high risk for severe illness from COVID-19 is long, and includes rarer conditions, as well as more common ones, such as moderate or severe asthma, hypertension and diabetes.

The exact share of Mainers with those conditions is not clear. But at the start of the pandemic, the Maine CDC estimated that nearly half of Maine adults had a high-risk condition that put them at risk of severe COVID-19. An estimate from the Kaiser Family Foundation put that figure at only 42.5 percent, with only four states — West Virginia, Kentucky, Alabama and Arkansas — seeing a greater share of adult populations at high risk.

Those estimates pre-date the availability of COVID-19 vaccines, which substantially reduce the risk of severe illness across all groups. But vaccines — while important — may not offer as much protection for someone who is immunocompromised or has other significant health conditions, said Horsburgh, the epidemiologist.

The U.S. CDC guidance for immunocompromised people reflects they remain at higher risk, he said. And use of high-quality masks, such as N95s or KN95s, should substantially reduce COVID-19 risk for the person that is wearing them, even if others around them are not similarly wearing face coverings.

Amy Stoddard of Whitefield, who has several health conditions including lupus, an autoimmune disease linked in studies to higher risk of mortality due to COVID-19, said she plans to continue wearing a mask, as does her husband.

But most people were without them when she went to pick up a to-go order at Hannaford on Monday. Stoddard said she understood why people want to remove masks and “get on with their lives” nearly two years into the pandemic, and does not want to debate anyone over it. But she hoped people would also understand why she is still cautious.

“People that don’t have any health issues don’t understand what it’s like to be in chronic pain or have chronic illness, and I’m glad for them,” she said. “I hope they never have to.”