On Sunday, I spent nearly five hours on an airplane, flying home from the West Coast. For long stretches of the flight, whenever the crew was serving food and drinks, many passengers were not wearing masks. Even when people did have their masks on, many wore them below their noses.
My flight was the day before a federal judge threw out the C.D.C.’s transportation mask mandate, but my experience was typical, as any recent flier can attest. The mandate was already more of an aspiration than a reality, which indicates that the ruling may be less important than the furor over it suggests. The Covid-19 virus, after all, doesn’t take a break from spreading so that you can enjoy the in-flight beverage service.
As Michael Osterholm, a University of Minnesota epidemiologist, puts it, a mask mandate with as many exceptions as the airline mandate is like a submarine that closes three of its five doors.
On the other hand, research shows that, when used correctly, masks can be a valuable tool for reducing the spread of Covid. How, then, should the country be thinking about masks during the current stage of the pandemic? Today’s newsletter tries to answer that question.
Broad and lenient
The trouble with the transportation mask mandate was that it was both too broad and too lenient.
Its breadth required people to muzzle their faces for long periods of time, and most people don’t enjoy doing so. (If you doubt that, check out the gleeful responses of airline passengers and school children when told they didn’t have to wear masks anymore.)
A central lesson of public health is that people have a limited capacity to change their routine. They’re not machines. For that reason, the best responses to health crises depend on triage, with political leaders prioritizing the most valuable steps that people can take. Whenever politicians impose rules that are obviously ineffective, they undermine the credibility of the effective steps.
The transportation mandate had so many exceptions that many Americans understandably questioned its worth. Travelers took off their masks to eat and drink. Some flight attendants removed their masks to make announcements. Some passengers wore their masks on their chins. The mandate also did not require N95 and KN95 masks, which are more effective against the virus than cloth masks or standard medical masks.
These problems — the open doors on the mask-mandate submarine — help explain a pandemic conundrum: Rigorous laboratory tests show that masks reduce Covid transmission, but supporting real-world evidence tends to be much weaker.
The most glaring example in the U.S. is that liberal communities, where masks are a cherished symbol of solidarity, have experienced nearly as much Covid spread as conservative communities, where masks are a hated symbol of oppression. Another example is school mask mandates, which don’t seem to have had much effect. A third example is Hong Kong, where mask wearing is very popular (although often not with N95 or KN95 masks, Osterholm notes); Hong Kong has just endured a horrific Covid wave, among the world’s worst since the pandemic began.
Osterholm, who spent 15 years as Minnesota’s state epidemiologist and has advised both Democratic and Republican administrations in Washington, argues that much of the U.S. public health community has exaggerated the value of broad mask mandates. KN95 and N95 masks reduce the virus’s spread, he believes, but mandates like the one on airlines do little good.
“Public health advice has been way off the mark, all along, about mask protection,” he told me. “We have given the public a sense of a level of protection that is just not warranted.”
Osterholm added: “Let’s just be honest.”
Narrow and strict
A more effective approach to mask mandates would probably be both narrower and stricter. It would close the big, obvious loopholes in any remaining mandates — but also limit the number of mandates.
The reality is that masks are less valuable today than they were a year or two ago. Covid vaccines are universally available in the U.S. for adults and teenagers, and the virus is overwhelmingly mild in children. Treatments for vulnerable people are increasingly available.
And consider this: About half of Americans have recently had the Omicron variant of Covid. They currently have little reason to wear a mask, for anybody’s sake.
Together, vaccines and treatments mean that the risks of severe Covid for boosted people — including the vulnerable — seem to be similar to the risks of severe influenza. The U.S., of course, does not mandate mask wearing every winter to reduce flu cases. No country does.
Another relevant factor is that one-way masking reduces Covid transmission. People who want to wear a mask because of an underlying health condition, a fear of long Covid or any other reason can do so. When they do, they deserve respect.
“One-way masking works,” Dr. Amesh Adalja, an infectious-disease specialist at Johns Hopkins University, said. When he is treating tuberculosis patients, they are typically maskless, and he wears an N95 mask to protect himself.
Still, if Covid illness begins surging again at some point, there may be situations in which mandates make sense. To be effective, any mandates probably need to be strict, realistic and enforced. Imagine, for example, that a subway system mandated KN95 or N95 masks inside train cars — but not on platforms, which tend to be airy.
Or imagine that the C.D.C. required high-quality masks in the airport and aboard a plane on the runway — but not in flight when people will inevitably eat and when a plane’s air-filtration system is on. “When I travel, I’m always more worried about in-airport exposures than I am the plane,” Jennifer Nuzzo, a Brown University epidemiologist, said.
Unfortunately, the U.S. has spent much of the past two years with the worst of all worlds on masks. People have been required to wear them for hours on end, causing frustration and exhaustion and exacerbating political polarization. Yet the rules have included enough exceptions to let Covid spread anyway. The burden of the mandates has been relatively high, while the benefits have been relatively low. It’s the opposite of what a successful public health campaign typically does.
Related:
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Rather than bickering about masks, the country should enact less divisive policies — like better ventilation — that can protect people, Dr. Aaron Carroll of Indiana University writes in Times Opinion.
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