US COVID cases are on the rise again – and as always, Americans are arguing over masks.
It is a pattern as sustainable as the pandemic itself. Infections go up. So are the masks. And the same reflexive Twitter wars – are they actually slowing the spread? Should they really be required? – follow proper command, with the usual fighters retreating to their predictably polarized and politicized corners.
But what if the Great American Mask-Off is a waste of time right now in the pandemic? Worse, what if it’s a diversion† What if we were fighting over one relatively insignificant factor when we could focus on much more useful solutions instead?
The latest round of U.S. mask hostilities began earlier this week when Philadelphia became the first major city in the country to announce it would reinstate its indoor mask mandate in a bid to curb climbing cases. (The BA.2 variant – a more transmissible sublineage of the original BA.1 Omicron strain – is now responsible for nearly all US infections and case numbers. have therefore gradually increased†
some universities also brought back mask requirements, including American and Georgetown in Washington, DC, and Columbia in New York City. Then the Biden administration announced on Wednesday that it was temporary extension of its own nationwide mask requirement for planes, buses, trains and transit hubs that was due to expire on April 18.
The news caused the usual cheers and cheers. In the extremes, some cited such reversals as proof that inner mandates — which all 50 states eventually lifted earlier this spring — should never have expired in the first place, but should have remained in effect indefinitely. Others continued to insist that masks were always meaningless.
For the record, face coverings — especially high-quality, well-fitting ones — do help. A California study released on February 4, for example, found that using masks indoors, including in schools, reduced the likelihood of a positive COVID outcome by an average of 44%; N95s and KN95s reduced them by 83%. A lot other studies show similar benefits.
There are more nuanced positions on either side of the current debate – both for and against renewed mandates – that acknowledge this reality. Former Baltimore Health Commissioner Leana Wen wrote on Tuesday that “Philadelphia’s mandate for indoor masks was premature” and “other cities should not follow suit” — not because masks are ineffective, but because “mandates should not be reintroduced” when “hospitals have good capacity and vaccines work well against variants.” “
“If it were the case that even a very minimal increase in cases with no increase in hospitalizations leads to more masking requirements, you would see a lot of masking requirements,” agreed Dr. Bob Wachter, chair of the Department of Medicine at the University of California, San Francisco. “I think the backlash from the public is going to be pretty big. We want the public to trust us at this point that the masks can stay off… unless there’s a significant threat to the community.”
In response to such arguments, Philadelphia Health Commissioner Cheryl Bettigole told Politico earlier this week she took “a deep dive into Philadelphia’s data” and found that during “each of the” [previous] waves” the statistic “which appeared to be the most predictive” of a subsequent increase in hospitalizations “was a 50 percent increase in cases over a 10-day period.”
“So it feels like something is starting,” Bettigole continued, adding that her goal was to make it happen. But “if it turns out that we’ve reached a point in the pandemic where hospital admissions are no longer associated with an increase in the number of cases,” she concluded, “then great. That would be great news.”
Each of these positions — let’s not overreact against let’s be careful — has merit, especially in the early stages of what may or may not be a turning point toward a less disruptive and dangerous virus† It’s not a mistake to demand a bit longer masks, or wait and see how BA.2 behaves before deciding.
But in the end, neither side seems to consider an even deeper truth: Pandemic regulations are not the same as pandemic behaviour — and it’s unclear if changing the former can still meaningfully change the latter. However, the impact may be limited.
In less cautious areas, mask mandates ended long ago; widespread personal masking ended even earlier. It’s not coming back.
In more cautious areas, people still “believe” in masks and mandates are still on the table. But the thing with mask mandates is that they don’t apply to institutions where the most transfer happens – while private get together with family and friends, or drinking in barsor dining in restaurants, or drinking or dining at concerts. Likewise, most school administrators have decided that the risk to children is low enough to make masking in the classroom optional.
When COVID kicks in, unmasked shoppers in supermarkets are not the primary cause. The primary cause is prolonged exposure in areas not covered by mask mandates.
The more COVID spreads through a given community, the more cautious many people will choose. But that will happen regardless of the rules. “Despite two years of evidence to the contrary, we continue to attribute to policy what is better understood as people making independent decisions in response to the status of the pandemic,” Financial Times data journalist John Burn-Murdoch recently explained:†
The question then is whether rules that don’t even require people to consistently cover their faces in bars, restaurants, concert halls, schools or private homes can mean much Lake of a difference in behavior (and thus in transmission).
If not, Americans may be paying more attention to mask mandates than they deserve — and the U.S. might want to focus elsewhere in the future, experts say.
An Italian study published in March, for example, showed that efficient ventilation systems spread in schools by more than 80%. But while the Biden government just released new guidelines for indoor ventilation and filtration in schools and businesses — a welcome first step — there is no new federal funding earmarked to encourage upgrades. There is also no way to enforce the recommendations.
“If We Must” live forever with this coronavirus – as seems very likely – some scientists are now pushing to rethink building ventilation and clean up indoor air”, writes the Atlantic’s Sarah Zhang† “We don’t drink contaminated water. Why do we tolerate breathing polluted air?”
Next-generation vaccines delivered not by an injection in the arm but by a spritz in the nose would be another way to limit transmission.
“As experts debate when, if and who should get extra boosters, a growing number of scientists are beginning to think that extra injections could have marginal benefits for most healthy people,” explains the Caroline Johnson of the Washington Post† “A change in the route of vaccine administration from an injection to a pinch can erect a wall of immunity right where viruses take hold and block the spread of the virus, prevent even mild infections†
But while “we could have Operation Warp Speed” [these] next-generation mucosal vaccines,” said Karin Bok, director of Pandemic Preparedness and Emergency Response at the National Institute of Allergy and Infectious Diseases, “we don’t have the money to do it.”
And then there’s the antiviral pill Paxlovid, that is 88% effective against hospitalization and death when administered to unvaccinated people at high risk for severe COVID within five days of the onset of symptoms. But in February there was actually an oversupply of this potentially life-saving drug at some US pharmacies; many Americans continue to hesitate, don’t know how to get a prescription, and aren’t sure if they qualify. And unless a jammed senate Badges another $10 billion in COVID fundingthe US will not have the money to buy additional oral antiviral pills above the 20 million already secured.
The list goes on: exporting more vaccine doses to under-immunized countries to boost equity and help block new variants. A renewed push to vaccinate and stimulate the elderly. And for the immunocompromised, an abundant and easily accessible supply of Evusheld, a cocktail of two doses of monoclonal antibodies that still way too hard to access†
Two years after the pandemic, America has largely allowed masking to become an individual decision — and even if mandates return, they will remain so in most environments where the virus is spreading. In other words, the government can do little to change who wears masks and when.
Still, the US can do a lot to protect the vulnerable. The more Americans focus on what they can control — and the less they fight about what they can’t — the better.