The Morning Jolt

Health Care

The Return of the Mask Wars

A COVID-19 safety poster in New York, N.Y., August 2, 2021. (Andrew Kelly/Reuters)

On the menu today: The New York Times editorial board calls for the return of mask mandates, in a spectacular demonstration of how the zero-COVID mentality wastes energy on symbolic fights instead of lasting solutions.

Are Mask Mandates Making a Comeback?
There’s something amusing about watching the New York Times editorial board talk itself into a policy that it knows deep down isn’t going to work, but that feels right and that it doesn’t want to been seen as publicly opposing:

Until vaccination rates increase, masks — and thus, mask mandates — will continue to be necessary. Resistance to this idea is understandable. The mask culture war has been exhausting; the people most likely to abide mandates are the same ones who need those mandates the least because they are already vaccinated; and in the long run it will be far more important to get people vaccinated than to pester them about face coverings. But public policies should reflect what science has made clear: Masks work.

When your mentality is that any vaccinated person interacting with any person who may not be vaccinated is a threat, and that threat must be mitigated at any cost, that is how you end up with National Institutes of Health director Francis Collins going on national television and telling parents to wear masks around their unvaccinated children: “For kids under twelve, that they avoid being in places where they might get infected, which means recommendations of mask-wearing in schools and at home. Parents of unvaccinated kids should be thoughtful about this, and the recommendation is to wear masks there as well. I know that’s uncomfortable. I know it seems weird, but it is the best way to protect your kids.” (Collins walked back his statement later in the day.)

Once again, we have public-health advice that is well suited for programmable robots but destined to cause friction among actual human beings.

It is fair to wonder if the editorial board of the Times reads its own paper or website. Because one click over, Dr. Jennifer B. Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, and Beth Blauer, the executive director of the Johns Hopkins University Centers for Civic Impact, warily evaluate the return to mandatory-masking policies and ask a lot of questions.

“Bringing back masks for everyone will be most effective if a significant amount of Covid-19 transmission is occurring in public spaces like grocery stores and dance clubs,” they write. “But health officials haven’t shared sufficient data showing this is the case, and that’s a problem.”

Nuzzo and Blauer also write that, “Since vaccines offer durable protection against serious illness, tying masking requirements to reasonable vaccination coverage goals and acceptable hospitalizations levels will provide a clearer view of progress than case numbers, which can fluctuate.”

And this is where the recent return of masking mandates really starts to look bizarre.

Marin County, Calif., just announced a mask mandate for everyone indoors, and the county “strongly recommended” masks for crowded locations outdoors. An astounding 86.8 percent of the population twelve and over in Marin County is fully vaccinated.

The CDC is recommending masks in Chittenden and Essex Counties in Vermont. More than 85 percent of Chittenden County residents ages twelve and over have received at least one shot, and 58.8 percent of Essex residents ages twelve and over have received at least one shot. (Keep in mind, Essex County has fewer than 7,000 people and roughly nine people per square mile.) Overall, 84.2 percent of Vermont residents twelve and over have received at least one shot.

Starting yesterday in Westport, Conn., all staff and visitors in town buildings are required to wear a mask, as well as complete a temperature check. (Never mind the fact that temperature checks aren’t a reliable way to detect infection.) Almost 68 percent of residents in Westport are fully vaccinated; overall, 75 percent of Connecticut residents are fully vaccinated.

You can see where this is going. The most-heavily vaccinated counties in America are going to start wearing masks again, the least-vaccinated counties in America will not implement mask mandates, and the national news media will be full of people asking why the remaining unvaccinated don’t seem all that motivated to get their shots.

Then there’s the question of whether cloth masks are really all that effective against the Delta variant. The current verdict is it that it’s better than nothing, but you had better be wearing it correctly, according to Virginia Tech University environmental engineering professor Linsey Marr, who specializes in transmissions of infectious disease through aerosols:

MARR: Delta transmits in the same way as the other variants that we’ve seen so far. It’s just that people who are infected seem to release a lot more virus into the air. So, masks still work, but with Delta, we need better-performing masks.

STEIN: So, Marr says everyone should take a good look at their mask to make sure it’s good enough. A mask that filters out, say, 75 percent of viral particles might’ve been good enough before delta, but with delta, you really need a mask that’s going to filter out something more like 90 percent.

SIMON: So, what kind of mask would that be? Because a lot of people have gotten very used to using cloth masks or maybe surgical masks. Do they need to switch to something more like the N95?

STEIN: Well, those are the gold standard, and so are similar masks, like those KN95s. But Marr says cloth masks can still do the trick as long as they fit really well, and they’re made out of the right stuff.

MARR: Which means something that has a dedicated filter layer and that fits really well with no leaks.

STEIN: So it can’t fit loosely, you know, leaving gaps on your cheeks or under your chin where the virus could sneak in, and it should pinch tight over your nose. And if you’re wearing a cloth mask, it should have a layer made out of special filter material, not just regular cloth. If you’re not sure, you can hold your mask up to the light to see if you can see pinpricks of light through it. If you can, then it’s probably not good enough. Or, you know, another thing you can do is spray water through it in front of a mirror. If water gets through to the mirror, not good enough.

We could have Americans, coast to coast, holding their masks up to mirrors and spraying water and seeing if the mirror gets wet, like some bizarre national Mr. Wizard experiment. Or, you know, we could really focus our efforts on getting more people vaccinated.

Who do mask mandates protect? Let’s go back to Collins:

“Can you clear this up? Do most vaccinated Americans need to wear mask indoors in order to protect themselves and other vaccinated Americans, or is this primarily about protecting unvaccinated Americans, including children under 12 or people who are refusing to get vaccinated?” host Jake Tapper asked Collins on CNN’s “State of the Union.”

“It’s mostly about protecting the unvaccinated. That’s where the real serious risks of illness are,” Collins responded.

So, mask mandates represent requiring people who are fully vaccinated, and who may well reside in areas with high vaccination rates, to put masks on that may not be all that effective against this variant, in order to protect kids who can’t get vaccinated yet and people who have chosen to not get vaccinated. And to the editorial board of the New York Times, this sounds like a swell idea.

There’s one last line in Nuzzo and Blauer’s piece that should be heeded by any American crafting public-health policy at any level: “The nation cannot simply revert to the broad tactics employed during previous surges and expect compliance.”

It’s not April 2020, it’s August 2021. People are tired of being told they can’t do what they want to do, even if they’ve done what they were told to do until now. A recent Quinnipiac poll found that, “37 percent say there should be more mask mandates, 32 percent say there should be fewer mandates, and 24 percent say that there are the right number of mask mandates.” (I’d love to see people answer a differently worded question of whether there should be more mask mandates in the community where they live.)

Keep in mind, as recently as June 30, CDC director Rochelle Walensky was going on television and saying fully vaccinated people didn’t need to wear masks — even with the Delta variant spreading. Many Americans feel jerked around.

Think of public compliance with pandemic mitigation as a finite resource. Do we want to waste that compliance on masking? Or do we want to focus on the longer-term answer of getting people vaccinated? Those not-yet-vaccinated Americans might not be so unpersuadable. Yesterday 864,000 Americans got vaccinated.

Or, we could just re-hash all the masking fights from 2020, and the New York Times editorial board can feel good about themselves.

ADDENDA: No, WHO, wealthier countries are not obligated to forsake boosters and expose their senior citizens to higher risk so that poorer countries can catch up.

Aaron Ravin lays out how New York City’s envisioned vaccine-passport system is going to result in large numbers of minority New Yorkers turned away from establishments while large numbers of white New Yorkers are let in.

Nat Malkus calculates that less than half of the money Congress allocated to reopening schools will be spent on steps necessary to reopen schools or get them operating normally after the lengthy interruption. The rest will be spent on . . . whatever the local authorities think is a good idea.

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