The bar for reimposing mask mandates is getting higher and higher
New York City raised its coronavirus alert level last week in response to rising cases, triggering a recommendation - but not a requirement - that people wear masks in public indoor settings. In Philadelphia, officials reimposed a mask mandate last month after cases rose, only to scrap the rule four days after it took effect.
The decisions by the Democratic-run cities illustrate how mask mandates are falling out of favor with American public health authorities in the third year of the pandemic and the bar to bring them back is getting higher, even in places where the requirements were long embraced as a proven way to reduce the spread of coronavirus.
"They are responding to the public," said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. "People are really fed up with all of these restrictions."
The shift away from mask mandates in blue cities and states has been months in the making, and they are not coming back even as cases of the highly transmissible BA.2 coronavirus variant rise. Democratic governors urged residents to learn to live with a virus that isn't going away when they lifted mask mandates in quick succession in February and March. The spread of BA.2 and other subvariants of omicron - which are even more transmissible than their highly contagious predecessor - on the East Coast presented an early test of that commitment.
But the latest uptick hasn't turned into major surges and has not resulted in overrun hospitals. There was little appetite to impose mask mandates proactively, as Philadelphia had done, in the event cases abruptly spiked and admissions soared.
The broader landscape on masks is also shifting. A federal judge last month struck down a federal mask mandate for transit systems; President Joe Biden said it's now up to passengers whether they wear a mask. A host of transit agencies and the Democratic governors of New Jersey and Illinois voluntarily ditched their own mandates for trains and buses. The Centers for Disease Control and Prevention (CDC) last Wednesday repeated its recommendation that passengers mask while traveling.
"In a time when we have fairly mild variant and a public that's really mask-averse, it might not be the most important thing to mandate masks," said Chrissie Juliano, executive director of the Big Cities Health Coalition.
But it's too soon to declare government mask mandates a relic of the past. Under a new CDC framework, people should still wear masks when their communities are considered high risk. But the definition of high risk has shifted to emphasize hospitalizations and the strain on the health care system, rather than a high volume of cases.
Officials say mask mandates would probably be tied to cases again under a dreaded scenario where a highly contagious variant that evades vaccine protection and causes more severe disease emerges.
Even if future surges are worse, health officials say the bar to mandate masks is getting higher because rising cases are not as worrying as they used to be. Vaccinations have stayed strong as an effective shield against hospitalization and death, although not foolproof, particularly for the elderly and immunocompromised. The expanded availability of therapeutics such as the antiviral Paxlovid are offering another layer of defense for those who do become sick.
"It's helpful to always look at the actions we need to take in relationship with the tools we have," said Barbara Ferrer, director of the Los Angeles County Department of Public Health. "There are ways for us to approach the post-surge time we are in with a lot of care and compassion for other people and we've got tools we can use broadly - vaccination, therapeutics, testing."
Just a handful of places have reimposed mask mandates recently, including Bangor schools in Maine, Milwaukee courts and jails and several colleges and universities.
New York last week reached the medium alert level, meaning there are more than 200 cases per 100,000 residents. Under metrics the city set in March, the government should consider mandating masks in schools at medium alert. City officials did not do so and instead recommended masks indoors.
Health Commissioner Ashwin Vasan told CNBC Tuesday that officials might bring back mask requirements and vaccine checks if the city moves to high alert when there is substantial pressure on the health care system. Adams has kept a mask mandate in place for children younger than 5, who are too young to be vaccinated. In response to questions about decision-making on masks, a spokesman for the city health department said officials are monitoring data.
In Philadelphia, officials quickly scrapped the mask rule even after describing the mandate as necessary to protect residents of color who face worse outcomes if infected.
"Philadelphia is not a bubble, of course, and no other city was doing that. The federal government was not even doing that. The president said, well, do whatever is best for you," said Usama Bilal, an assistant professor of epidemiology and biostatistics at Drexel University. "There wasn't really federal support for what Philadelphia was doing, and it was complicated to keep that up without that kind of support."
But some experts and activists fear public health authorities have disarmed too soon. They fear that low-income people and people of color who disproportionately work in person, take crowded public transportation and are less likely to be boosted will bear the brunt of the consequences when the mandates are lifted.
Oni Blackstock, a primary care physician who advocates for addressing racial disparities in health care as executive director of Health Justice, said leaders abandoning mask mandates are failing to live up to their commitments to racial equity. Access to antiviral treatment is uneven. The highest-quality respirator masks are also among the most expensive and the federal supply of free N95 masks is limited.
"I suspect we will see again these existing inequities exacerbated by the lifting of these mandates," Blackstock said. "It puts the onus on people who are not in the best position to protect themselves to do so."
Others who praised Philadelphia for bringing back its mask mandate at the first signs of a potential surge worry the CDC's emphasis on hospitalization data for masking is ill-timed.
"Once you already get the hospitalizations peaking, you can't go back in time a week and change what you did before," said Abby Rudolph, an associate professor of epidemiology and biostatistics at Temple University.
When local journalists pressed Philadelphia Health Commissioner Cheryl Bettigole about her credibility to issue mask mandates, she argued the decision to lift the rule in light of declining hospitalizations would build trust.
"By keeping those promises, if I do come back to Philadelphia and have to say this one looks bad, we really have to do something different, I feel like then people are more willing to trust that we're only going to do what we have to do and not be more restrictive than we have to," Bettigole said.
Other public health leaders are making similar calculations as they try to nail down when, if ever, to bring mask mandates again.
Allison Arwady, commissioner of Chicago's Department of Public Health, says the right time to impose mask mandates is when hospital capacity is threatened, as it was when the city faced record admissions during the omicron surge. While she is strongly urging people to wear masks, she is not considering a mandate because hospitalizations are low.
"I don't want to do that all the time forever. I want to do that at a time the risk is higher so it's not like we are not crying wolf all the time," Arwady said. "Mandates don't do a whole lot to increase trust in government necessarily. We use them when we have to."
Polling has shown throughout the pandemic masking has been more popular than the vitriolic outbursts seen on social media would suggest. But that support is eroding.
An Axios/Ipsos survey conducted in early April found 56% of Americans opposed their state or local government requiring masks in all public places. It was the first time since pollsters started asking the question in August that a majority opposed the mandates.
A Quinnipiac University survey released last month found a slim majority of Americans opposed a mask mandate for public transit, but would also continue wearing masks in planes, trains and buses.
Some worry authorities are jeopardizing public health as a result and that politics are creeping into the decision-making as a midterm election where Democrats are at a disadvantage looms.
Philadelphia's mask mandate prompted criticisms from some Democrats running for statewide office, including gubernatorial contender Josh Shapiro, who called the measure "counterproductive."
In a Washington Post Live interview before the city scrapped its mandate, Philadelphia Mayor Jim Kenney responded to Shapiro's criticism by noting "he is running in a state that's not necessarily always blue, coming from an area of the state that is blue."
Critics say Democrats who are shying away from mask mandates in the face of rising cases are acting like Republicans who turned on mitigation measures early in the pandemic by prioritizing residents fed up with mask rules.
"Democrats in municipalities who are rolling back these mandates are caving in in fear of the political repercussions, but what we are failing to see is this is only turning off constituents," said Byron Sigcho-Lopez, a Chicago alderman.
He has pressed city officials to reimpose a mask mandate, worried rising cases will inflict a heavier burden on Black and Latino neighborhoods with lower vaccination and booster rates. If the city waits until hospitalizations rise, Sigcho-Lopez says, it will be too late to save those lives.
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