WASHINGTON — As Covid-19 cases have surged, top Biden administration officials have been divided over how strongly to encourage Americans to wear high-filtration masks such as N95 respirators. They are coming under increasing pressure from public health experts to urge people not to use masks that offer less protection, including those made of cloth or thin blue paper.
The Centers for Disease Control and Prevention updated its guidance Friday, saying Americans "may choose" to wear N95 and KN95 masks because they offer the best protection against Covid. But the agency stopped short of recommending that people should opt for certain masks over others.
The White House has signaled it is willing to go further. President Joe Biden, who for weeks has been wearing N95 masks in public, said Thursday that he was planning to make "high-quality masks" available to Americans for free, without elaborating. Some inside the White House have been pushing for the federal government to send an N95 mask to every American, one person involved in those conversations said.
As cases and hospitalizations have spiked due to the highly contagious omicron variant, public health officials have criticized the administration for not doing more to encourage Americans to wear N95 or KN95 masks, which they said could significantly reduce transmission compared with cloth masks. But the CDC's guidance on Friday said the agency "continues to recommend that you wear the most protective mask you can that fits well and that you will wear consistently."
Inside the White House, Surgeon General Vivek Murthy has been among those pushing for more widespread distribution of the N95 masks, including mailing one to every American, the person involved in the conversations said. But others, including CDC officials, have pushed back on the idea of a mass distribution of N95 masks, the person said.
The debate marks the latest point of division among Biden's top health officials. Last month, Biden's chief medical adviser, Dr. Anthony Fauci, appeared to contradict updated guidelines from the CDC that said infected people could leave isolation after five days without a negative Covid test. There was disagreement over the summer over how widely booster shots should be made available and when, with Biden's top medical advisers breaking with career Food and Drug Administration officials.
The Biden administration has struggled throughout the pandemic on its recommendations around masks, which quickly became an area of political division. The CDC told vaccinated Americans in the spring they were free to go maskless before reversing the recommendation in July, telling even the vaccinated to wear masks in areas where the virus was widely circulating.
Since the arrival of the omicron variant, Biden has increased his calls for people to wear masks indoors, but has stopped short of advising them to wear N95 masks. Biden, the vice president and top administration officials have been wearing the high-quality masks publicly and around the halls of the White House for weeks.
”I know we all wish that we could finally be done with wearing masks, I get it," Biden said Thursday. "But they are clearly a really important tool to stop the spread, especially of a highly transmittable omicron version. So please, please wear the mask.”
White House press secretary Jen Psaki said the administration would have more details next week on how free masks would be made available, noting it has already given out more than 30 million masks to food banks and community health centers.
Biden administration officials have solicited advice in recent weeks from outside medical experts who have given a range of recommendations, including letting people use a new website the administration is developing for free at-home Covid tests to also request an N95 mask, one person who has been in contact with the administration said. A group of medical experts who advised Biden during the transition encouraged the White House publicly last week to give Americans a voucher to buy masks on their own from a retailer.
There has also been division outside the White House over how the benefit of N95 masks should be communicated and how far the administration should go to urge people to wear them. Some public health experts say the masks should be shipped to every person in the country, while others warn it would be a waste of resources.
“There is no question that high-quality masks can make a difference. They have protected myself and many other health care workers from significant exposures in hospitals and clinics,” said Dr. Kavita Patel, a former Obama administration adviser. “But the administration will need to be cautious about overpromising on the effect that this action might have given the trajectory of omicron. We are already seeing cases peaking in parts of the country. High-quality masks are important but in terms of controlling omicron, it’s a bit like bringing an umbrella to a Category 5 hurricane.”
Michael Osterholm, an infectious disease expert who advised the Biden transition, said he has been pushing the administration over the past year to strengthen its recommendations on masks. He said he supports the idea of sending an N95 mask to every American, and that the CDC recommendations need to make clear the benefits of wearing an N95 mask over cloth or surgical masks.
"I think the CDC recommendations have been problematic because they're not based on good science. They're making assumptions about what people will and won't wear," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "We just need to have clear messages. If no one has learned anything right now in this pandemic, it is, keep it simple, stupid. We have failed at communication because we've made it so complicated."
Administration officials have also expressed concern that emphasizing the benefits of N95 masks and discouraging cloth masks could lead people to stop wearing masks altogether if they don’t like the fit of the N95 masks, an issue Dr. Rochelle Walensky, CDC director, alluded to during her remarks Wednesday.
“We will provide information on improved filtration that occurs with other masks such as N95 and information that the public needs about how to make a choice of which mask is the right one for them,” she said. “But most importantly, we want to highlight the best mask for you as one that you can wear comfortably.”
Osterholm said he disagrees with that notion, arguing a more comfortable cloth or surgical mask is going to provide less protection.
"I challenge this whole notion CDC keeps putting forward that we have to recommend what people wear and to me, that's always been a backwards approach," Osterholm said. "What you do is you recommend what makes a difference and then you work from there."
Another concern about more strongly urging N95 masks has been the cost, said a person who has been involved in conversations with the administration on the issue. While N95 masks can sell for as little as $1 and be reused a few times, they are more expensive than a reusable cloth mask over time.
During the early days of the pandemic, Americans were urged to leave N95 masks and the KN95 versions made in China for health care workers. But since then, the U.S. has bolstered its manufacturing capacity, and the nation currently has a stockpile of 750 million N95 masks as part of the Strategic National Stockpile for health care workers.
“It's not a supply problem at all,” said Dr. Ezekiel Emanuel, a health adviser to the Obama administration, who says all Americans should be wearing N95 masks. “We could easily gin up production in this country and get going. So it's not an issue of we've got to reserve these for the health care profession. That's just nonsense.”