Masks fall out of favor as policy choice

WASHINGTON — During the second game of the NBA Finals on Sunday, celebrated Boston Celtics first-year coach Ime Udoka pulled down his face mask to apparently utter an imprecation at Steph Curry, the Golden State Warriors superstar preparing to shoot a free throw. Udoka then diligently pulled his mask back up, only to pull it back down again to lob another insult in Curry’s direction.

Udoka’s itinerant mask wearing (one often rests on his chin during the game, but he puts it on during the post-game press conferences) is a symbol of sorts for a nation where most people still support wearing face coverings as a coronavirus preventative measure — but many are also no longer doing so.

Some denounced Udoka for engaging in virtue signaling, while others celebrated his efforts. “I’m no Celtics fan, but I really appreciate Coach Udoka wearing a mask,” tweeted Dr. Lucky Tran, a public health advocate who has called for protective measures to remain in place. “Sure, he doesn’t wear it 100% of the time, but he clearly makes an effort when he’s in close contact with his players and the press.”

That same day, Boston Mayor Michelle Wu was heckled by anti-mask protesters at the Dorchester Day parade, although she has no plans to reinstate the city’s mask mandate. The fury appears to have been directed at the city’s public schools, where masks are still required.

In this third summer of the pandemic, public health policy has largely devolved to a matter of personal preference, with new mask mandates a rarity but the debate over masking hardly diminished from earlier stages of the pandemic.

Even though the coronavirus case count remains at high levels, Americans’ behavior no longer reflects that reality. The availability of vaccines and treatments appears to have attenuated pandemic anxiety, which has been replaced by fresh anxieties about war, crime and inflation.

“Just look around us,” Dr. Leana Wen, a public health professor at George Washington University, told Yahoo News. “The majority have returned to their pre-pandemic lives. Public health policy has to adapt to where people are.”

Late in May 2021, the Centers for Disease Control and Prevention dropped the masking mandate for indoor spaces for vaccinated people. But the rising prevalence of the Delta variant led to a quick reversal of that decision. Then, as states were planning to roll back mask mandates in the late fall, the even more transmissible Omicron variant appeared.

Mask mandates continued into early 2022, but by early February even the most restrictive Democrats began to worry that voters may penalize them for keeping restrictions too long. Led by Colorado, many blue states did away with their mask mandates, arguing that high vaccination rates and the availability of treatments meant that collective measures were no longer necessary.

The CDC followed suit, revising its community spread guidelines in a way that tied risk levels to hospitalizations, not case rates. “I just know people are tired,” CDC Director Rochelle Walensky said at the time. “The scarlet letter of this pandemic is the mask.”

A dip in Omicron cases throughout the spring was followed more recently by a rise driven by Omicron subvariants, all of which are highly transmissible but don’t appear to cause severe illness in vaccinated people.

Infection rates appear to be falling, with an 8.5% dip this week compared to the week before. The decrease may result from the fact that so many Americans have immunity either from vaccination or a prior infection. And at-home testing has almost certainly kept public health officials from learning the true extent of the current wave, since those results are not reported, as laboratory tests are.

There is little debate that the virus is continuing to spread. This week, 11.7% of coronavirus diagnostic tests processed in laboratories returned a positive result, a rise of .74% from the previous week. Hospitalizations are also rising, 4.7% higher this week than the week before.

To some public health experts, the solution is simple. “Everybody should be wearing a mask,” University of Chicago infectious disease specialist Dr. Emily Landon told the podcast Nerdette late last month. “The only reason we don’t” have a mask mandate, Landon reasoned, “is because CDC decided to move the goalposts to make their recommendations more about protecting and protecting health care than about protecting individuals.”

Last month, Boston University environmental health professor Jonathan Levy attained Twitter fame when someone posted an image of him masked alone in his office while on a Zoom call. Levy defended his own behavior in a Twitter thread of his own; in an email to Yahoo News, he pointed out that nearly a quarter of the United States met the CDC’s own criteria for mask mandates.

“Given the high rates of COVID in many areas right now, indoor masking is called for in many places,” he wrote. “We know that high-quality masks work, and that the more people wear those masks, the faster we can get things under control.”

A CDC spokesperson reiterated the importance of "preventative measures," including masks, in an email to Yahoo News. The agency suffered a blow last month when a Florida judge struck down its travel mask mandate. The Department of Justice is appealing, though less to reimpose the mask mandate than to preserve the CDC’s authority.

“Masks are now part of the culture wars, just as much as abortion and guns. But they shouldn’t be,” says Lawrence O. Gostin, a public health law scholar at Georgetown, one of several prominent experts submitting an amicus brief in favor of the CDC mandate.

“If the argument is that CDC has made errors during the pandemic, I accept that,” Gostin told Yahoo News in a telephone interview, arguing that those errors have been exploited by conservatives to undermine public health at a time when pandemic diseases are sure to appear again.

“The culture warriors should be careful what they wish for,” Gostin counseled.

Detractors of masking argue that the practice is not as effective as boosters claim and that, at this stage in the pandemic, masks are more political symbol than public health tool.

“I think for some in public health, masks have become a litmus test, indicating shared concern about the risk of COVID (and now monkeypox, I guess),” argued Stanford professor of medicine Dr. Jay Bhattacharya in a text message to Yahoo News. “It is a signifier of attention to the opinions of public health authority.”

Philadelphia had reimposed a mask mandate in late April, only to quickly reverse course — though it did call for masking in schools the following month. There followed a mandate-free spell interrupted last week when Alameda County in Northern California brought back indoor masking. Los Angeles County indicated that it might do the same.

Sacramento schools reimposed a mask mandate starting this Monday. “We understand this return to universal indoor masking may be a challenging transition,” the school district there said.

Some public health officials have argued that a well-fitted N-95 mask works well enough to protect an individual to obviate the need for collective masking. And most everyone concedes that the political cost of mandates has become unacceptably high, in part because the culture wars over masking had gotten so intense.

“Masks are ineffective and no one trusts The Experts™️,” tweeted Missouri’s attorney general, Eric Schmitt, in response to an article about St. Louis seeing a surge in cases. “If St. Louis County imposes a mask mandate again — we will sue and win again. Have a great summer and live your life!”

“No one in public health will tell you masks don't work,” Yale epidemiologist Gregg Gonsalves told Yahoo News. “It's the politicians who will decide when and how they will be used.” Gonslaves added that the nation could “prevent infections, hospitalizations and deaths with masks in combination with other mitigation efforts, but whether they return broadly across the US is depends on how much death and suffering we're willing to accept at a nation.”

Where they have returned, it has generally been on a subcounty level: for employees of the Chicago-area supermarket chain Jewel-Osco; at several Philadelphia-area colleges. But even in the cautious Northeastern states where precautions were among the last to lift, mask mandates do not appear to be coming back.

Ventilation upgrades could be a bipartisan solution, not to mention a way out of the masking morass, argues Dr. Abraar Karan, also of Stanford. "You can wipe the virus out of the air" with HVAAC systems that can fully replace the air circulating in a room about every five minutes.

"It doesn't have to be expensive," Karan says of ventilation upgrades. Although the Biden administration has called for better ventilation systems, that initiative has not been a White House priority, leaving masks as the most visible and potent symbol of the pandemic.

“We all wish the pandemic was over, but it is likely to be here and harmful for the long term. Mask policies are one of the most effective approaches to reducing spread,” says Boston University public health expert Julia Raifman, who has argued that the Biden administration has not been aggressive enough in its pandemic response.

“The politics have changed,” Raifman told Yahoo News, “but the facts and policy impact haven’t.”