Americans hate masks, but there’s no safely ending the pandemic without them

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Masking strategy 360 OVERVIEW

Don’t throw your masks away just yet.

It’s not clear yet whether this is a minor bump as the country once again tries to resume a more normal daily routine, or whether it heralds another wave of infection like the one battering much of Europe.

The whipsawing of mask mandates illustrates the tension inherent in returning to normal while the virus still rages. Infections, hospitalizations and deaths will continue to surge and ebb as humanity comes to immunological terms with the coronavirus. The onus is shifting to individuals to determine what level of risk they face — and what level they are ready to accept — and act accordingly.

That’s made all the harder by the federal public health officials’ messaging failures on masks, beginning in the earliest days of the pandemic. As the crisis dragged on, masks came to symbolize the political polarization that has hampered efforts to contain the virus. Evidence shows masks have prevented many deaths, but their controversial status has limited their ultimate impact.

During the relative lull of the past two months, indoor mask rules have largely vanished. The Centers for Disease Control and Prevention relaxed its guidelines in late February; in an instant, the number of counties where masks were warranted under the agency’s approach dropped from more than 90 percent to 37 percent. Soon after, President Joe Biden delivered his State of the Union address to a chamber of barefaced lawmakers, a signal that the country had reached a new phase of the pandemic.

Masking strategy 360 THESIS

Thesis

Masks remain a cheap, accessible and effective tool for limiting both individual infections and tamping down community spread. But widespread masking, necessary for shielding the most vulnerable, is becoming less and less workable in a polarized and pandemic-fatigued public. An unwillingness to don masks when cases surge could make getting to the end of the pandemic harder than it needs to be.

Messaging Lens

Federal officials muddy the waters

By Emma Yasinski - Freelance Reporter

Much of the confusion about when, where and how to wear masks stems from confusing guidance from U.S. public health authorities, beginning in the earliest days of the pandemic.

“A lot of people expect that it is easy to do the kinds of research that would be helpful to answer the question. And what we saw was, there’s a number of different ways you can look at how this is transmitted, but it still might not give you really good information about what happens in the real world,” said Glen Nowak, who directs the Center for Health Risk and Communication at the University of Georgia and who served as director of media relations at the CDC during the 2009 influenza pandemic.

“You don’t want to tell people to do something that they then can’t do, because it creates anger, frustration,” said Nowak.

The study also highlighted a disconnect between federal policies and messaging at the local level, due in part to a lack of funding to help disseminate key public health messages around masks and other precautions.

As more and more people have some level of immunity from vaccination, prior infection or a combination thereof, the metrics guiding the CDC’s masking advice have changed. The agency now advises people to wear masks indoors only if their local hospitals are strained, rather than calling for mask-wearing in areas of high covid transmission. That represents a shift away from basing masking decisions on a person’s individual risk of contracting the disease.

“It makes sense that you evolve toward looking at healthcare systems and their capacity, their ability to treat people, whether they have covid or not, because at the end of the day, they have to be ready to treat people or diagnose people and treat people for whatever illness they have,” said Nowak.

Science Lens

A powerful tool

By Jonathan Lambert - Public Health Reporter

The coronavirus’ modus operandi is relatively simple: Hitch a ride on tiny droplets and airborne particles exhaled by infected people, and wait until those particles get inhaled by a potential host.

Masks thwart this scheme by capturing virus-laden particles as they’re exhaled and before they’re breathed in. It’s a numbers game: The more particles captured, the greater the protection to both the wearer and those around them.

“Masks are basically filters strapped to your face,” said Aaron Collins, a mechanical engineer with a background in aerosol science who posts on YouTube as the “Mask Nerd.” How well those filters work depends on how well the material traps particles and how snugly the mask fits. Even the highest-quality mask — such as an N95 — can’t stop the virus from entering gaps around the cheeks or nose.

Basic cloth masks block most large droplets larger than 20 or 30 microns (less than half the thickness of a human hair) that might contain viruses. But cloth masks are worse at capturing smaller particles called aerosols that can remain airborne for hours and are bigger drivers of transmission, especially indoors where they can accumulate.

It’s difficult to measure the precise impact of community masking because of many confounding factors, but the totality of evidence suggests masks protect both the wearer and the community, Clase said, especially when more people wear masks, and more of those masks are higher-quality.

Mask quality has become increasingly important with the arrival of new, more transmissible variants. Delta and omicron aren’t riskier because they’re better at weaving through mask fibers; rather, infected people may kick out more viral particles, and those particles are more likely to kickstart an infection if breathed in. “Masking gives you a proportionate reduction in the particles that come through your mask,” said Clase. “If the particles out there are more infectious, then you’re going to experience a greater risk, and ideally you’ll have a better mask.”

The rollback of mask mandates places the burden of protection on the most vulnerable, including the elderly, immunocompromised and unvaccinated, Clase said. Wearing a high-quality mask reduces risk for these people, but it cannot eliminate it. When cases are low, that risk may be manageable. But during surges, it becomes increasingly untenable, Clase said. “It is just so wrong that we are not prepared to protect people in our society who are more vulnerable.”

The coronavirus isn’t done evolving, and we very well face future surges or variants that are even more transmissible than omicron (including the latest flavor, BA.2) or evade existing immunity. Other tools, like vaccines, might have to be tweaked in the face of new variants, but masks will remain a cheap, powerful and responsive tool for curbing covid, especially when widely adopted. “The cost of wearing a mask is really quite small compared with the impact it can have across society,” Clase said.

Politics Lens

How face coverings became a flash point

By Anya van Wagtendonk - Misinformation Reporter

Masks became a stand-in for much of this divide, reflecting people’s frustrations with the pandemic and standing in as an expression of partisan identity and philosophical ideals of individual liberty and social commitment.

That divide was helped along by public officials. In the earliest days of the pandemic, when the virus was least understood, health officials sent mixed messages that stuck in public consciousness. Then-President Donald Trump also decried masks publicly and tweeted mocking images of those who wore them, including of Biden, then a presidential candidate.

Now, more than two years in, most Americans report wearing a mask indoors at least sometimes and are about evenly split on whether to lift mask mandates, according to a poll the Kaiser Family Foundation released last week. But respondents split starkly along party lines: 85 percent of Democrats agreed that “people should continue to wear masks in some public places,” while 69 percent of Republicans agreed with the statement, “People should stop wearing masks in most public places so things can get back to normal.”

In that case, pro- and anti-mask divisions reflected culture wars over gender and patriotism, according to Rabinovitch-Fox. Resisters of mask-wearing equated them with weakness and femininity, while mask-supporters appealed to notions of civic pride to encourage their adoption.

Unlike today, however, those divides weren’t necessarily partisan, Rabinovitch-Fox added, but were “still imbued with the contemporary politics of the day. Similar to this current moment, masks became a conduit to discuss the limits of government power, as well as if and how much authorities should intervene in individuals’ lives and the economy in the name of public health.”

In parts of East Asia, mask-wearing is a common practice, gaining traction after the outbreak of severe acute respiratory syndrome (SARS) in China in 2002. Over the course of two years, an estimated 774 people died out of 8,098 reported cases, according to the World Health Organization.

Masking strategy 360 CONCLUSION

Despite early messaging failures and confusion around the usefulness of face masks, the evidence now clearly shows they can play a powerful role in curbing covid. The crucial question going forward is one of public perception: whether Americans will be willing to put masks back on when another surge hits.