By Jennifer S. Bard
The U.S. Centers for Disease Control and Prevention (CDC) announced today that fully vaccinated individuals no longer need to wear masks indoors or outdoors in most cases.
The agency has emphasized that this is merely guidance, and is not intended to affect public policy or to change practices of private companies. But it is naïve to imagine that health departments and private organizations will not make changes in response to the announcement.
There is a growing public wish to put COVID-19 behind us by eliminating visible signs that it still exists (e.g., mask wearing). But guidance driven by this magical thinking will cause unnecessary harm. Public health measures should protect the larger population, including those who cannot be or have not yet been vaccinated. This CDC guidance proffers individual advice at the expense of the goals of public health.
Public Health vs. Individual Advice
As a matter of advice to individuals who have been full vaccinated, the news that they no longer have to wear masks in places where they are at lower risk of infection is reassuring and good to hear. But, as a matter of federal guidance that will be translated into public health law and used as basis for challenging or removing mask mandates, it’s a mess on several levels.
First and foremost, it shifts the responsibility of protecting people still vulnerable to COVID-19 from the state to the very individuals who can cause the most harm. Whether the harm comes from unvaccinated individuals who choose not to wear masks as a matter of principle, or who simply leave the house without one, or from vaccinated individuals who are still able to transmit the virus, the danger is the same. There will always be people who cannot be vaccinated, whether because of a medical condition, or simply because they are too young.
Nor does it make any sense to suggest that those who are worried should wear masks themselves and leave others to do as they wish. First, there will, again, always be people, such as babies, who simply cannot wear a mask.
Second, while medical grade N-95 masks work very well to protect their wearer — even among sick, unmasked people — surgical and cloth masks don’t provide that kind of unilateral protection.
In other words, if you’re wearing a cloth mask and the other people in the classroom, or movie theater, or plane, aren’t, it pretty quickly makes you almost as vulnerable as if you weren’t wearing anything. But if everyone is wearing a cloth mask, you are all relatively better protected.
This also raises an issue of social justice: those who want to protect themselves must buy expensive, high-tech masks to protect themselves from others who are unwilling to use inexpensive cloth or paper ones.
The Role of Law in Promoting Public Health
Using this CDC guidance as a justification for lifting mask requirements means that the protection of every individual not yet immune to COVID-19 (let alone the ever emerging variants) depends on others’ individual choices of whether to wear a mask.
That’s not how law works. We don’t have special traffic laws for particularly skillful drivers allowing them the leeway to drive a little faster. And it’s especially not how law works when based on the public health principle of preventing harm at the earliest point possible, instead of merely punishing offenders after the damage is already done.
The big picture here is that laws that set standards to protect public health are different from medical guidelines for individuals. They are part of the foundation of, and set the terms for, everyday life. Individuals can’t make their own decision about whether they want a car with airbags, whether it’s safe to drive above the speed limit, or even whether they should put their own child in a rear facing car seat. Food safety codes require hand-washing of restaurant workers; schools require vaccinations.
These laws also express cultural norms — and may not make a lot of sense outside the culture that requires them (like having to carry an Orange Vest in your car France). In Asia, mask wearing is a matter of politeness, a courtesy extended to prevent spreading respiratory diseases to others. That’s never been the custom here.
But the more we learn about COVID-19, the clearer it is that our goal needs to be to prevent people from catching it all. COVID-19 is an airborne virus — light enough that it doesn’t need the direct propulsion of a cough or sneeze to infect others. Talking or breathing in a space is enough to expel virus, which may then linger in the air for hours. Not only are unvaccinated individuals as vulnerable to the virus now as we all were six months ago, but its natural mutation means that the threat now is very different than it was then. Today’s variants are more contagious, more lethal, and apparently more likely to do harm to young people (although it’s still not clear how much of that is a factor of young people not being as likely yet to be fully vaccinated).
Putting the health of the unvaccinated in the hands of those who might infect them is especially ill-advised when the vast majority of children, a majority of Americans in some regions, and most of the rest of the world are not yet vaccinated — and perhaps never will be.
Taking a Longer Term Perspective
Another reason why the CDC’s new guidelines are misguided is that the situation is still very unstable, even for people who have been fully vaccinated. It’s good news that the vaccines currently approved for emergency use in the U.S. seem to offer broad protection against most of the existing variants (although this is not true for all the vaccines in use globally). But the virus is always changing, so this might not remain the case for the authorized vaccines in the U.S.
And unlike a hurricane that can usually be seen coming days in advance, the emergence of the variants has been difficult to track because of still-inadequate public health surveillance. Without aggressive testing programs to look for variants, we don’t know about them until they have become firmly entrenched.
So, until there is a more effective way of protecting everyone, not just those vaccinated, it makes no sense to roll back laws requiring mask wearing in places of maximum infection potential (indoor, closed spaces). And there’s certainly no reason to shame, ridicule, or armchair psychoanalyze people who would like to reduce their exposure to all respiratory infections and allergens. Who wouldn’t want that for people and their families (other than perhaps the cold remedy industry)?
Given the amount of money Americans spend every year on dietary supplements that claim to improve or bolster health but likely have very little benefit for most people, it is amazing that when presented with a low-cost item that significantly reduces the likelihood of catching a broad range of viruses, bacteria, and allergens that cause sickness and discomfort we are so fast to reject it.
A Look Back
There is nothing new about changing public health practices based on changing information about disease transmission. Starting about 20 years ago, we were all encouraged to start coughing into our elbows, not our hands. Not anything anyone had really done before, a little strange looking at first, but not very controversial.
And even further back, Ignaz Semmelweis waged a vicious battle with his peers over their belief that hand washing was a completely unnecessary practice having nothing to do with the spreading of germs from patient to patient. He won. Doctors wash their hands — and we know we should, as well.
Perhaps one day we’ll view masks in a similar light. Personally, I’m much less afraid of contracting COVID-19 now that I’m fully immunized, but I’m keeping my cloth masks and look forward to buying N-95 masks when they become more universally available. Of course, saying that it’s too soon to remove mask mandates doesn’t mean that they should never go away. Right now, though, it’s hard to imagine being in a crowded theater, mall, or airplane without one.
Even if the historical context and the appeal to self-protection don’t move you, perhaps the public health law perspective will. Without any effective way of knowing who is and who is not vaccinated, it’s inconsistent with the preventative focus of public health law to make the protection of people still vulnerable to COVID-19 dependent on the willingness of any particular individual to wear a mask indoors.
