The mainstream consensus on anti-COVID-19 masking practices is shifting dramatically. In the past week or so, we’ve had a gravy train of critical or inquisitive takes on outdoor masking, and particularly outdoor mask mandates, from The Atlantic, the New York Times, and Slate. The New Republic, hardly a bastion of libertarian outrage, demands: “Set Us Free From Outdoor Mask Mandates!”
While I absolutely support this reassessment, I find its timing, frankly, infuriating.
The facts about COVID-19 that are suddenly grabbing eyeballs among center-left media have been understood by epidemiologists since nearly the beginning of the pandemic. Moreover, I strongly suspect that the year spent studiously ignoring those facts has done genuine harm to Americans’ faith in public health authorities, and maybe even in science more broadly.
Both health authorities and some parts of the media have practically begged for anti-science backlash with their treatment of the topic. Many have failed to convey the realities of outdoor transmission, while also too often taking an attitude of sweeping condescension towards even legitimate skepticism. To be clear (in a caveat also dutifully repeated by these newly-minted mask liberationists), I’m not a moron: masking inside, on public transit, and probably even in crowded outdoor situations should be enforced with every tool of social shaming and de jure health regulations we have at our disposal.
But way back in May of 2020, I reported on the origins of the ‘six foot’ rule for social distancing. Though it wasn’t the focus of that piece, the clear epidemiological consensus even at that time was that there was nearly no logical, scientific, or empirical basis for the idea that outdoor coronavirus transmission was a serious risk. The debunking of outdoor masking, to be clear, has nothing to do with rising vaccination rates: the practice was always, at best, marginally impactful and highly situational.
Of course, this doesn’t mean throw common sense out the window. COVID-19 is transmitted by an airborne virus, so if you’re going to be swimming in a bunch of strangers’ air for a while (let’s say at some secret wild desert dance party that you should definitely tell me about), sure, mask up.
But if you’re out for a hike and pass someone every twenty minutes? C’mon, man.
There are some vaguely viable arguments in favor of broad mask mandates, above all simplicity and the reinforcement of new social norms. Personally, when I’m outside, I wear a mask as a courtesy when I’m on a crowded sidewalk or other congested outdoor area. It’s the respectful thing to do, even if there’s minimal medical reason for it: you can’t know what everyone around you knows or believes about the virus, so there’s a solid chance your gesture is sparing someone else some anxiety at an incredibly taxing time.
But here are the facts: SARS-CoV-2 transmission occurs when you inhale a concentration of exhaled active virus. If you’re moving, you’re not hanging out in those viral clouds long enough to get a dangerous dose, and even the mildest outdoor air movement disperses them rapidly. You’d have to work really hard to catch COVID-19 outside – by, for instance, having a long, unmasked conversation while standing a foot or two away from an infected person. And that’s not new information: Slate’s observation that “briefly passing someone on the sidewalk just isn’t risky” was right there nearly the whole time.
But heaven forfend the CDC or certain state health authorities acknowledge that. The New Republic’s piece on outdoor masking opens with a riff on Massachusetts’ punitive outdoor mask mandate, but there was barely a critical peep when it was issued last November (though scientists did their level best to convey the truth). Or remember when people got angsty about jogging or biking without a mask? Those concerns were misplaced, but very few authoritative voices took the opportunity to communicate reality to the public.
Even more infuriating is that over the same period, the CDC has arguably understated the full risk of indoor transmission. The ‘six foot rule’ in particular seemed to discount research showing that viruses travel quite comfortably not just on heavier exhaled droplets, but also on aerosolized micro-droplets that can travel as far as 27 feet indoors. Superspreader events like the infamous Washington choir practice could still easily have occurred if participants had followed the six-foot rule while gathered inside. (And just because I love a good litany of grievances, the CDC also took its sweet goddamn time conveying to Americans that you probably won’t catch COVID-19 from touching a cereal box.)
Overbroad mask mandates and messaging are part of a bigger failure to acknowledge complexity and nuance during the pandemic. It is increasingly clear that this baby’s-first-virus paternalism (and whatever you’d call the bizarre triangulation behind U.S. health authorities’ early anti-mask statements) has real and possibly major costs. As Harvard epidemiologist Julia Marcus warned back in November, unscientific orders like the Massachusetts outdoor mask mandate “do more to reduce trust than … to reduce infections.” (She might as well have been shouting at the wind: the Massachusetts outdoor mandate is still in place. So is New York City’s.)
That reduced trust, in cahoots with partisan culture wars, led people in some parts of the country to sneer at masking even inside, where it is still vital. But the worst fallout of distrust is now staring us in the face: there’s a real possibility that vaccine hesitancy is going to make it harder for the U.S. to reach herd immunity and stop community circulation of SARS-CoV-2.
The buffoonishly evil anti-vaxx/supplement-sales movement predates COVID-19, of course, but against all reason, the ranks of its adherents have held fast during the pandemic, and may even have grown: there’s limited polling, but Pew found an 80% increase in COVID vaccine resistance between May and September of 2020, for instance. There’s more recent evidence that people on the fence about COVID vaccines, the so-called ‘hesitant,’ are gaining faith in them. But the level of outright vaccine rejection and skepticism remains largely unchanged since December.
The causality between oversimplified public health messaging and broader scientific distrust remains to be untangled by social scientists and anthropologists. But based on what we know right now, the takeaway seems clear:
Treat people like adults. It might save their lives.
A Final Note: This is my last installment of The Capsule, and my final week at Fortune. I’ve been writing for Fortune nearly continuously since 2013, and it still blows my mind that I’ve been given that privilege, and the opportunity to work with some of the smartest people in the world. But all good things must end: I’ll be moving on to an exciting new role, which I’ll announce publicly after a short hiatus. To stay in the loop, follow me on Twitter or Substack.
I leave you in Sy’s extremely capable hands. Godspeed.
David Z. Morris
@davidzmorris
DIGITAL HEALTH
HHS and FDA reject Trump admin deregulation of health devices. In a quiet notice posted last week, the Department of Health and Human Services and the FDA said they will withdraw a regulatory notice that would have exempted more than 130 digital health devices from regulatory oversight. The now-scotched notice was released just five days before the end of the Trump administration, and according to the rollback, came “without adequate scientific support,” while also containing “errors and ambiguities.” (mHealth Intelligence)
INDICATIONS
Biogen keeps plugging on its troubled Alzheimer’s treatment. Not unlike a certain medieval peasant, Biogen appears insistent that its problematic Alzheimer’s drug, aducanumab, is not dead yet. The drugmaker is ready to launch the drug at more than 600 clinical sites in the U.S. if it receives FDA approval. But following a long run of disappointing clinical trials, the drug stands “less than a coin flip’s chance of a clean approval,” according to one recent analysis. Biogen’s persistence seems largely financially motivated: it expects strong demand for aducanumab despite a dearth of evidence that it’s actually effective, at the same time that sales for several of its other headline drugs are falling off a cliff. (FiercePharma)
THE BIG PICTURE
By summer, COVID-19 could become a disease of the young. As COVID-19 hospital admissions for those over 70 drop dramatically, they remain steady for younger adult groups that have become eligible for the vaccine more recently. Children under 16, meanwhile, are largely ineligible for vaccination until ongoing trials confirm their safety for that group. This means they’ll still be vulnerable after many adults have returned to something like normal. Of course, kids are at much lower risk for the most acute outcomes of COVID-19, and Pfizer’s shot is likely to be approved for children ages 12-15 soon. But young children can suffer from the mysterious and frightening syndrome known as “long Covid.” That drives home the selflessness of getting vaccinated: The faster adults get the jab, the faster we can cut community spread, protecting kids from potentially lifelong fallout until they can get vaccinated, too. (The Atlantic)
REQUIRED READING
The freedom of biking during lockdown - Lindsey Tramuta
Health care workers must think about self-care - Arianna Huffington and David Agus
Europe may sue AstraZeneca over vaccine delivery shortfalls - David Meyer
