The Reason That Even As Mask Mandates Fade, Mask Usage Expected To Continue

Masks have become normalized among that segment of the population conscious of health and will probably continue to be used by many in public settings, especially travel. JL 

Helen Branswell reports in Stat:

Experts believe people — some, anyway — will continue to wear masks at certain times or in certain settings, beyond what the CDC recommends. Over time, masks could become “a courtesy normalized in our culture. We are in different circumstances now. We have more tools.” “I can imagine a lot of people will want to wear them while they’re traveling, even if it’s not required. I can imagine people will wear them in the winter because they don’t want to get the flu.”

Late last year, Rochelle Walensky, the director of the Centers for Disease Control and Prevention, made a commitment about face masks, one of the defining symbols of the Covid-19 pandemic. “Masks are for now, they’re not forever,” Walensky told ABC News. “We have to find a way to be done with them.”

On Friday, Walensky is expected to deliver at least in part on that pledge, outlining long-awaited new guidance on when the CDC believes people should consider wearing masks and when they might safely stash them in a drawer for a time.

These will be recommendations, not orders. Except in settings under federal government jurisdiction — airports, for instance — the power to require people to wear masks in public rests with states and municipalities. (The federal requirement to wear masks on planes, trains, and other modes of interstate travel is not expected to be lifted soon.)

The CDC guidance is expected to be based on a series of metrics that go beyond case counts. Are hospitals in your region able to handle Covid cases and deliver standard care? Are intensive care units filling up? Is wastewater surveillance showing rising levels of virus transmission in a region?

 

The guidance comes at a time when many states have already canceled mask mandates or announced they will roll them back soon, when the choice of whether to wear a mask in public settings will in most cases transition to individuals — at least for the time being.

Is it a signal that we’re effectively done with masks? Probably not, experts tell STAT, though they also acknowledge many jurisdictions are unlikely to resurrect mask mandates unless they have absolutely no other choice.

“I’m not sure that we’re done with the need for widespread mask use, which is what mask mandates are intended to accomplish. But I’m not sure where we are with respect to compliance with those types of requirements in the community,” said Jeffrey Duchin, health officer for the Seattle and King County public health department.

Jennifer Nuzzo, the epidemiology lead at the Johns Hopkins University Coronavirus Resource Center, feels the use of mask mandates this late into the pandemic has done a disservice to a useful public health measure. Mandates are blunt instruments that were better suited to earlier in the pandemic, she said, when we had few tools with which to combat the SARS-CoV-2 virus, and hospitals were on the verge of collapsing under an avalanche of desperately sick Covid patients.

“We are in different circumstances now. We have more tools,” said Nuzzo, who is also a senior scholar at the Hopkins Center for Health Security. “Generally speaking, public health functions better when it is seen more like social workers than law enforcement. And I do think it is important for us to shift our approach to be not exclusively reliant on mandates.”

She supports shifting to a place where people are urged to wear masks when conditions require it. Taking the element of force out of the equation could help people to see masks through a different lens, she suggested.

“I would personally like to see us move towards a culture where instead of perhaps mandating masks to the point where the poor barista at Starbucks has to yell at people or call the police if they don’t come in with a mask that perhaps we make masks available at the entryway of buildings and say ‘Please use one, particularly if you have a cold’ or something along those lines,” Nuzzo said.

 

Over time, masks could become “a courtesy normalized in our culture,” she said. “I don’t love masks. I am very much looking forward to not having to wear them. That said, in the future, if I have a cold and I know it’s not Covid and I have to go out, I’ll wear a mask.”

It’s increasingly apparent, though, that many people are ready to cast off their masks. Will getting rid of mask mandates make masks perhaps more palatable? That’s not clear. The lowly face mask has acquired a lot of emotional baggage over the past couple of years.

“Unfortunately it’s become a symbol of people’s discontent with all the difficulties and struggles associated with this terrible pandemic,” said Duchin, who is also a professor of infectious diseases at the University of Washington. “And it’s a shame because it’s counterproductive. Masks can be useful.”

The experts STAT spoke to for this story believe people — some, anyway — will continue to wear masks at certain times or in certain settings, beyond what the CDC recommends. “I can imagine a lot of people will want to wear them while they’re traveling, even if it’s not required. I can imagine people will wear them in the winter because they don’t want to get the flu or anything else,” Nuzzo said.

That latter scenario was common practice in some Asian countries before the pandemic, especially among countries that were hit during the first SARS outbreak in 2003, Gabriel Leung, dean of medicine at the University of Hong Kong, told STAT via email.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said he expects people who are immunocompromised will likely want to continue to wear masks in public, even after mask mandates expire. Covid-19 vaccines do not trigger the same levels of protection in people who are moderately or severely immunocompromised, such as recipients of solid organ transplants who must take immunosuppressant drugs, or people who are undergoing cancer chemotherapy.

Osterholm thinks masks have been oversold as a Covid control measure — not because they don’t help reduce transmission, but because many people don’t wear them properly or are still wearing cloth masks or poorly fitting surgical masks, which don’t offer enough protection.

“I think when historians go back and look at what was said and done during this pandemic, one of the absolute lowest moments from a scientific perspective and a public policy practice will be what we did with ‘masks,’” Osterholm said, putting the term in verbal air quotes. “What we did with masks was not based on good science.”

It should be noted Osterholm continues to wear N-95 masks and plans to for some time. But he bristles at mandates and guidance that hasn’t differentiated between snuggly fitted N-95s and KN-95s, and other less effective types of face coverings.

Nuzzo agreed. “I’m looking at Hong Kong right now and how they are struggling with their own Omicron wave. And there is no deficit of mask usage. And there is no deficit of public health control measures. There was a deficit of vaccine uptake among the elderly.”

Duchin said he thinks mask guidance may need to be more directive again at some point, depending on how the rest of the pandemic plays out. Case counts are falling rapidly now, but a new variant that causes more severe illness or waning of acquired immunity might alter the threat level — and the need to use layers of control measures such as masks.

“I think a lot of people think the pandemic is over right now,” he said. “And that’s, I think, tragic.”