Covid-19 mask mandates

A version of this story appears in CNN’s What Matters newsletter. To get it in your inbox, sign up for free here.

Washington CNN  — 

It’s a confusing time, yet again, in the Covid-19 pandemic.

Consider this: Covid-19 cases are increasing across the US, driven by the most transmissible variant of the coronavirus yet. Reinfections are up too, and may increase the likelihood of new health problems. Even President Joe Biden has contracted the virus, forcing him to work in isolation from the White House.

Each of these developments is alarming in their own way. But none of them seems to have shaken the public conscious like earlier pandemic news could. In CNN’s latest national poll, Covid-19 was a central concern to just 26% of voters, far behind the economy, abortion and the climate crisis.

There’s good reason for this: A significant proportion of Americans are vaccinated – although the percent having received a booster is lower – and there are new treatments offering better outcomes to those who get the virus. Despite Biden’s age putting him at risk for severe Covid-19, for example, because of these advances, his experience with the coronavirus should look a lot different from that of President Donald Trump, who was in the hospital for days in October 2020. (Biden, who’s double boosted, is receiving the antiviral Paxlovid, and his physician wrote Sunday that his “symptoms continue to improve significantly.”)

But with a subvariant that can outmaneuver vaccination or immunity from recent Covid infections, our days of putting Covid-19 on the back burner may be numbered.

Take Los Angeles, for example, the second most populous city in the US. Health officials say LA County’s high Covid-19 community level means a universal indoor masking mandate could be enacted as soon as this week. While daily reported cases have leveled off, with about 6,700 new cases daily, Department of Public Health Director Barbara Ferrer said last week that the community level must decline back to “medium” by July 28 to avoid an indoor mask requirement occurring on July 29.

And it’s not just LA that’s reacting to rising case numbers and hospitalizations. The share of the United States population that lives in a county with a “high Covid-19 Community Level,” where the US Centers for Disease Control and Prevention recommends universal indoor masking, has doubled over the past two weeks. And as Americans have switched to more rapid at-home tests, official case counts reflect just a fraction of the true disease burden.

That’s why there’s renewed discussion of indoor masking, with Boston, for example, issuing a new mask advisory earlier this month. But a lot depends on local politics, and the merits of such measures – especially mandates – remains a matter of debate.

For more on this, we turned to Dr. Leana Wen, a CNN medical analyst and public health professor at the George Washington University. Our conversation, conducted over email and lightly edited for flow and brevity, is below.

What Matters: Does the recent rise in Covid-19 cases call for indoor mask mandates to return?

WEN: There is a big difference between a recommendation for individuals to mask and a government-imposed mask requirement. Government requirements for public health precautions should be used extremely sparingly, for emergencies where there is no other option. This is not that time.

I worry about eroding trust such that when a mask mandate is actually needed – if there is a much more lethal variant or if hospitals are once again overwhelmed – there will be no appetite to accept mitigation measures at that point.

What Matters: What should lawmakers consider as they weigh whether to implement indoor mask mandates again?

WEN: There are other tools now besides mask mandates. This is not 2020. I’d advise lawmakers to use other tools that are very effective at reducing the likelihood of severe illness but that do not come with such backlash – for example, why not surge boosters and Paxlovid? Why not urge testing ahead of get-togethers?

What Matters: On an individual level, at this point in the pandemic, when should we be masking up and when can we leave it off?

WEN: That depends on the individual and how much they want to keep avoiding Covid-19. Those who prioritize avoiding infection should keep masking – but make sure they are using an N95 or equivalent (KN95 or KF94), that it’s well-fitting, and that they use it in all indoor public spaces.

There are many who do not prioritize avoiding Covid any more, as they are well-protected against severe disease because of vaccines and treatments; they may not wish to don their masks even with high levels of transmission around them. That’s why mask mandates from the government do not make sense at this point in the pandemic.

What Matters: Anything else you’d like to add about any of this?

WEN: It is both true that masks reduce the risk of virus transmission and that mask requirements are very controversial. I’d urge lawmakers to focus on tools that do not draw such public backlash and that make as much – or even more – of a difference as government-imposed masking.