Joseph A. Ladapo for Wall Street Journal
A
hallmark of Covid-19 pandemic policy has been the failure of political leaders
and health officials to anticipate the unintended consequences of their
actions. This tendency has haunted many decisions, from lockdowns that
triggered enormous unemployment and increased alcohol and drug abuse, to school
closures that are widening educational disparities between rich and poor
families. Mask mandates may also have unintended consequences that outweigh the
benefits.
First,
consider how the debate has evolved and the underlying scientific evidence.
Several randomized trials of community or household masking have been
completed. Most have shown that wearing a mask has little or no effect on
respiratory virus transmission, according to a review published earlier this
year in Emerging Infectious Diseases, the
Centers for Disease Control and Prevention’s journal. In March, when Anthony
Fauci said, “wearing a mask might make people feel a little bit better” but
“it’s not providing the perfect protection that people think it is,” his
statement reflected scientific consensus, and was consistent with the World
Health Organization’s guidance.
Almost
overnight, the recommendations flipped. The reason? The risk of asymptomatic
transmission. Health officials said mask mandates were now not only reasonable
but critical. This is a weak rationale, given that presymptomatic spread of
respiratory viruses isn’t a novel phenomenon in public health. Asymptomatic
cases of influenza occur in up to a third of patients, according to a 2016 report in Emerging Infectious Diseases, and
even more patients had mild cases that are never diagnosed. Asymptomatic or
mild cases appear to contribute more to Covid-19 transmission, but this happens
in flu cases, too, though no one has called for mask mandates during flu season.
The
public assumes that research performed since the beginning of the pandemic
supports mask mandates. Policy makers and the media point to low-quality
evidence, such as a study of Covid-19 positive hairstylists in Missouri or a
Georgia summer camp with an outbreak. These anecdotes, while valuable, tell us
nothing about the experience of other hairdressers or other summer camps that
adopted similar or different masking practices. Also low-quality evidence:
Videos of droplets spreading through air as people talk, a well-intended line
of research that has stoked fears about regular human interactions.
Rather,
the highest-quality evidence so far is studies like the one published in June in Health Affairs, which
found that U.S. states instituting mask mandates had a 2% reduction in growth
rates of Covid-19 compared with states without these mandates. Because
respiratory virus spread is exponential, modest reductions can translate into
large differences over time. But these shifts in trajectory are distinct from
the notion that mandating masks will bring the pandemic to an end. Based on
evidence around the world, it should be clear that mask mandates won’t
extinguish the virus.
The
most reasonable conclusion from the available scientific evidence is that
community mask mandates have—at most—a small effect on the course of the
pandemic. But you wouldn’t know that from watching cable news or sitting next
to a mother being forced off an airplane because her small children aren’t able
to keep a mask on.
While
mask-wearing has often been invoked in explanations for rising or falling
Covid-19 case counts, the reality is that these trends reflect a basic human
need to interact with one another. Claims that low mask compliance is responsible
for rising case counts are also not supported by Gallup data, which show that the
percentage of Americans reporting wearing masks has been high and relatively
stable since June. Health officials and political leaders have assigned mask
mandates a gravity unsupported by empirical research.
On
even shakier scientific ground is the promotion of mask use outdoors. One contact-tracing study identified
only a single incident of outdoor transmission among 318 outbreaks. Even the
Rose Garden nomination ceremony for Justice Amy Coney Barrett, which the media
giddily labeled a “superspreader” event, likely wasn’t; transmission more
likely occurred during indoor gatherings associated with the ceremony.
By
paying outsize and scientifically unjustified attention to masking, mask
mandates have the unintended consequence of delaying public acceptance of the
unavoidable truth. In countries with active community transmission and no herd
immunity, nothing short of inhumane lockdowns can stop the spread of Covid-19,
so the most sensible and sustainable path forward is to learn to live with the
virus.
Shifting
focus away from mask mandates and toward the reality of respiratory viral
spread will free up time and resources to protect the most vulnerable
Americans. There is strong evidence that treating patients early in outpatient
settings can be effective, as outlined in a recent American Journal of
Medicine paper, but these treatments are underused. Identifying
effective treatments for hospitalized patients with Covid-19 is essential, but
preventing severe illness before hospitalization will save more lives.
Until
the reality of viral spread in the U.S.—with or without mask mandates—is
accepted, political leaders will continue to feel justified in keeping schools
and businesses closed, robbing young people of the opportunity to invest in
their futures, and restricting activities that make life worthwhile. Policy
makers ought to move forward with more wisdom and sensibility to mitigate
avoidable costs to human life and well-being.
Dr. Ladapo is an associate professor
at UCLA’s David Geffen School of Medicine.