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Tag: COVID States Project

  • Should Everyone Be Masking Again?

    Should Everyone Be Masking Again?

    Winter is here, and so, once more, are mask mandates. After last winter’s crushing Omicron spike, much of America did away with masking requirements. But with cases once again on the rise and other respiratory illnesses such as RSV and influenza wreaking havoc, some scattered institutions have begun reinstating them. On Monday, one of Iowa’s largest health systems reissued its mandate for staff. That same day, the Oakland, California, city council voted unanimously to again require people to mask up in government buildings. A New Jersey school district revived its own mandate, and the Philadelphia school district announced that it would temporarily do the same after winter break.

    The reinstated mandates are by no means widespread, and that seems unlikely to change any time soon. But as we trudge into yet another pandemic winter, they do raise some questions. What role should masking play in winters to come? Is every winter going to be like this? Should we now consider the holiday season … masking season?

    These questions don’t have simple answers. Regardless of what public-health research tells us we should do, we’ve clearly seen throughout the pandemic that limits exist to what Americans will do. Predictably, the few recent mandates have elicited a good deal of aggrievement and derision from the anti-masking set. But even many Americans who diligently masked earlier in the pandemic seem to have lost their appetite for this sort of intervention as the pandemic has eased. In its most recent national survey of health behavior, the COVID States Project found that only about a quarter of Americans still mask when they go out, down from more than 80 percent at its peak. Some steadfast maskers have started feeling awkward: “I have personally felt like I get weird looks now wearing a mask,” Saskia Popescu, an epidemiologist at George Mason University, told me.

    Even so, masking remains one of the best and least obtrusive infection-prevention measures we have at our disposal. We haven’t yet been slammed this winter by another Omicronlike variant, but the pandemic is still here. COVID cases, hospitalizations, and deaths are all rising nationally, possibly the signs of another wave. Kids have been hit especially hard by the unwelcome return of influenza, RSV, and other respiratory viruses. All of this is playing out against the backdrop of low COVID-19-booster uptake, leaving people more vulnerable to death and severe disease if they get infected.

    All of which is to say: If you’re only going to mask for a couple of months of the year, now is a good time. “Should people be masking? Absolutely yes, right now,” Seema Lakdawala, a flu-transmission expert at Emory University, told me. That doesn’t mean masking everywhere all the time. Lakdawala masks at the grocery store, at the office, and while using public transportation, but not when she goes out to dinner or attends parties. Those activities pose a risk of infection, but Lakdawala’s goal is to reduce her risk, not to minimize it at all costs. A strategy that prevents you from enjoying the things you love most is not sustainable.

    Both Lakdawala and Popescu were willing to go so far as to suggest that masking should indeed become a seasonal fixture—just like skiing and snowmen, only potentially lifesaving and politically radioactive. Even before the pandemic, influenza alone killed tens of thousands of Americans every year, and more masking, even if only in certain targeted settings, could go a long way toward reducing the toll. “If we could just say, Hey, from November to February, we should all just mask indoors,” Lakdawala said, that would do a lot of good. “The idea of the unknown and the perpetualness of two years of things coming on and off, and then the confusing CDC county-by-county guideline—it just sort of makes it harder for everybody than if we had a simple message.” Universal mandates or recommendations that people mask at small social gatherings are probably too much to ask, Lakdawala told me. Instead, she favors some limited, seasonal mandates, such as on public transportation or in schools dealing with viral surges.

    David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, is all for masking season, he told me, but he’d be more hesitant to resort to mandates. “It’s hard to impose mandates without a very strong public-health rationale,” he said, especially in our current, hyperpolarized climate. And although that rationale clearly existed for much of the past two crisis-ridden years, it’s less clear now. “COVID is no longer this public-health emergency, but it’s still killing thousands of people every week, hundreds a day … so it becomes a more challenging balancing act,” Dowdy said.

    Rather than requirements, he favors broad recommendations. The CDC, for instance, could suggest that during flu season, people should consider wearing masks in crowded indoor spaces, the same way it recommends that everyone old enough get a flu shot each year. (Although the agency has hardly updated its “Interim Guidance” on masks and the flu since 2004, Director Rochelle Walensky has encouraged people to mask up this winter.) Another strategy, Dowdy said, could be making masks more accessible to people, so that every time they enter a public indoor space, they have the option of grabbing an N95.

    The course of the pandemic has both demonstrated the efficacy of widespread masking and rendered that strategy so controversial in America as to be virtually impossible. The question now is how to negotiate those two realities. Whatever answer we come up with this year, the question will remain next year, and for years after that. The pandemic will fade, but the coronavirus, like the other surging viruses this winter, will continue to haunt us in one form or another. “These viruses are here,” Lakdawala said. “They’re not going anywhere.”

    Jacob Stern

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  • It’s Gotten Awkward to Wear a Mask

    It’s Gotten Awkward to Wear a Mask

    Last week, just a couple of hours into a house-sitting stint in Massachusetts for my cousin and his wife, I received from them a flummoxed text: “Dude,” it read. “We are the only people in masks.” Upon arriving at the airport, and then boarding their flight, they’d been shocked to find themselves virtually alone in wearing masks of any kind. On another trip they’d taken to Hawaii in July, they told me, long after coverings became optional on planes, some 80 percent of people on their flight had been masking up. This time, though? “We are like the odd man out.”

    Being outside of the current norm “does not bother us,” my cousin’s wife said in another text, despite stares from some of the other passengers. But the about-face my cousin and his wife identified does mark a new phase of the pandemic, even if it’s one that has long been playing out in fits and starts. Months after the vanishing of most masking mandates, mask wearing has been relegated to a sharply shrinking sector of society. It has become, once again, a peculiar thing to do.

    “If you notice, no one’s wearing masks,” President Joe Biden declared last month on 60 Minutes. That’s an overstatement, but not by much: According to the COVID States Project, a large-scale national survey on pandemic-mitigation behaviors, the masking rate among Americans bounced between around 50 and 80 percent over the first two years of the pandemic. But since this past winter, it’s been in a slide; the project’s most recent data, collected in September, found that just 29 percent have been wearing masks outside the home. This trend may be long-standing on the population level, but for individuals—and particularly for those who still wear masks, such as my cousin and his wife—it can lead to moments of abrupt self-consciousness. “It feels like it’s something that now needs an explanation,” Fiona Lowenstein, a journalist and COVID long-hauler based in Los Angeles, told me. “It’s like showing up in a weird hat, and you have to explain why you’re wearing it.”

    Now that most Americans can access COVID vaccines and treatments that slash the risk of severe disease and death, plenty of people have made informed decisions to relax on masking—and feel totally at ease with their behavior while paying others’ little mind. Some are no longer masking all the time but will do so if it makes others feel more comfortable; others are still navigating new patterns, trying to stay flexible amid fluctuating risk. Saskia Popescu, an infectious-disease epidemiologist at George Mason University, told me that she’s now more likely to doff her mask while dining or working out indoors, but that she leaves it on when she travels. And when she does decide to cover up, she said, she’s “definitely felt like more of an outlier.”

    For some, like my cousin and his wife, that shift feels slightly jarring. For others, though, it feels more momentous. High-filtration masks are one of the few measures that can reliably tamp down on infection and transmission across populations, and they’re still embraced by many parents of newborns too young for vaccines, by people who are immunocompromised and those who care for them, and by those who want to minimize their risk of developing long COVID, which can’t be staved off by vaccines and treatments alone. Theresa Chapple-McGruder, the public-health director for Oak Park, Illinois, plans to keep her family masking at least until her baby son is old enough to receive his first COVID shots. In the meantime, though, they’ve certainly been feeling the pressure to conform. “People often tell me, ‘It’s okay, you can take your mask off here,’” Chapple-McGruder told me; teachers at the local elementary school have said similar things to her young daughters. Meghan McCoy, a former doctor in New Hampshire who takes immunosuppressive medications for psoriatic arthritis and has ME/CFS, has also been feeling “the pressure to take the mask off,” she told me—at her kid’s Girl Scout troop meetings, during trips to the eye doctor. “You can feel when you’re the only one doing something,” McCoy said. “It’s noticeable.”

    Read: Mask mandates are illogical. So what?

    For Chapple-McGruder, McCoy, and plenty of others, the gradual decline in masking creates new challenges. For one thing, the rarer the practice, the tougher it is for still-masking individuals to minimize their exposures. “One-way masking is a lot less effective,” says Gabriel San Emeterio, a social worker at Hunter College who is living with HIV and ME/CFS. And the less common masking gets, the more conspicuous it becomes. “If most people met me, they wouldn’t know I was immunocompromised,” McCoy told me. “There’s no big sign on our foreheads that says ‘this person doesn’t have a functioning immune system.’” But now, she said, “masks have kind of become that sign.”

    Aparna Nair, a historian and disability scholar at the University of Oklahoma who has epilepsy, told me that she thinks masks are becoming somewhat analogous to wheelchairs, prosthetics, hearing aids, and her own seizure-alert dog, Charlie: visible tools and technologies that invite compassion, but also skepticism, condescension, and invasive questions. During a recent rideshare, she told me, her driver started ranting that her mask was unnecessary and ineffective—just part of a “conspiracy.” His tone was so angry, Nair said, that she began to be afraid. She tried to make him understand her situation: I’ve been chronically ill for three decades; I’d rather not fall sick; better to be safe than sorry. But she said that her driver seemed unswayed and continued to mutter furiously under his breath for the duration of the ride. Situations of that kind—where she has to litigate her right to wear a mask—have been getting more common, Nair told me.

    Masking has been weighed down with symbolic meaning since the start of the pandemic, with some calling it a sign of weakness and others a vehicle for state control. Americans have been violently attacked for wearing masks and also for not wearing them. But for a long time, these tensions were set against the backdrop of majority masking nationwide. Local mask mandates were in place, and most scientific experts wore and championed them in public. With many of those infrastructural supports and signals now gone, masking has rapidly become a minority behavior—and people who are still masking told me that that inversion only makes the tension worse.

    San Emeterio, who wears a vented respirator when they travel, recently experienced a round of heckling from a group of men at an airport, who started to stare, laugh, and point. Oh my god, look at what he’s wearing, San Emeterio recalls the strangers saying. “They clearly meant for me to hear it,” San Emeterio told me. “It didn’t make me feel great.” Alex Mawdsley, the 14-year-old son of an immunocompromised physician in Chicago, is one of just a handful of kids at his middle school who are still masking up. Since the start of the academic year, he’s been getting flak from several of his classmates “at least once a week,” he told me: “They’re like ‘You’re not gonna get COVID from me’ and ‘Why are you still wearing that? You don’t need it anymore.’”

    Alex’s mother, Emily Landon, told me she’s been shaken by the gawks and leers she now receives for masking. Even prior to the pandemic, and before she was diagnosed with rheumatoid arthritis and began taking immunosuppressive drugs, she considered herself something of a hygiene stan; she always took care to step back from the sneezy and sniffy, and to wipe down tray tables on planes. “And it was never a big deal,” she said.

    Read: Put your face in airplane mode

    It hasn’t helped that the donning of masks has been repeatedly linked to chaos and crisis—and their removal, to triumph. Early messaging about vaccines strongly implied that the casting away of masks could be a kind of post-immunization reward. In February, CDC Director Rochelle Walensky described masks as “the scarlet letter of this pandemic.” Two months later, when the administration lifted its requirements for masking on public transportation, passengers on planes ripped off their coverings mid-flight and cheered.

    To reclaim a mask-free version of “normalcy,” then, may seem like reverting to a past that was safer, more peaceful. The past few years “have been mentally and emotionally exhausting,” Linda Tropp, a social psychologist at the University of Massachusetts at Amherst, told me. Discarding masks may feel like jettisoning a bad memory, whereas clinging to them reminds people of an experience they desperately want to leave behind. For some members of the maskless majority, feeling like “the normal ones” again could even serve to legitimize insulting, dismissive, or aggressive behavior toward others, says Markus Kemmelmeier, a social psychologist at the University of Nevada at Reno.

    It’s unclear how the masking discourse might evolve from here. Kemmelmeier told me he’s optimistic that the vitriol will fade as people settle into a new chapter of their coexistence with COVID. Many others, though, aren’t so hopeful, given the way the situation has unfolded thus far. “There’s this feeling of being left behind while everyone else moves on,” Lowenstein, the Los Angeles journalist and long-hauler, told me. Lowenstein and others are now missing out on opportunities, they told me, that others are easily reintegrating back into their lives: social gatherings, doctor’s appointments, trips to visit family they haven’t seen in months or more than a year. “I’d feel like I could go on longer this way,” Lowenstein said, if more of society were in it together.

    Americans’ fraught relationship with masks “didn’t have to be like this,” Tropp told me—perhaps if the country had avoided politicizing the practice early on, perhaps if there had been more emphasis on collective acts of good. Other parts of the world, certainly, have weathered shifting masking norms with less strife. A couple of weeks ago, my mother got in touch with me from one such place: Taiwan, where she grew up. Masking was still quite common in public spaces, she told me in a text message, even where it wasn’t mandated. When I asked her why, she seemed almost surprised: Why not?

    Katherine J. Wu

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