Once again, the United States is at a turning point in the covid-19 pandemic. As infections fall, local and state officials are lifting mask mandates, and a bipartisan group of governors is calling on President Biden to “move away” from the pandemic by providing an off-ramp for remaining restrictions.
Both extremes are wrong. Public health policy is nuanced and complex, and the sooner we acknowledge this, the quicker we can move from polarizing rhetoric to reasonable compromises that allow us to live with covid-19.
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To begin, just because restrictions might now be lifted in many areas doesn’t mean that they weren’t needed before — or that we won’t need them in the future. At the start of the pandemic, there were few tools in the public health arsenal to fight a new and deadly virus. At that time, and during subsequent surges, masks and physical distancing were crucial measures that helped “flatten the curve” and save lives.
Times have changed. Cases are falling rapidly. Vaccines are widely available for everyone 5 and older, and they work: People vaccinated and boosted are 97 times less likely to die of covid-19 compared with the unvaccinated. Research also shows that respirator masks (N95, KN95 or KF94) are highly effective at protecting wearers, even if others around them are unmasked.
All of this explains why mask requirements were the right policy before and why masking can now move from a government-imposed mandate to an individual decision.
“If we want to preserve trust and respect for public health, we need to pivot when data tell us that we should,” said Jeanne Noble, an emergency physician at the University of California at San Francisco. Noble is co-founder of a new movement, the Urgency of Normal, that calls for nuance around pandemic restrictions. In an interview, she told me that we “can’t continue the same generic messaging that we have to do everything we can to prevent coronavirus transmission. It shouldn’t be all or nothing, ‘you’re either with us or against us.’ ”
For example, she advocates ending mask mandates in schools. “To say that masking doesn’t have any harm goes against decades of child development research,” Noble said, pointing to the pre-pandemic consensus that young children need to learn face-reading skills. The American Speech-Language-Hearing Association reports that referrals of children to speech therapy have increased since the pandemic began, and though it’s not known if this is because of masking, some studies show that visible articulations are important to early learning.
I think it’s possible to hold two seemingly contradictory things to be true. It can be true that masks reduce respiratory infections and also that they can have unintended harms, especially in the very young and children with learning disabilities. Masks, after all, are a type of medical intervention, and nearly every intervention carries risks and benefits. Sound policies require constant reevaluation of these trade-offs.
In the same vein, it can be true both that covid-19 causes illness and harm, and also that its continued prioritization, to the exclusion of other issues, does, too. Another Urgency of Normal co-founder, internal medicine physician Lucy McBride, told me that many of her vaccinated and boosted patients are still extremely anxious despite their relatively low risk from covid-19. “I tell them that I’m more concerned about their hypertension, diabetes, depression and overall mental health. I’m concerned about them missing mammograms. I worry about their relationship with alcohol and the social isolation they’re experiencing.”
The impact of these other issues is harder to measure, because, as McBride said, “there’s no PCR test for despair.” But that doesn’t make other issues any less consequential to people’s overall well-being. On the societal level, a narrow-minded focus on infection control comes with the trade-off that opioid overdoses, childhood obesity and other public health crises will continue taking a back seat.
Throughout much of the pandemic, there were two camps: One that opposed restrictions and one that supported them. As both sides became more entrenched, a third has emerged. This group advocated restrictions from the start but now believes circumstances have changed enough that mandates can go. These people acknowledge the tragic toll of the pandemic but also understand that good health cannot simply be the absence of covid-19. Policymakers would do well to heed this group as we enter the next phase of the pandemic, when we as a country strive to replace vitriol and divisiveness with nuance and compromise.