The city of Philadelphia reinstated its indoor mask mandate on Monday, citing an increase in daily covid-19 cases driven by the highly contagious BA.2 omicron subvariant. Though the uptick in cases is important to keep an eye on, I believe it was premature for the local government to reimpose a mask requirement. Other cities should not follow suit.
Less than two months ago, the Centers for Disease Control and Prevention laid out new masking recommendations that changed the primary measurement from cases to hospitalizations and hospital capacity. To allow for more tailored guidance, the CDC also released an interactive map for people to look up the covid-19 risk level where they live. Individuals should wear a mask if they are in communities designated as high-risk. Those in medium-risk areas can choose to mask based on their medical circumstances, and those in low-risk areas do not need to mask.
Philadelphia is still solidly in the low-risk zone. City officials, in explaining why they are not following CDC guidelines, have said that they want to get ahead of a potential surge. While acting out of abundance of caution is generally an admirable principle, there are three problems with this decision.
First, there is no convincing evidence that the rise in cases is so significant that it risks straining hospitals. Other areas in the Northeast, including New York City, have also experienced an uptick in cases, but they are not seeing a subsequent surge in hospitalizations. Just three days before the Philadelphia mask mandate was reimposed, the Children’s Hospital of Pennsylvania’s Policy Lab wrote on Twitter, “Our team advises against required masking given that hospital capacity is good.”
Second, by deviating so much from CDC guidance, Philadelphia is adding to confusion around public health recommendations. Federal health officials have already changed their focus from preventing infection to reducing severe illness. President Biden’s new coronavirus response coordinator, Ashish Jha, said this week that he is not “excessively concerned” about the rise in BA.2 and that the administration does not expect any substantial changes to its masking guidance. Anthony S. Fauci, Biden’s chief medical adviser, echoed that shift away from top-down mandates to individual decision-making.
Are Philadelphia officials saying that they disagree with and won’t follow the Biden administration’s approach to the coronavirus? Or do they believe that hospitals will become strained, despite evidence to the contrary? Neither instills confidence, which is crucial to compliance and restoring trust in public health.
Third, and relatedly, I worry that if mask mandates are being brought back when they aren’t needed, it will be hard to get people to abide by them when they are. This is the classic case of “crying wolf”: If you tell me the wolf is coming now, but then it doesn’t come, why would I believe you next time?
In the future, there really might be an instance when restrictions have to come back. For example, a new variant could arise that evades prior immunity and causes more deadly disease. We would want to have the option of reinstating mask mandates and other mitigation measures. But will people listen and follow the guidance at that time if they were not applied rationally before?
This is why federal, state and local officials need to be on the same page about our path forward with covid-19. We need to agree that eradication of the virus is not on the table. Rather, as Biden coordinator Jha reminded the American people in television interviews this week, the United States is now at its lowest point for hospitalizations since the beginning of the pandemic. Vaccines and boosters protect well against severe illness, and we have other tools, including highly effective treatments.
At this point, therefore, it is no longer appropriate to use cases as the metric that determines when mandates return. Instead, there should be two specific criteria: Are hospitals at risk of being overrun, and do vaccines still provide protection? So long as hospitals have good capacity and vaccines still work well against variants, mask requirements and other government mandates should not be reinstated.
Of course, just because the government doesn’t require masks doesn’t mean that people shouldn’t wear them. Those who prioritize avoiding covid-19 should wear a high-quality N95 or equivalent mask when in indoor public settings. Certain institutions, such as hospitals and nursing homes, should still mandate masks to safeguard their vulnerable patients. And workplaces and large events can add additional protections, such as proof of vaccination and regular testing, if they so choose.
But government-imposed mandates are a last resort. They are blunt tools to be used extremely sparingly and in true public health emergencies, when all other options have been exhausted. Now is not that time.