You’ve heard the joke, “We have to do something! This is something; therefore, we must do this!” That line of talk even has a formal name, the politician’s syllogism. Mask mandates are a “something” and with Colorado’s Fifth Wave of Covid severely stressing hospitals, various counties imposed or maintained mask mandates. But do mask mandates work? And, even if they work, are they just?
My take is that good-quality masks worn well probably make some difference in reducing viral spread. Counties have a plausible public-health rationale for imposing short-term mask mandates when a pandemic involving an airborne virus threatens hospital capacity. And the imposition for most people is trivial. I have no problem wearing a surgical, KN95, or N95 mask when going into the store or the like. To me, it’s a matter of taking personal responsibility seriously and of valuing members of my community, including the doctors and nurses overwhelmed by Covid patients.
At the same time, I think mask mandates don’t make a lot of difference and that some people get overexcited about them. So when columnist Krista Kafer announced in the Denver Post that she would “no longer comply with government mask mandates” because masks are a nuisance and evidence for their effectiveness is weak, I thought she overplayed her hand but that her critics also overplayed theirs. Far-left political writer Trish Zornio, for example, vehemently denounced Kafer and called for her to be cancelled over the column, saying the Post should “permanently remove” her as a contributor.
Zornio, always eager to tout her credentials as a scientist, also blasted Governor Jared Polis for not instituting a state-wide mask mandate, saying Polis “continues to ignore public health officials” and “is just another politician who doesn’t respect scientific experts like me.”
Her denunciations based on appeals to her own authority are odd (even aside from the fact that her credentials have no direct bearing on epidemiology), in that Zornio makes surprisingly little effort to present the scientific evidence for her position. For example, in her November 3 column for the ideologically progressive Colorado Newsline berating Polis for not imposing a mask mandate, Zornio mentions not so much as a single scientific study regarding masks or mask mandates. The same goes for her November 15 column for the Colorado Sun also berating Polis.
A precarious case for mandates
Many advocates of mask mandates presume that it is enough to justify mandates to show that wearing masks reduces viral spread. It’s not. If we’re going to sensibly talk about policy, we also have to consider such things as whether a policy is proper to government (in this case I don’t see a problem there), whether there’s a less-intrusive means to accomplish the goal, and whether a policy can be fairly enforced. When we start asking questions about such matters, the case for a mask mandate becomes a lot more precarious.
Having now observed mask mandates in action, I have changed my mind somewhat regarding how much mandates can shift behavior. Earlier in the pandemic I didn’t go into public and ordered everything for delivery or curbside pickup, but now that I’ve been vaccinated I’m going out and about.
This is anecdotal, I realize, but I think it’s illustrative: I went to my local Costco in Jefferson County a couple days before the county imposed a new mask mandate and also on the first day of the mandate, November 24. Notably, on the second trip, the store’s staff were handing out surgical masks to people coming in the door. And mask use obviously was up dramatically, I’m guessing from around 40–50% to around 80–90%. More importantly, the quality of the masks also was higher, with most people wearing surgical masks and some wearing KN95 or N95 masks. It’s hard to know how much of the increased mask use was due to the store providing masks, but, at least at that facility, the mandate clearly made a huge difference.
This suggests to me that many people have a go-along-get-along attitude with respect to masks. They might not go out of their way to wear masks, but neither will they resist wearing them. And Costco had good success with the honey of free (store-provided) masks rather than the vinegar of threats or warnings. Others have reported not seeing much of a change in mask wearing, though, and good data about such trends is hard to get. (The November 3 Anschutz School of Public Health report on Covid reports some Facebook survey data on mask use; perhaps a subsequent report will shed more light on recent trends.)
I’m prepared to accept that mask mandates “work,” then, in the sense of increasing the wearing of good-quality masks. But what we really care about is whether the mandates decrease viral transmission and hence ease pressure on hospitals. That’s not so clear.
It’s not mandate or bust
Insofar as people do have a go-along-get-along attitude regarding masks, that seems to imply that government could get by with issuing a strong advisory to mask up short of a mandate, without getting government involved in enforcement. Or government could provide resources to help stores enforce mask rules they choose to impose. Or government could purchase surgical masks for stores to distribute. It’s not mandate or bust.
How much do masks actually help? By my reading, the best science indicates that wearing a good-quality mask well does reduce viral transmission. Note the qualifiers: Masks must be good-quality, and they must be worn well.
A huge problem with mask mandates is they are extremely hard to enforce. Sure, stores can deny entry to people who refuse to wear masks or can kick them out. Practically, it’s pretty easy to wear a mask going in the door and then pull it down. I saw several people in Costco wearing a surgical mask around their chins. Although the mandates try to specify what sorts of masks people must wear and how they must wear them, in practice, hardly anyone ever checks. And it’s pretty obvious that, even if we had a state-wide mask mandate, compliance would be relatively low in certain parts of the state.
Another problem is that the very people least likely to comply with the spirit or the letter of a mask mandate are also the people least likely to be vaccinated. (That’s not true of Kafer, who has strongly promoted the Covid vaccines.) To put the point another way: The people most likely to wear good-quality masks well are the people least likely to catch or spread the disease. According to state figures updated through mid-November, a fully vaccinated person is only about 28% as likely to test positive for Covid. But I think the true benefit to vaccination might be undercounted, because people who refuse to get vaccinated probably also often avoid getting tested even if they have symptoms. So cases among unvaccinated people might be less likely to show up in the stats.
At best, masks are a stop-gap. Especially in the context of the highly infectious Delta variant now dominant, and the perhaps-more-infectious new Omicron variant, just about everyone is going to be exposed to Covid, either the easy way (vaccination) or the hard way (infection). The question is whether mask mandates slow the spread enough to ease the strain on hospitals and allow for more development of treatments. (Economist Tyler Cowen discusses such complexities in a recent post.)
I think the evidence on net is pretty convincing that masks work to some extent. Chase Woodruff, a reporter for Colorado Newsline, claims, based on a pre-Delta January review of various scientific findings, “that we have overwhelming population-level evidence that masks and mask mandates work.” But it’s not clear that they help much. As Nature summarizes, a recent big study in Bangladesh “linked surgical masks with an 11% drop in risk, compared with a 5% drop for cloth.” But Ben Recht, a professor of machine learning at Berkeley, doesn’t think the differences in numerical outcomes are large enough to draw firm conclusions.
And it’s worth noting that the cloth masks distributed for the Bangladesh study are much better than most cloth masks I see in common use in our region. Here’s how the study describes these masks: “The cloth mask had an exterior layer of 100% non-woven polypropylene (70 grams/square meter [gsm]), two interior layers of 60% cotton / 40% polyester interlocking knit (190 gsm), an elastic loop that goes around the head above and below the ears, and a nose bridge. The surgical mask had three layers of 100% non-woven polypropylene, elastic ear loops, and a nose bridge. The filtration efficiency was 37% (standard deviation [SD] = 6%) for the cloth masks, and 95% (SD = 1%) for the surgical masks.”
Mask order absurdity
Do the mandates require that people wear masks that actually work well? Of course not. Denver requires a “face covering” in many public settings and defines it as “a covering made of cloth, fabric, or other soft or permeable material, without holes, that covers the nose and mouth and surrounding areas of the lower face. A Face Covering may be factory-made or may be handmade and improvised from ordinary household materials. The Face Covering should fit snugly but comfortably against the side of the face, include multiple layers of fabric, allow for breathing without restriction,” etc.
This order obviously is ridiculous. A permeable mask by definition has holes. What Denver is trying to disallow is, say, a knitted mask with obviously large holes. But the city doesn’t want to try to define acceptable hole size, because then the mandate would be obviously unenforceable. It’s not like we’re going to have cops get out their microscopes to check. And the order ambiguously talks about various properties masks “should” have without explicitly mandating that they have those properties.
The Boulder and Jefferson orders punt to CDC guidance, which is barely better: “Cloth masks should be made with two or more layers of a breathable fabric that is tightly woven (i.e., fabrics that do not let light pass through when held up to a light source).” But almost all masks will allow some light to pass through; that is not a sensible standard. I held up my surgical, KN95, and N95 masks up to the window and, guess what, they all “let light pass through.” Is it too much to ask that health orders make sense? In practice, no authority is going to check people’s masks to see how much light passes through, except perhaps in the most egregious cases.
If government is going to impose a mandate, it should have to prove not only that the policy is the least-intrusive means to achieve some worthwhile end but that it can be fairly enforced. Because the orders are heavier-handed than necessary, do not mandate very effective masks, and make various exceptions (such as for dining), enforcement of them is inherently capricious. And do we really want authorities out harassing frazzled mothers whose toddlers refuse to wear a mask?
I have no problem throwing on a surgical or K/N95 mask until this Covid wave calms down, even if bureaucrats tell me I have to. But let’s get real here. Mask mandates at best moderately delay viral spread. What we really need is more testing (still), faster approval of new treatments, more vaccination regionally (including boosters), much faster global vaccination, and, if Omicron turns out to substantially cut through our existing defenses (we’ll see), faster development of improved boosters. There’s not an easy way out of this, but there is a way out.
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