Today, Explained - The case against masks

Episode Date: February 3, 2022

At least in schools. This episode was produced by Victoria Chamberlin, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

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BetMGM.com for terms and conditions. Must be 19 years of age or older to wager. Ontario only. Please play responsibly. If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. It's Today Explained. I'm Sean Ramos-Rum, and I'm sure you've noticed that we've reached the point in this

pandemic where ideas that used to seem unscientific or fringy are now being discussed more seriously or even accepted by the large majority of us. That lab leak theory, that was a total conspiracy until maybe not. Those cloth masks will do the trick until maybe not. Schools should remain closed. Well, probably not. Or maybe even kids shouldn't wear masks at school anymore. For two years, having kids learn masked, not really seeing their teacher's faces or their friend's faces, this is likely not going to be a no-cost intervention. You know, we're seeing some anecdotal evidence start to pop up that masks are exacerbating speech delays.

It's harder for language acquisition. It impedes social, emotional skills and facial recognition. They're obviously harder to communicate in. This is Dr. Marjorie Smelkinson. She's an infectious disease scientist based in Maryland. If this is a layer that we can eliminate because it's not backed up by robust data, we should. We shouldn't have to wait for the data to be collected about the harms to eliminate this if it's simply just not backed up by data that it's significantly reducing spread. It's worth noting here that almost half the country isn't waiting. They've gone ahead and

lifted school mask mandates if they ever had them to begin with. And those places with unmasked kids, they got just as much COVID as places with kids wearing masks. Dr. Smelkinson recently joined forces with a few fellow doctors to make an argument directed at all those places that still have mask mandates in schools, the blue states. They wrote the case against masks at schools for the Atlantic, and we asked her to make the case on the show today. We started with the data. This year, nearly half of school districts don't have mask mandates. So we're actually able to make these comparisons between districts with and without masking and controlling for things like community transmission and vaccination rates and demographics. And again, we're seeing very little difference in case rates in schools

between schools that have masking and those that have optional policies. There were a couple of other CDC studies this year that were conducted in the early fall. Everyone 12 and up had eligibility for vaccines. And they actually did show that masking did reduce spread. But these studies were very heavily flawed. They didn't control for vaccination rates. And when these studies were conducted, breakthroughs were very rare, unlike now. But, you know, back when these studies were conducted, controlling for vaccination rates when looking at cases was a huge confounder because areas with higher vaccination rates had less spread everywhere, including schools. And those areas also tended to have more mask mandates. So

it wasn't really fair to conclude that it was masks reducing spread in school when it was much more likely that it was the lower rates of transmission in the communities with higher vaccination rates. For example, one of the studies, almost all of the schools that were mask optional were in the district with lower vaccination rates. So it was much more likely that it was much more likely that it was that causing the increase in spread in those schools. I see. Areas that had mask mandates usually had other measures in place, especially in the beginning

of the pandemic. You know, areas that implemented mask mandates earlier typically had more business closures, limits on gatherings, more cautious behavior, and just tighter lockdowns. And so it may have been these other things that were driving case rates down and not specifically masking. But at this point in the pandemic, we're two years in, we really need robust evidence that these interventions are working and that they outweigh the harms. And mask mandates at school at this point, especially with children now eligible for vaccination, it just doesn't meet this standard. So you would argue that there is no clear evidence that shows that masking in schools at this point in the pandemic is making a big enough difference for the CDC's current guidelines?

I would say that if there is a benefit at this point, it's not outweighing any potential harms. There's some countries that never mask students. Several countries in Scandinavia never mask students or teachers. And there's many more countries that follow the WHO, which only masks kids under 12 very sparingly, and they don't mask kids under five. And even as we were writing this, there was a report out of the UK that showed that COVID-related absences were very similar between their schools that had mask optional and those that had mask mandates. And I just want to say that in the UK, they typically don't mask kids under 12. So this is really just at the secondary level. The CDC,

in contrast, they don't make any distinctions. They just say everyone two and up in schools has to mask all the time. And what would you say to someone out there who's maybe got an immunocompromised grandmother at home and they're scared that if their kids go to school unmasked, they might bring home COVID and get grandma sick. Would you say that that's going to happen anyway, or would you say that it's worth it? We have to look at the data, and if the masks haven't really been that effective,

then this is going to happen anyway with our current policies. There have been calls for some people to use better high-quality masks. And I don't think that this is reasonable to mandate this for kids. There's not really data that they're going to work much better in a school setting, particularly how our kids wear masks. They're generally less comfortable. They do have to be tightly fitted. So it's not really appropriate to mandate this. But for those high-risk individuals that want the heightened protection or live with someone that is high-risk, they can wear a higher quality mask that fits tightly to the face. They can learn how to fit tested and make sure it's tight. And that's where this idea of one-way masking comes in, where you can wear a mask and be protected

without having to rely on everyone else taking the same level of precautions. So this one-way masking is what some public health officials are calling for as we pivot into mask-optional policies. In your article in The Atlantic, The Case Against Masks in Schools, you don't really spend too much time focused on the politics at hand here. But I mean, it's impossible to ignore

that basically what you're saying is that all of those red state politicians and all of those, you know, vigilant and in some cases even borderline violent anti-maskers were kind of right about something here. Did that occur to you? When you're a scientist or public health official, you have to evolve your stance. My stance has even evolved. And in the beginning, it made sense to support masks.

We didn't have vaccines. We had to really do whatever it took to limit spread. I mean, I even had an op-ed around this time last year titled, Mandate Masks, Not Metrics. Because in Maryland, where I lived, our schools were waiting to meet just an insane metric set by the CDC to open our schools while we were looking at neighboring states and seeing they were open. And generally, these schools that were open, they had mask mandates, seemed to be working, even if we couldn't state for sure that it was masks.

But as a temporary measure to get the schools open, sure, I will put a mask on my kid, just open their schools. It was supposed to be a temporary measure. But my stance evolved, and it evolved with the wide availability of vaccines. So now, you know, we miss this other logical off-ramp by having vaccines available to everyone five and up. You know, it's still not in the discussion. And unfortunately, the vaccine eligibility or availability aligned with the surge of Omicron. So it kind of took that discussion off the table. But cases are easing. Kids have had access to vaccines for about three months now. It's time to take a look at the data because I don't think two years of masking kids or maybe even more is going to be some benign

intervention. It's going to have consequences. And it's not really feeling like a temporary mitigation measure anymore. The mask has really become a political symbol. I think that there's some people that are going to keep masking no matter what the data says. And sadly, I think a lot of public health officials have dug in their heels and it's hard to change course and admit that maybe they were overstating the benefits. But that is science. And when you have a hypothesis, you test it. And if it doesn't work, you change your hypothesis. And talking about unmasking kids in schools feels like an entry point to talking about unmasking everyone in general. Does this lead to a conversation about the rest of us taking our masks off?

Yeah, I mean, I really was focusing on the kids because I really see the harms during development. You know, it's also, there's harms for adults too. It's harder to communicate. It's harder to make those social connections. It's all about the vaccination rate when you look at cases and hospitalizations, or at least hospitalizations. And we crunched our own numbers out of Maryland districts, and we found that there was a very sharp correlation between

hospitalization rates and vaccination rates, but not the mask mandate policy. Do you feel frustrated with the CDC? Yes, I feel like they are very slow to pivot on any policies. They were slow to acknowledge that schools could open. They were slow to acknowledge that you could reduce physical distancing. And they were ignoring that all these places were already doing it and not really taking in that data. They were very slow to acknowledge that tests to stay could be used in schools as a quarantine modification technique. And I think that what is going to happen is there's a lot of lost trust in our public health officials and our CDC, because people can see the neighboring state has normal

schools while our kids are still masked and having silent lunch. And I think that, you know, if we want to start regaining this trust, our public health officials need to start really looking at the data and making decisions that are based on that evidence and really start prioritizing children because they have carried the weight of this pandemic on their shoulders and being the least at risk. So they've been very, very, very slow. And I think that they've lost a lot of trust and it's going to be very hard to regain. I am Genevieve Martin and I'm nine years old and I live in District of Columbia. My name is Natalie Martin. I am 10 years old, I live in the District of Columbia and I'm in fifth grade. I was in first grade when the pandemic started. So I started my second grade and I barely knew my teacher's face and it was really weird.

I hate them, but I know that they're better for me. And I especially hate it when people tell me to pull my mask up because it's like, I love talking. I talk a whole lot and just with the shape of my face and the shape of the masks that I wear, they fall down when I talk. So they get to like down here sometimes. It's just bothersome because teachers are always saying, they're always saying, I want you to participate, I want you to talk. And then when people's masks fall down because they're talking, they get mad. And that's really annoying sometimes. People know that this is hard, and they're always thinking about how hard it is for us and how hard it is for the teachers. They're right, it's hard for the teachers,

but this is really building on the kids, and we're trying to kind of push the limits to see where the boundaries are and to find out when enough is enough. Thank you. And put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join RAMP. You can go to ramp.com slash explained, ramp.com slash explained, r-a-m-p.com slash explained.

Cards issued by Sutton Bank. Member FDIC. Terms and conditions apply. Dylan Scott, you're a senior correspondent at Vox.com. You recently wrote about why the CDC is so bad at speaking to Americans as of late. Why? Why? Why? So we're living through a global pandemic, the likes of which no one has ever seen before. So, you know, I think it's worth reminding people of that and reminding people that the CDC has been trying to navigate ground that nobody's really had to

go through before. So this is tough. And like, you know, America is a big country. It's a politically and culturally fractured country. And so it's not necessarily easy to come up with like some simple message that everybody is going to hear and understand and adhere to. What has become unavoidable at this point in the pandemic is that the CDC has failed, largely, in its communications campaign. Like over and over and over again, no? Over and over and over again. So the most recent example was when the CDC revised its guidelines for isolating after somebody tests positive.

As COVID cases surge, the CDC cutting the recommended isolation period from 10 days to five if you test positive but are asymptomatic. The new guidance comes as the Omicron variant exploded over the Christmas holiday. They shortened the isolation period from 10 to five days. And they actually said, said, for most people, after the five days, you don't even need a negative test. And the CDC, under growing scrutiny, after recommending people infected with COVID isolate for five days instead of 10, but there wasn't any guidance to get a test at the end of those five days.

You can just basically assume that you're fine and go back about your life. And then came the memes. Six feet? Nah, CDC actually says it's six inches apart now. Is that big or small? The CDC is now recommending apple-bottom jeans, boots with the fur. And I think the fact that the CDC became a punchline was the moment that really cinched for me. Like, we have bungled this so badly that people are looking at the foremost

public health authority in the United States in what is still the middle of a public health emergency and making jokes at its expense and specifically making jokes about its inability to craft effective and sort of meaningful messages and recommendations for people. Hey, mom, it's me. Well, hey, I wanted to see if you saw what the CDC is now recommending. Oh, you haven't seen it? Yeah, they said that they recommend that kids stay with their grandparents this weekend.

Yeah. Okay. Well, I'm sure you'll see it. We'll be by in 15 minutes. Let's dial it back to the beginning of the pandemic. Where did the CDC's trip-ups begin with the coronavirus? It goes all the way back to the very beginning of the pandemic, when the CDC told most Americans, like, you don't need to wear a mask to protect

yourself against this respiratory virus. Right. The CDC recommends only people with the coronavirus symptoms wear a mask, not the healthy people trying to prevent themselves from getting sick. It was really confusing because, like, federal health officials, you know, tended to frame it as like, well, you know, a lot of people are really bad about not touching their face and basically giving people the impression that masks just straight up, unambiguously, probably didn't work that well. But at the same time, it was clear they were trying to reserve the supply of masks for healthcare workers, people working in medical settings, for whom it would be the most valuable, at least at the start of the public health

emergency when hospitals were being overwhelmed with COVID patients and we were still kind of figuring out how our health system was going to be able to manage. But that wasn't the message from the CDC. It was this kind of muddle message of like, man, we're not really sure if they work or like people are really bad at wearing masks or they're not used to it. So like, yeah, just don't, don't, don't bother wearing masks for right now. What comes next? What really kind of reinforced for a lot of people how like confusing this was is like within a month, the CDC completely reversed itself and basically advised everyone to wear masks all the time, at least when they're out in public or around other people. So the message went from like-

Even outside, right? Yeah, don't wear a mask. And like, you know, because people are bad at it. And we don't even know if they work to like, you must wear a mask as much as possible. And so I think, you know, right there, and that's, you know, the first month of the pandemic when everybody's scared, everybody's trying to figure out what they're supposed to do. And they're getting these completely conflicting messages from, you know, the public health authority in whom you would think they would place the most trust. About a year later, in April of 2021, the CDC initially was telling vaccinated people, you know,

you need to keep wearing a mask, you know, to reduce transmission. And then within a matter of weeks, it completely reversed itself again and said, like, actually, vaccinated people, you know, you can feel free not to wear a mask indoors unless it's, you know, required by your state or local government. The CDC announced that fully vaccinated people no longer have to wear masks or socially distance, except if you go to most places. Anyway, have fun out there. And that was once again a case of like,

well, is this what the science is saying? Or there was a lot of kind of speculation of like, well, we need to tell vaccinated people that they don't need to wear masks because that will encourage people to get vaccinated because they're tired of wearing masks. And so once again, it became like, like, is there some sort of like some ulterior motive for changing this guidance? Or like, are they just quote unquote, following the science, which has been like what federal health officials have repeated again and again, like we're just

following the science. And then they roll that one back too, right? The Delta variant certainly kind of changed the calculus when it came around and like was much more transmissible than the variants that had come before it and, you know, was driving a new surge of infections. But yeah, within a matter of months, we had the CDC saying, For now, the CDC recommendations stand that if in fact you are vaccinated, fully vaccinated, you are protected, and you do not need to wear a mask outdoors or indoors. And so like, you know, understandably, I think it left a lot of people, first of all, with just their heads spinning, maybe literally not knowing what they're supposed to do at any given time.

But I think it also helped to sow a lot of distrust. You know, it gave, I think, a lot of ammunition to the people who have wanted to undermine the CDC's authority of like, look how like arbitrary these decisions are. I mean, the amount of bad data that has been purveyed by our supposed public health experts is astonishing. If you want to talk about the people

who have actually undermined confidence in our institutions, it's the leaders of these institutions themselves. Can you really trust anything that these guys are saying? And certainly from some of the conversations I've had with communications experts, it's kind of created this worst-case scenario where the people who want to follow the rules don't really know what they're supposed to do. And the people who might be skeptical of the rules are finding all kinds of justifications for why they don't need to trust the CDC and other health officials. And we didn't even get into the confusion on boosters, but we covered that on the show,

so we can leave that for now. Help me understand why the CDC hasn't done a better job. We know it was sort of an unprecedented pandemic for this country and the rest of the world. And we could have expected some slip ups. But the number here and the gravity feels substantial and exceptional. A couple weeks ago, I asked like a dozen or so people who specialize in health communication specifically, I asked them this question, why are we so bad at this? And, you know, I think they, there were a variety of responses.

Everybody kind of has their own theories. But if I were to distill it down to two things, I would say that one, they were left trying to defend poor policies that didn't necessarily have a strong scientific basis. So this recent change to the isolation guidelines is, I think, a good example of that. The other sort of distinct but related reason that I think they've struggled so much to

communicate is sometimes they're basically trying to communicate their way out of a policy problem. Rather than making a difficult policy decision, they're trying to massage the situation with some kind of clever messaging. From everyone that I've spoken to, a communication strategy that relied on transparency, that relied on being frank with people about some of the difficult trade-offs that come with all of these public health policies, and being very direct with people that the situation is going to change and we are going to have to update our public health guidance as the situation changes. You know, that would have been sort of the foundation of a more

effective communication strategy. So basically, what you're saying is they could have done a lot better if they expressed a little more uncertainty. Right. The problem here is the certainty they've expressed. The rules from God are this until God changes his mind and then all of a sudden you lose your faith in God. Yes, exactly. I think that is a wonderful metaphysical way to put it. One in particular expert I talked to,

Brianna Mezek at the University of Michigan, she was so frustrated with the idea that we kept saying, well, we're following the science. And there were two reasons for that. One was the science is going to change. And so like you, the science one day might not be the science the next day. And if you say you're following the science, that's going to leave people kind of like confused. It doesn't really prepare them for that fact that the situation is going to evolve. And the other part of it is like, there were always

more considerations than just the science or the public health impact. Like there were social and economic factors, you know, effects of the pandemic that, you know, political leaders had an obligation to consider. And, you know, we are making trade-offs between public health and the economy and, you know, teaching our kids and et cetera and so forth. Like, none of this is easy. People know that there's more to consider here than just, quote unquote, the science, whatever the science may be at a given time. It feels like the faith lost in the CDC is sort of irreparable in this pandemic.

But what's it going to take? Is it going to take another pandemic where the messaging is clear and the policies feel tailored to the moment for the CDC to sort of recuperate its reputation? I think there have certainly been, you know, lessons learned. And, you know, I certainly think it'll be a process to restore trust in the CDC and to kind of reset the relationship between the public and our public health leaders. People are working on this. There was a long kind of paper retrospective written by a group out of the National Academies of Science that looked at specifically some of the communications failures.

And they, you know, and they are trying to, you know, assess what went wrong and think about how we could do better in the future. Simple messages are, you know, it sounds maybe like the most obvious thing in the world, but like simple messages make all the difference. If there's like one example of a public health message that I do think resonated and had the desired effect, at least for a time, it was probably flatten the curve. That's a pretty simple message. we're trying to at least suppress the spread of the virus and the number of infections at any given time in order to prevent hospital symptoms from being overwhelmed. And like, the ways we do that are taking precautions and wearing masks, social distancing, etc, and so forth. But like, at least for a time, you know, that

flatten the curve was was a clear message that people grasp at least sort of the broad strokes of, even if they didn't understand all the intricacies that were embedded in it. And it gave them something sort of to rally around. The U.S. is a diverse country. It's huge. We've got a lot of political and cultural differences. But I think, you know, drawing on some of those lessons of radical transparency, really simple messaging could hopefully give us a better rubric to handle, you know, to communicate with one another the next time something like this happens. Dylan Scott writes about health at Vox.com. Victoria Chamberlain produced today's show.

Afim Shapiro mixed and mastered. Matthew Collette edited. And Laura Bullard fact-checked. This is Today Explained.