On masks and outdoors
Moving on, hopefully
I have two new articles out, one in The Atlantic and the other (a debate with co-authors Müge Çevik and Stephan Baral) in The British Medical Journal, both on masks and outdoors.
You could read the one in The Atlantic, or just watch this Trevor Noah rant:
In fairness, I had not seen it when I wrote my piece, but if I had, I might have just not written it, as he puts it a bit more colorfully than I would. Essentially, I think it was possible to be less timid, more simple and more explanatory. I realize the CDC essentially inherited a very difficult situation, and has made a lot of progress since. But it is a pandemic, still, and we have to keep aiming for a situation where even Trevor Noah doesn’t feel like ranting about our charts to millions of people.
We wear masks for three reasons: to protect ourselves from people who might be infected, to protect others from our infections, and to set social standards and norms appropriate for a pandemic. The last one is also important: A pandemic requires a collective response. As we learn more, we move from broader precautions to targeted mitigations. Early in the pandemic, the existing guidelines that suggested only the sick should wear masks and the objection that we didn’t know all we needed about the effectiveness of masks violated both the need for social norms, by stigmatizing the sick, and the precautionary principle, by letting remaining uncertainty stop us from protecting ourselves as best we could even with imperfect knowledge. So we changed the rules.
Now, a year later, both the sociology of outdoor masks and the precautionary principle operate in the opposite direction, because the science is in. We need to change the rules again, but also explain why.
But there’s another principle at stake as well: equity and effective mitigations. In The BMJ piece, my co-authors and I argue that, after a whole year of data, we can’t just invoke the “precautionary principle” with blanket rules, exactly because doing so can so can be misleading and take attention away from vulnerable populations and effective mitigation:
Some people may choose to wear masks outdoors because of personal preferences or individual needs, even without specific recommendations. While outdoor activities are low risk and outbreaks have not been observed even with intense public demonstrations, a higher risk may be associated with prolonged close interactions and adjacent activities such as public transport or car sharing, and this could be incorporated into the public health messaging. People make complex decisions about risks every day, and they should be informed and empowered to make the right decision for themselves on outdoor masking
Ultimately, outdoor mask mandates may be popular in some settings, as they are among the most “visible interventions” purporting to demonstrate decisive leadership. However, these mandates do little to tackle the critical transmission risks or to address outcomes of socioeconomic inequities and structural racism, driving a disproportionate number of the infections and consistent disparities observed worldwide.
The cool thing about The BMJ debate is that it is a debate! With another article arguing the other side! It’s good to see such things published, as open but substantive debate like this makes it easier to clarify the stakes and discuss the trade-offs.
As you can see, it’s been an intense publication schedule for me lately, and you might have seen the subscriber-only open thread (which is on Sundays) where I mentioned having to also go to New York this week to find a place to live. It was a very short trip, necessarily, and not ideal for wrangling with that housing market but it was really, really good to be in a city again, and that city in particular. I had not flown in more than a year and while I managed it, it was a bit of a hoot. First, I booked the ticket for the wrong month. Luckily, I noticed it in time and fixed it. Or so I thought—I had only fixed the outbound. Then, on my way to the airport, it occurred to me that I had not booked a hotel or a place to stay. Did that on my phone at the last minute. I ended up looking at the conveyor belt thinking, did we still take off our shoes? (Of course we do, just like we will be publishing beach-shaming photos well into 2157).
In the end, though, I managed to get on the plane, find my way around and get back! And now back at more writing! Like almost all academics and writers, I’ve always had a lot more I’ve wanted to write about than I could reasonably do so, but I cannot remember a year in which it diverged this much! I am grateful, though, for all the opportunities to write here and elsewhere. Still, though, it was just plain exhilarating to simply walk around in a big city again. Due to time constraints, I could not meet with any of my many friends there—many of whom suffered so much going through the worst of the crisis last spring—but I’m certainly looking forward to many, many reunions.
Your comments on the confusing pictures reminds me of the way I always have to look up the laundry symbols on my clothes. I've also had to contact support for my washer and dryer (is "delicate" slower agitation or shorter agitation? Is "heavy" for heavy clothing or heavy soil? Is "easy care" hotter than "delicates"? What temp is "timed dry?") I don't want to know what some engineer guy thinks is good for my clothes, I want to know what's physically happening inside those barrels.
The other problem with the CDC graphical messaging is that it doesn't really include distancing. For the entire Covid period people losing friends and neighbors over vehement "mask AND distance" vs. "mask OR distance" arguments. (Maybe we've at least arrived at a kind of scolding fatigue and will just give it up for awhile.)
Finally, thanks for the realistic listing/prioritizing of our reasons for wearing masks. For me, protecting myself has always been #1. Since I've been so, so careful (easy when you're retired), the probability of me making someone else sick has always seemed pretty low. Now that I'll be traveling fully vaccinated, visiting kids, that probability will rise a bit. But now that I've finally got genuine, U.S. manufactured, comfortable N-95s, tightened glasses and shorter hair, mask-wearing is ironically a lot easier now.
Thanks for the post, Zeynep, and for the Atlantic piece which I read and enjoyed. I take your points about the communication blunders. How many categories should that CDC chart have though? Would a fair representation of your positions be:
1) vaccinated - don't worry about masks unless you want
2) unvaccinated, outdoors and distanced - don't worry about masks unless you want
3) unvaccinated, outdoors and talking closely - put a mask on
4) unvaccinated, indoors - put a mask on