Masking can feel like a thing of the past in the US, even in cities such as New York and Los Angeles that once embraced the precaution. But as healthcare facilities grapple with a “tripledemic” of respiratory viruses – with Covid, flu and RSV surging simultaneously – experts are once again urging the public to don face coverings.
“I would not go into a grocery store without a mask,” says John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at the University of California, Berkeley. “I wouldn’t go into rapid transit without a mask. I wouldn’t go into an airplane or be in an airport without a mask,” nor would he attend a crowded outdoor event such as a concert without one, Swartzberg says.
Still, after nearly three years of mixed messaging from officials, with many Americans seeming to have moved on from Covid – and a president who has said “the pandemic is over” even as hundreds die every day – will anyone listen?
As of 2 December, the CDC reported a seven-day average of 4,201 Covid hospitalizations and 254 deaths. Meanwhile, the flu and RSV seasons have come unusually early, with flu hospitalizations at their highest in a decade. On 2 December, the agency reported 8.7m cases of the flu, including 78,000 hospitalizations and 4,500 deaths, this season. And we haven’t seen the worst yet, given that it’s been less than two weeks since Thanksgiving, with many more holiday gatherings to come, Swartzberg says.
The good news: “Masks work against Covid, masks work against RSV, masks work against influenza and masks work against other respiratory viruses,” Swartzberg says. “They really do work to help prevent people from getting infected and the consequences of that infection.”
Abraar Karan, an infectious diseases expert at Stanford University, agrees – as do a number of studies, including a recent “natural experiment” comparing masking and non-masking schools in Boston.
“Masks will help to reduce risk of acquisition of viruses,” Karan says. “The better the mask that you use, the more effective it’ll be, depending on the fit and filtration of the mask” – with N95s, KN95s and KF94s offering good protection. His own experience speaks to their effectiveness: through years of treating Covid patients, he managed to avoid infection. “When I did get infected, it was actually from someone who was sick in my own home,” he says.
When it comes to Covid, he notes, vaccines work well against severe disease but are less effective against infection. Masks offer an important additional line of defense. As for other, less transmissible viruses such as flu and RSV, they “largely went away when we used mitigation” such as masking early in the pandemic, he says. After pulling back on such measures, however, “we’ve now seen an upswing”.
But, as anyone who’s gone to a grocery store or ridden a subway in recent months knows, trying to find someone in a mask these days can feel like a round of Where’s Waldo? And according to Sara Wallace Goodman, a political scientist at the University of California, Irvine, and co-author of Pandemic Politics: The Deadly Toll of Partisanship in the Age of Covid, that’s not likely to change anytime soon.
“The pandemic really eroded public trust in health officials. And that kind of has a long-term staying power,” Goodman says. The US never “developed a narrative of flexible policy response” – a “shared understanding” in which, for instance, we treat “masking as like a raincoat or like an umbrella: you take it out when you need it, and you put it away when you don’t”.
In the meantime, messaging on masking has “devolved” from treating it as a question of community response to a question of personal choice. “It’s really hard to unwind that messaging and say it’s no longer an individual choice. Especially in America – we’re very opposed to that kind of messaging,” she says.
Benjamin Rosenberg, a social-health psychologist at Dominican University of California, wishes we had heard more from social scientists as the government’s pandemic messaging took shape. At this point, however, Rosenberg, who studies psychological reactance – “what happens when people are told what to do” – argues that the language of mandates and demands for compliance won’t do much to change behavior.
Still, there are other ways to increase mask use. “In general, people like to choose their actions. We want to have volition, we want to have choice over what we do and the decisions we make, so mandating something is really taking away that choice,” he says. On the other hand, pushing for masking in a “softer, encouraging way” means “saying you’re actually going to have this freedom. We’re not going to take it from you … but here’s some reasons why you might consider, in this context, wearing one.”
When it comes to messaging, Karan says, public health officials need to be “more straightforward” with the message that “masks will reduce the risk of being infected”. Governments could also help by increasing the availability of masks. Not everyone has access to them, and “there have been times where I’ve forgotten to pick up my mask, and I wish there was a way for me to quickly get one before I go into certain spaces.”
Goodman also sees benefits in “meaningful community interactions”. It would be great if Joe Biden kept wearing a mask, she says, but seeing neighbors wearing them is likely to have a bigger impact: “If people you know and trust wear a mask, then maybe you’ll think twice about not wearing one.”
Ultimately, Swartzberg says, what we need is a cultural shift so that masks are “somewhat normalized, so that people are more comfortable wearing a mask in certain settings”. Such broad change is not unprecedented: the 1918 flu pandemic helped usher in societal shifts such as an expansion of women’s rights, fueled in part by women’s growing role in the labor force at the time, he notes.
“History is going to look back and say: ‘Why were masks politicized in this country? How bizarre,’ and frankly, it is bizarre,” Swartzberg says. “But we’re in the midst of making history right now.”
