WASHINGTON — When Sen. Rand Paul clashed with the nation’s most beloved doctor last week over the need for mask wearing after achieving vaccination from the coronavirus, he was unsurprisingly castigated by liberals and mocked by his opponents.
But Paul was undeterred, appearing on Fox News this week telling Dr. Anthony Fauci to “put up or shut up” by providing evidence there’s widespread contraction of the virus from those who have already had it or those who are vaccinated.
There isn’t so far — but Fauci’s case for masks is based on an old Irish proverb: Better be safe than sorry — especially when attempting to emerge from the worst pandemic since the 1918 Spanish flu.
“You could look at Dr. Fauci and say, ‘Well, what if the Spanish flu comes back? Shouldn’t we wear a mask every year for the rest of our life because someday the Spanish flu’s going to come back?’ That’s not science. That’s sort of emotionalism and fear-mongering,” Paul argued.
Interviews with an array of medical professionals found that while most see Paul’s call for mass mask abandonment premature, many also envision such a scenario taking hold in many parts of the country in just months if vaccinations continue at the current pace.
Paul was wrong to contend there’s a “virtually zero percent” chance a vaccinated person could get COVID-19, they say, especially given the new strains that have emerged. Yet some acknowledge that part of continued mask wearing is designed to create comfort and ease fears among the population, a slight nod to Paul’s assertion of a performative aspect to face covering.
Here are the top takeaways from McClatchy’s conversations with nine leading public health experts about Paul’s claims and the future of mask wearing in an increasingly vaccinated post-pandemic world.
—PAUL’S CALL COMES TOO SOON
With just one in seven Americans fully vaccinated, most epidemiologists said Paul’s call for the immunized to ditch masking comes too soon. Kentucky’s current vaccination rate is slightly higher than the national average at 14% and its coronavirus cases are on the decline over the last two-week period.
While it’s true that all three vaccines being administered in the U.S. are highly effective in preventing infection from the original coronavirus, scientists are still awaiting a thorough evaluation about how they’ll stand up against variant strains from Brazil and South Africa.
“You won’t be hospitalized and you won’t die as far as we know from these other variants. It looks like you’re protected against severe disease, critical disease. But you’re not protected particularly well against mild or moderate disease, that’s why you wear a mask,” said Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “The degree in which you don’t wear a mask is the degree to which you risk becoming infected with one of those strains. He’s arguing that well, that really hasn’t happened because those strains aren’t that common yet. But they might be.”
Added Dr. Zeke Emanuel, an oncologist and bioethicist who serves as a vice provost at the University of Pennsylvania, “Yes, fully fascinated people have been reinfected — the studies show infection rates are down but not zero.”
—BURDEN FALLS ON BUSINESSES
One practical problem with Paul’s position is that allowing people to unmask puts businesses in the tough spot of trying to evaluate those who are vaccinated versus those who are anti-maskers.
“If you’re working at McDonald’s, how are you going to look at people’s vaccine cards?” asked Dr. Amesh Adalja, a senior scholar at the John Hopkins Center for Health Security.
Dr. Lee Harrison, an infectious disease specialist at the University of Pittsburgh School of Medicine, said there’s an economic benefit to masking that allows people to feel safer as they walk through a store or into a restaurant.
“People are going to be more reluctant to go out if there’s a whole bunch of people (out and) they don’t know their immunization status. Are they just against wearing masks? Are they not wearing masks because they’re immunized?” Harrison noted. “Some of the mitigation efforts have pluses and minuses ... Masks have no downside, zero.”
Paul isn’t entirely wrong when he asserts that masks have become a symbol, but doctors say that’s not necessarily a bad thing if it eases people’s mental stress about the pandemic.
“Even if you think your likelihood of infection is low, wearing a mask is socially responsible, may help reduce conflict, and promotes norms of public health behaviors,” said Dr. Andrew Brouwer, a research scientist at the University of Michigan.
“I think it is about giving others peace of mind and this is all temporary until we get to mass vaccination,” said Dr. Monica Gandhi, a professor of medicine at the University of California, San Francisco.
—A MASKLESS SUMMER OR FALL?
There’s a maskless future coming at some point, the question is exactly when.
Many doctors believe it will happen when a four-point criteria has been met: the most vulnerable have been protected, a significant portion of the U.S. population is vaccinated — some experts say 80% — the stress on hospitals has been alleviated and coronavirus cases have dropped significantly.
States and local jurisdictions will undoubtedly set different bars for these standards, and some conservative states like Texas, Alabama and Mississippi already believe they’ve been met, having removed their mask mandates in recent weeks.
Dr. Isaac Bogoch, an infectious disease physician and scientist at the University of Toronto, disagreed that America was there yet, but warned that policymakers should be ready to adapt rules for a massively vaccinated population.
“When enough people are vaccinated, it’s reasonable to start lifting those mask mandates, it’s reasonable to start allowing for larger and larger groups to be gathering in outdoor settings,” he said. “We will probably get there in the 2021 calendar year.”
It was lost inside his pointed back-and-forth with Fauci, but Paul’s most salient point, according to some doctors, was the importance of combating vaccine hesitancy with a reward that their life will change for the better.
Some experts are already worrying that vaccine supply will begin to exceed demand as soon as April.
“(Paul’s) larger point I agree with. If people don’t see the vaccine as something that’s going to improve their life, they’re less likely to get it,” said Dr. Adalja. “I do think there’s been a lot of underselling of the vaccine. And that kind of messaging was wrong and harmful. If it doesn’t help you with your life, why would you want to be vaccinated?”
Even as mask mandates begin to relax this summer, they will likely never completely disappear. Businesses that have struggled to hobble through the last year financially may still require them in order to protect their employees from an outbreak that could suddenly shut them down again.
“You’re going to have to carry it in your pocket until you know where you have to wear it,” said Dr. Adalja.
Others may choose to continue to wear masks in the fall and winter months when influenza cases spike.
Place Kavita Patel, a primary care physician and Brookings Institute fellow in Washington, in that category.
“Why? In all my years practicing, I have never seen so little flu,” she said.
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