Where US Mask Rhetoric Went Wrong
Refusal to consider harms led to nuance-free policies
There’s recently been a major debate related to the Cochrane Review about masking, with significant disagreement over questions like the following...
Do masks physically work to stop viruses? What type of masks?
Do public health programs to encourage masking help?
Do mask mandates work to reduce community transmission?
As most everyone is aware, US public health initially didn’t recommend masking, then they suddenly reversed course in early April 2020, citing concerns about asymptomatic spread. A lot of people have wondered what was behind this abrupt policy change, and why did the US CDC recommend masks even for very young children, unlike most other countries? Recently, an old article came to light that pointed to some potential answers.
Some excerpts from a New York Times article from August 2020 were shared on Twitter. The article was a profile of Dr. Zeynep Tufekci and her role in shifting the thinking around masking for Covid.
The article described Dr. Tufekci’s history, her mask advocacy, and more. But the part that really got people’s attention was the following line about the CDC’s masking recommendations:
“Dr. Tufekci’s public criticism of the agency was the ‘tipping point.’”
Who knows if this claim by the CDC insider is even true, but if it is, it’s troubling that key CDC recommendations were made based on a New York Times editorial. It’s clear though that Dr. Tufekci’s early advocacy on masks is something she is very proud of, and she has bragged multiple times on Twitter with being credited for the CDC reversing their guidance. In her March 17, 2020 op-ed criticizing the CDC, she wrote, “everyone should use masks” and specifically called out “young people” as asymptomatic spreaders (remember that fears around asymptomatic spread were the main impetus for community masking). Also, a paper she co-wrote about mask evidence with Jeremy Howard (one of the founders of the #masks4all movement) states, “everyone, adults and children, should wear masks.”
But Zeynep got angry this past weekend when Twitter users started blaming her for being the reason that CDC policy called for masking 2-year-olds in America. (The European CDC did not recommend masks for children under 12, and the World Health Organization did not recommend masks for children under 6.) Zeynep called everyone who said that she was behind toddler masking a liar, and she went on a Twitter blocking spree. (She blocked me, as I was replying with evidence that she didn’t actually support masking toddlers.) It feels like Dr. Tufekci would like all of the credit for CDC mask policies, but none of the blame for their worst aspects.
Masking Two-Year-Olds
It’s most likely true that Zeynep didn’t specifically tell the CDC to mask 2-year-olds. I searched her old tweets and found a total of three tweets in which she said that it wasn’t necessary to mask toddlers. But for someone who tweets a lot, and opines on many subjects, that was the extent of her position against masking such young children. I don’t think that gets her off the hook. And I certainly don’t think it’s fair to call people liars and anti-vaxxers 🙄 for directing some of the blame for bad CDC policy at one of the people credited with the change in CDC recommendations. If a government agency implemented a policy based on my advocacy, but included some aspect that I thought went too far, I’d be very vocal about the flaws before bragging about being the “tipping point” behind the policy.
Some of us have been loudly and consistently arguing against the CDC’s insane policy of masking 2-year-olds since the beginning. We’ve seen families get kicked off planes when their 2 year old couldn’t mask consistently, we’ve criticized the federal mandate requiring preschoolers in Head Start programs to mask, we’ve brought up concerns about masked speech therapy and about language acquisition and early reading/phonics lessons when kids and teachers are masked. But those arguments have often fallen on deaf ears, because US public health decided early on that masking is a harmless intervention — that there are no downsides, harms, or risks of masking that need to be balanced with any potential benefits.
I suspect that when the CDC got a strong message from mask advocates that everyone should mask, they would have recommended it to literally everyone of all ages, but then they realized it would be a suffocation/choking hazard for children under 2. If it weren’t for existing CDC guidance about suffocation and choking, we may have required masking infants in this country.
No Plausible Harms?
One of the biggest problems with mask advocacy in this country, from Zeynep and others, was the complete refusal to discuss harms. The World Health Organization (WHO) seemed much more willing to accept that any masking advice needed to be balanced with potential harms of masking. But the mask advocates insist that there are no harms of masking — still to this day. Zeynep, in particular, has written extensively on this, and uses her expertise as sociologist to shut down any debate.
On Twitter, she said that a list of potential disadvantages of masking from the WHO was “not a good list” and that “they just went out of their way to inflate a harms list.” That list of potential harms from the WHO included obvious issues with masks like:
“difficulty with communicating clearly”
“potential discomfort”
“difficulty wearing … especially for children, developmentally challenged persons, those with mental illness, elderly persons with cognitive impairment…”
In later tweets and articles, she said she couldn’t come up with any plausible harms from masking, except that they block lip-reading. In a Substack article she said people were finding harms “even when no major ones plausibly exist” and bemoaned that some doctors are focused on “all sorts of alleged ‘harms’ from masks” before describing the proposed harms as “nonsense” and “ridiculous”.
This kind of rhetoric that masks are harmless and there was no need to worry about them providing a false sense of security is exactly what led to the nuance-free recommendations from CDC, which later became nuance-free mandates in many places, both via government mandates and requirements from private businesses, public schools, and more.
The narrative quickly strengthened behind this idea that masks had no harms whatsoever, and that it was your fault if you or your child struggled to wear one. Many adults who were setting these policies were hunkered down at home and only had to wear masks for brief trips to the grocery store, while children and essential workers were often required to mask for 8+ hours a day, and there was zero empathy or concern given to anyone who struggled with masking for whatever reason. Masks became an all or nothing intervention — masked faces were considered “safe” while unmasked faces were considered “unsafe.” People on the sidewalk would sometimes jump out into the street instead of walk past a person who was unmasked!
False Sense of Security
Zeynep was especially upset about the WHO’s concerns about masks providing a false sense of security. According to the New York Times article, Zeynep got on the phone with them and told them, “I’m a sociologist, I know that’s not true.”
However, I personally know many people who went out when they should have stayed home, either because they were sick or at high-risk. But they felt it was safe because their mask would “stop” the virus. We know that the loose cloth masks people were wearing provided little if any protection from Covid, so they were in fact getting a false sense of security. In this survey from July 2020, a majority of respondents felt more comfortable when stores had masked employees and shoppers. If that additional sense of comfort outweighed the amount of protection that loose cloth masks were providing, it means some people may have been going out in public when they would have been safer staying home.
The PNAS study Zeynep co-wrote, “An evidence review of face masks against COVID-19”, includes a section on “Sociological Considerations” around masking, which begins with a discussion around “Risk Compensation Behavior” — where she argues that the concerns about a false sense of security were unfounded. (The sociological discussion section also includes “Managing the Stigma Associated with Wearing a Mask” and “Creating New Symbolism around Wearing a Mask.”)
The paper cites decades of studies on risk compensation — the idea that safety devices could cause people to engage in riskier behaviors. But these pre-Covid studies are about safety devices like seatbelts, motorcycle helmets, and ski helmets, which, unlike masks, have substantial data showing they offer significant protection, and this can offset any additional risky behavior. Also, risk taking in a car or on a motorcycle or snow skis is much different than a more mundane risk like simply going to the store. Grandparents wearing masks didn’t feel like they were doing anything particularly risky by going to stores and events, but they were choosing to participate in certain activities precisely because they thought the masks made it safe to do so.
Additionally, the paper goes on to cite some early studies conducted in Spring 2020, which showed that mask wearing was “positively correlated with other preventative measures.” But what we saw in real life is that once masking became common due to widespread mandates, and the newness of masking wore off, many people actually got closer to masked faces because they felt protected by the masks. Others leaned in closer or talked louder because they had trouble hearing others or being heard in masked communications.
Furthermore, according to survey done in Fall 2021, 19% of respondents wore masks, but did not choose to get vaccinated. This could also be seen as a risk compensation behavior. In 2020, then CDC Director Dr. Redfield stated that masks may be more effective than the vaccine, which was covered heavily in the media. In 2021, Biden’s CDC Director, Dr. Walensky, tweeted “Masks can help reduce your chance of #COVID19 infection by more than 80%.” These kind of claims significantly oversold the protective nature of masks, and made people feel that masking was the most important thing they could do to protect themselves.
What Now?
While most Americans are done with masking, mask mandates are still not over for everyone. Masks are still required in many hospitals, doctors’ offices, and nursing homes. Masks are required indoors on federal property when the county’s Covid Community Level is in the High zone, per CDC recommendations that call for community masking during High Covid levels. And Dr. Walensky recently testified that the CDC’s masking policy “doesn’t really change with time.” The CDC has never backed down on their decision to mask toddlers, and they still refuse to discuss downsides to masking. Dr. Walensky recently told the Washington Post that she “probably mask(s) more frequently than most.” Clearly she’s happy with masking as a public health measure.
This one-sided discussion where mask advocates are heroes who saved everyone from certain Covid death, while anyone who questioned masking or suggested potential downsides is vilified as backwards and anti-science has been problematic. Unfortunately, that mentality set the tone for US mask policies. This kind of black-and-white thinking is not how how public health policy is supposed to work. As we’re beginning the process of looking back at the past three years, and discuss lessons learned, this kind of bullying and rhetoric from mask advocates is not conducive to good scientific discussions. And it does not leave me hopeful that we will make any better decisions in future pandemics.
My favorite thought exercise:
Late 2019 you go to a school board meeting. Tell them you think everyone in the school - students, teachers, visitors, administrators - should be forced to wear a hospital-style mask on their face, all day every day. The reason is this might prevent some cases of the flu.
Of course they would think you were crazy. If required to take a position, every single school board member regardless of ideology would oppose it. In fact the more "progressive" ones might oppose it more thoroughly, because they would think about the impact on special needs kids and so on.
The key point is that the opposition would not stem, mainly, from the school board's beliefs in the efficacy of masks. Presumably they would have no idea whether it would "work" or not. Who would even care, whether it "worked?"
Rather they would focus on how utterly absurb the idea is, that learning or even just living could take place in with everyone's faces covered for 8 hours a day. The list of problems with this is almost as endless as it is obvious.
Yet somehow, the idea that masking is a "zero-cost" intervention, hardly even worth measuing the downsides, became a pillar of covid orthodoxy for the last 3 years. Of all the gaslighting, this was some of the most impressive.
Outstanding review of unbiased facts, Kelley. Shows the honest work a person without an agenda can accomplish. Thanks for documenting the history of what happened, so necessary.