The Centers for Disease Control and Prevention (CDC) has confirmed an association between lifting mask requirements — including reopening restaurants for indoor dining, which is a type of mask requirement relaxation — with an increase in both coronavirus cases and deaths.
Yet Texas planned to lift its mask mandates and allow a full return to business as usual as of yesterday. In announcing the move, Gov. Greg Abbott urged individual responsibility and adherence to medical advice, but a mask is now optional rather than an urgently needed mandate to save lives. Mississippi followed in short order, and other states plan to follow suit, including Alabama on April 9.
More responsible is the evidence-based approach of Ohio, where Gov. Mike DeWine says he will maintain masking as part of a comprehensive pandemic control program until cases drop to 50 per 100,000. Or California, where businesses are reopening but with a mask mandate maintained.
The actions of Texas and other states moving to lift mask requirements are premature. They are casting this as a matter of leaning on personal choice. But the fundamental challenge is the misperception that public health is entirely a function of personal decisions.
Personal responsibility became a hallmark of public health practice in the 1970s. But epidemiological studies began to make clear, beginning in the 1980s, that structural determinants of health, not individual choices, strongly shaped patterns of chronic disease. In 2013, a landmark National Research Council and Institute of Medicine report implored Americans to “look beyond individual behaviors and choices” to “systemic processes that may influence multiple health outcomes.” Social structures such as racial and gender wage gaps, differences in housing opportunities, mass incarceration and unequal access to care can be related to infectious diseases, including COVID-19.
Further, one individual’s choice not to wear a mask can affect multitudes of others. The majority of infections occur when individuals are asymptomatic. In the midst of an airborne pandemic, a mask is the single most effective way not only to protect the wearer but also to protect others. More significantly, in a context in which minority communities and essential food and maintenance workers do not yet have equal access to vaccines, premature mask rollbacks will only serve to amplify deep social inequities in risk.
The spread of potentially more transmissive, more lethal variants of the virus that could be more resistant to vaccines means that masks must be the last, not the first, measure to relax. The CDC reports detecting “variants of concern” in all but one state. The greater the variant spread, the greater the proportion of the population that will require vaccination to achieve herd immunity and the greater the likelihood that booster vaccines will be required.
As variants take hold, we could see longer, slower case declines or pockets of small surges that could be prevented through simple masking. Already we are seeing a nationwide flattening of the sharp downward trend in infections at a moment when the overwhelming majority of Americans remain unvaccinated. This will create unnecessary cases and deaths, lower consumer confidence and slow economic recovery.
While there will come a time when COVID-19 is no longer the deadly threat that it currently is and masking can be a personal choice, now is not that time. Bringing the pandemic to an end is an urgent challenge that demands protective policy leadership, not abdication of government responsibility.
Amy Lauren Fairchild is the dean of the College of Public Health and professor of health services management and policy at Ohio State University. Cheryl Healton is the dean and professor of public health policy and management at the New York University School of Global Public Health. Sandro Galea is the dean and Robert A. Knox professor at Boston University School of Public Health. David Holtgrave is the dean of the University at Albany School of Public Health and SUNY distinguished professor. James W. Curran is the dean of the Rollins School of Public Health at Emory University.
The opinions expressed here are not to be interpreted as a position of the co-authors’ current or former employers. Governing’s opinion columns do not necessarily reflect the views of Governing’s editors or management.
