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COMMENTARY: Masks work; mask mandates don’t

by Matthew Yglesias | March 19, 2023 at 3:00 a.m.

So masks don't work after all? That's the conclusion many conservatives took from a comprehensive analysis of the use of masks to prevent the spread of respiratory infections such as COVID-19 -- and it's led, naturally enough, to a lot of football-spiking and I-told-you-so's.

Delve into the details of the study, however, and it's clear that the conclusion is better phrased this way: Masks work, but mask mandates don't. And while conservatives may be unwilling to acknowledge the first point, liberals are reluctant to admit the second.

The authors of the study reviewed 78 randomized controlled trials, but only two are actually about COVID and masks. And they weren't so much about the efficacy of mask-wearing, as my former colleague Kelsey Piper notes, as about "whether people were encouraged or told to wear masks." The evidence that well-designed, well-fitted masks block virus particles remains clear and convincing. It was the basis for the idea that mask mandates were a good idea. But this analysis shows that the mandating didn't do anything.

There's a gap, in other words, between our scientific knowledge and the policy measures that would take advantage of that knowledge. It's the job of politicians to close that gap. America's politicians largely failed at this job during the acute phase of the pandemic -- and they need to get better at it before the next one.

The truth about mask policy in the U.S. is that it was always a complete shambles, even at the high point of non-pharmaceutical interventions for COVID.

I remember taking my first pandemic-era flight in November 2020. There I was in Dulles Airport, dutifully masked like everyone else. Unless they were at one of the airport's restaurants, in which case masks were off. On board the plane, too, masks were strictly required -- except during food and beverage service. When I checked into my hotel in Austin, signs in the lobby explained that masks were required -- but not at the lobby bar, which was open.

It wasn't just that the formal rules didn't always make much sense. It's that the formal rules had only a limited influence on human behavior. During the era when masks were still required on mass transit in Washington, every time I got on a bus or a train I would see at least one passenger without a mask. Just as when I was in Kerrville, Texas, in the summer of 2021, I would always encounter shoppers wearing masks at the supermarket even though they weren't required.

All of which is to say: The COVID-cautious were behaving cautiously, and the incautious were not.

The point of rules was to try to force the incautious to behave cautiously. And in some countries around the world, especially Australia and many Asian countries, they seem to have worked. There were hard lockdowns with strict curbs on movement, and people were arrested for violating them.

But such rules would have been unthinkable in the U.S. No governor was willing to send police to kick down doors to people's homes, for example, to break up parties. Some people were frustrated that Washington Mayor Muriel Bowser allowed restaurants to reopen for indoor dining at a time when they were still closed in California and other liberal jurisdictions. But the wisdom of Bowser's approach was to acknowledge that -- in the spring of 2021 -- restaurant closures carried a high economic cost with a low accompanying public-health benefit.

One of the paradoxes of the pandemic in the U.S. is that it prompted a polarized debate about imposing invasive new rules about personal conduct, which liberals basically supported -- at the same time they were arguing against more intrusive policing in other contexts. The result was a series of bitter arguments that were substantially detached from real-world practice.

Patient zero in this epidemic of political and policy malpractice was former President Donald Trump. Almost from the beginning, he abandoned any effort to forge a bipartisan consensus around COVID measures.

Trump ignored his own White House's economic reopening blueprint, sidelined Dr. Anthony Fauci as a health adviser without actually replacing him, and declined to promote or even support the public-health rules -- including the mask mandates for aviation and public transportation -- that his own executive branch had issued. Many Democratic governors compounded Trump's failures by pretending that the polarization wasn't happening and that they could just count on unenforced rules to be followed without cost.

Many public-health experts, meanwhile, issued pronouncements on social media with no regard for public opinion or the realities of policymaking.

This was not necessarily their fault -- but neither was it a minor detail. When you say that drinking too much alcohol is unhealthy, for example, it does not imply that you favor a nationwide ban on alcohol consumption. Would a ban save lives? Almost certainly. But the lesson of Prohibition is it would save fewer lives than a naïve count of alcohol-related deaths would indicate, since just making something illegal doesn't mean everyone stops doing it. And enforcing the rules has considerable costs in itself.

These are all things that people more or less know. Not every scientific finding calls for a policy response. But in the context of the pandemic, this point got lost -- in part because of Trump's fumbling, and in part because of liberals' tendency to go in for anti-Trump maximalism.

Unfortunately, the odds are that there will be more respiratory pandemics, potentially more deadly than COVID. These pandemics will generate fear and debate -- and policy responses. The risk is that they will immediately become polarized and be ineffective. What the US needs is an approach that acknowledges crisis response is inherently political, and that large-scale non-pharmaceutical interventions have to be bipartisan or they aren't going to happen. Democrats should stick to arguing for rules they are actually willing to enforce, while realizing that in practice compliance will be much higher if they try to avoid restrictions that leading Republicans oppose.

Science alone cannot provide an answer to public-policy questions -- especially those that involve tradeoffs. Beyond that, the reality of human behavior is that the presence or absence of social consensus makes a big difference. Imposing a change to tax policy with a 50 percent plus one majority works fine. Asking people to alter their daily behavior doesn't.

The man who happened to be president when COVID struck was almost uniquely unsuited to the job of consensus-building -- and Democrats largely responded in kind to his provocations. Next time around, America's leaders should realize the policy response to any pandemic can be only as strong as the political consensus behind it.

Matthew Yglesias is a columnist for Bloomberg Opinion. A co-founder of and former columnist for Vox, he writes the Slow Boring blog and newsletter. He is author, most recently, of "One Billion Americans."

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