Dr. Carroll is the chief health officer of Indiana University and writes often on Covid-19 policy.
April 20, 2022: This article has been updated to include information about the Department of Justice’s filing notice to appeal to reinstate the transportation mask mandate.
When a federal judge struck down the mandate for mask wearing on planes, buses and other modes of public transportation on Monday, most major airlines wasted no time in ending their requirements. Passengers even cheered midflight when they were told they could take off their masks. The science on masking did not change this week, yet public health experts and policymakers are now forced to acknowledge what many will no longer do to protect others.
The Department of Justice filed notice to appeal the ruling after the Centers for Disease Control and Prevention said that extending the mask requirement is necessary. But it’s unclear how long the mandate would remain in place if reinstated, as it was already set to expire on May 3.
It’s an unfortunate reality that mask mandates, and masks themselves, have become politicized and unpopular for many. It’s why several governors and businesses rolled back requirements long before coronavirus case numbers dropped, and it is likely why airlines were also quick to do so. These groups have interests that compete with science. Members of the public who want to live as they did in 2019 can sway those groups if they are loud enough, even if they’re not the majority.
But the fact is that despite a desire to live as if Covid were no longer a threat, the United States does not have enough protections in place to do so right now. The interventions that make it safer to live normally again, like access to testing and drugs to treat Covid, are not equitably available to everyone. Vaccination and booster rates are not where they should be.
This pandemic is not over. A new variant could emerge at any time, and cases are rising in some parts of the country. Too many people are, according to the C.D.C., still at risk. The judge’s ruling may argue that the organization has exceeded its statutory authority, but that doesn’t mean that we’re out of the woods.
It’s not yet time to give up on measures that might protect the public and make places and activities safer for those who cannot protect themselves. But instead of continuing to bicker about things that have become hopelessly politicized like mask mandates, those in public health could focus on efforts that might make much more of a difference. One way forward is to identify and vocally get behind policies and tools with potentially higher impact and lower risk of backlash.
One of the most important is getting better ventilation in many buildings across the country. Too many don’t have filtration capabilities to remove infectious particles from the air, and too many aren’t of high enough quality to prevent spread.
Another policy that was important before Covid but is now imperative involves robust sick leave. Too many Americans are fearful of staying home if they’re ill, afraid to lose income or, even worse, employment. The American work culture still values toughing it out, and campaigns are needed to explain that this is not only misguided but also dangerous.
The law also needs to support better work accommodations for those truly still at increased risk, especially the immunocompromised. Some people may need to work from home; others may not be able to work at all. They and even some of their caregivers may need extra support as long as risk from Covid exists.
It is intolerable that disparities in the health care system still exist that prevent Covid-19 treatments from being equitably available to all. Making them free is necessary but not sufficient. The testing, prescription and sourcing need to be easily accessible for everyone, and yet many of those who need the most help are struggling to get it.
Cajoling has gotten the United States as far as it’s going to get on immunizations. Mandates work, but they’ve become politically toxic as well. America’s public health apparatus needs to get much more innovative with vaccination campaigns. Health workers could go out into communities door to door or where people work or spend their time and could offer them immediate immunization. We could do better at explaining how vaccines are free, safe and easily received. Public health departments should train a legion of trusted voices within different populations to help with the effort.
When Covid-19 came to my university and many others, we didn’t put the onus of risk management on students, faculty and other staff members. We invested in public health infrastructure; built labs to test for Covid locally; made testing easy; ran on-site vaccination clinics; increased Covid leave time for quarantine, isolation and even vaccine side effects; and shifted to work-at-home policies when appropriate.
Our success also depended on communicating extensively, so people knew what we were doing and why, especially if the policies we were adopting were unpopular. We were clear that when coronavirus cases rose sharply, as they did in January, we might need to increase protections, like requiring masks in all indoor spaces. When things got much safer, we ended our mask mandate in March. But the institutional interventions continued, and we have a high level of vaccination, at over 90 percent.
Committing to large-scale efforts that are less contentious and more effective seems like an easy choice. We spend too much time fighting one another and not enough time fighting the pandemic. Every day we do so, everyone loses."
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