Thursday, February 17, 2022

The Mask Debacle: How partisan warfare over mandates became a central feature of the pandemic/Tablet

https://www.tabletmag.com/sections/science/articles/the-mask-debacle

Recent days have witnessed the emergence of a new rift in our pandemic debate. Strikingly, this time the dispute is not just partisan, but also splitting the Democratic Party. While Democratic governors appear to see where political winds are blowing, some blue cities are moving in the opposite direction. And many states that are dropping adult mask mandates are retaining them for kids, resulting in the absurd prospect of indefinite masking for a less vulnerable population for whom masks have more significant downsides.

How did partisan warfare over mask mandates become such a central feature of the pandemic? The familiar answer is that the mask wars are just another symptom of national polarization. When Donald Trump casually denigrated cloth masks as president, the stage was set for a Democratic backlash—turning masks into not just a public health measure, but also a talismanic symbol of virtue signaling on one side and a rallying cry about freedom for the other. But polarization is only part of the story. Mask mandates are a microcosm of a key failure of our pandemic response: the poor climate for public discourse fostered by an elite culture whose overconfidence led to a prolonged strategy of undermining open discussion in a vain attempt to prove that complex questions could have only one universal and immutable answer.

From the beginning of the pandemic, technocratic elites have offered us a dubious bill of goods. Aided and abetted by the media and by many academics, politicians proffered—indeed, likely believed—the idea that the pandemic would go away if everyone just did as they were told. “If everyone wore a mask for two weeks …” became a telltale refrain, a claim that was neither true nor possible. Pundits celebrated President Joe Biden’s ill-fated “hundred days of masking,” which promised “just 100 days to mask, not forever.” This habit of exaggeration and blind optimism among elites helps explain gaffes like Biden’s bizarre claim during his campaign that every single pandemic death could have been averted by better leadership.

Choices needed to be made, and leaders got some right (accelerating vaccine research) and others wrong (failing to protect the elderly). In other instances, they missed opportunities, failing to strengthen policies like sick leave that would improve our resilience—a topic almost entirely avoided by political elites, who prefer to blame the pandemic’s consequences on a handful of dissenters. But in acting as if their policy choices came from scientific omniscience, elites minimized the messiness of the real world—in which chancetrust, and voluntary decisions all play a crucial role.

Today, the plerophory of elites—born of hubris and unbridled self confidence—is bearing bitter fruit. For some, the overselling of policy has led them to religiouslike zeal and dogmatism about particular interventions. For others, it has led to a complete loss of faith in institutions like the CDC, the FDA, and the NIH, which depend on public trust in order to fulfill their missions. Masking was simultaneously described as a panaceabetter than a vaccine, in the memorable words of the former CDC director—yet it wasn’t good enough to quickly reopen many closed schools, even given that an unvaccinated child faced lower risk than a vaccinated grandparent. The arbitrariness of the resulting policy recommendations and mandates is etched into the many photographs of masked kids, sometimes posed with unmasked politicians, that will likely come to represent much of our badly flawed pandemic response.

Indeed, toddlers and small children have borne the brunt of our illogic, while mask-mandating politicians go maskless and crowds gather around bars. The covering of toddlers’ faces—a policy that has always made the United States an international outlier, and in outright defiance of WHO guidance—stands in stark contrast to the lives of many elites who never stopped partying anyway. Perhaps nothing illustrates the absurdity of lockdown culture more than the performative spectacle of diners donning masks as they enter a restaurant, only to remove them at their table as they sit for several hours shoulder to shoulder with other patrons.

Mask mandates are just one of many pandemic policies; a similar disregard for curiosity and open debate have pervaded other areas, like lockdowns and booster policy. But they offer an object lesson in how overconfident, unnuanced messaging conditioned us to assume that all dissenting opinions are misinformation rather than reflections of good faith disagreement or differing priorities. In doing so, elites drove out scientific research that might have separated valuable interventions from the less valuable, and corroded much needed public trust. 

The overselling of policies began in the early days of the pandemic with the problematic #masks4all movement, which overstated evidence while promoting ineffectual masks made from old T-shirts and kitchen towels. Today, most experts are starting to concede the inadequacy of the cloth face coverings they promoted until a few months ago—an unsurprising development given what researchers have known since 2020.

Our purpose is not to rehash arguments about the efficacy of mask mandates, though. However one evaluates the evidence on masking effectiveness, the policies were presented and mandated with little nuance, with each subsequent flip-flop being oversold in a way that inevitably undermined public trust. That flip-flopping included the reversal from no masks to masks; the view that protesters, as long as they had the right cause, did not need masks while others outdoors did; the belated recognition that outdoor masking was not logical; the CDC’s famous flip-flop after widespread vaccination from dropping masks recommendations to reinstating them; and now the about-face on the (lack of) effectiveness of cloth masks. It took almost a year after the media began to accept the absurdity of outdoor masking for outdoor mandates to begin fading away, in fits and starts.

The ability of masks to impact the outcome of a pandemic, like the effect of most interventions, is in fact a complex question. Yet the discourse has been framed unhelpfully as a meaningless oversimplification: “masks work” versus “masks don’t work.” The theoretical value of an intervention in a vacuum is not the same as its real-world effect. While studies of aerosols on masked mannequins may tell us something about fabric quality, they do not tell us much about the effect of a mask mandate—the actual policy—in reality.

The earliest push for cloth face-coverings came from a citizen-activist group called #masks4all, spearheaded by an artificial intelligence entrepreneur named Jeremy Howard. The group published a narrative review that offered no original evidence, but came to a different conclusion from existing reviews. Thus, at a minimum, the scene should have been set for an active debate. Instead, Howard and others confidently proclaimed the science to be clear and settled—a claim that was picked up by Democratic pundits and was used to drown out any real discussion. Howard pushed back against anyone who questioned his results, going so far as to email demands to the boss of one virologist who raised issues with his analysis. Even Michael Osterholm, later a Biden adviser and very much a COVID hawk, reported backlash and mischaracterization of his views by Howard.

Early mask proponents made little effort to distinguish situations in which masks would be helpful from ones where they would not. Thus, we wound up with scenes like a lawyer dressed up as the grim reaper walking the beaches of Miami, garnering extensive media coverage, even as there was no particular reason to think masks would be helpful on beaches—and lots of reasons to think that mask-shaming would be ineffective. No attempt was ever made to have nuanced masking policies that accounted for density, transmission, and community spread. This would have been particularly important given the inevitability of policy fatigue.

Most people would probably be surprised by the weakness of evidence for community cloth masking. While the famous Danish mask study, one of only two randomized control trials that have been conducted, was not a death knell for the arguments of pro-maskers, it was also absurd to see tendentious headlines describing a study finding no effect: “Face mask trial didn’t stop coronavirus spread, but it shows why more mask-wearing is needed.” Aspects of another randomized control trial in Bangladesh that did not comport with the pro-mask argument were minimized. One scientist commented that a much-criticized study was “well-conducted using appropriate methods” and lent support to her pro-mask message, only to later recant and say, “we cannot confidently conclude anything from this paper.” The manifest illogic, motivated reasoning, and flip-flopping by some limelight-hungry scientists and doctors was compounded by the media’s tendency to choose experts who would parrot the party line. Many mainstream media outlets repeatedly amplified questionable voices on one side, exaggerated the negative over the positive, obscured nuance, and failed for too long to tell the stories of students and others who were hurt by our pandemic policies.

It rapidly became conventional wisdom in liberal circles that masks needed no further consideration, in part because they had “no downsides whatsoever.” If anyone questioned that conventional wisdom, it was interpreted quite literally and then dismissed—as if the only potential downside to mask-wearing could be oxygen deprivation. This no-downsides framing made it nearly impossible for masks to ever go away: If they had no downsides whatsoever, why not wear them permanently to protect against other respiratory viruses? In fact, while there were some mask opponents who pushed nonsense ideas, the vast majority of mask skeptics had more nuanced points about the balance of costs and benefits than masking advocates like Howard.

The argument advocates should have made was that the benefits of masking outweighed the costs, in particular situations and in particular periods of the pandemic. But by dismissing the possibility of any costs to policies like masking small children in schools for eight hours a day, it is now difficult to discuss masking offramps intelligently.

Moreover, the idea that there were ever “no costs” to masking is dubious. For one, little was known about the effects of masking on childhood development, which is part of the reason why the WHO and most European countries recommended against masking 2-year-olds. On this topic, there was an extreme imbalance in how the mainstream narrative treated the absence of clear evidence. On the one hand, it was said, if there was no evidence of downsides to children, masks had no downsides—to the point that even asking about downsides was “misinformation.” On the other hand, those same individuals said that even if there was little real-world evidence for the effectiveness of masks, they should still be worn given the precautionary principle. But how about taking the same precautions to avoid harm to small children?

Beyond potential downsides to children, the no-downsides rhetoric failed to account for the social impact of masks. For many, seeing faces was important, and the normalization of a forever masking regime was, in fact, a real cost. For others, seeing faces was essential, and insisting otherwise was magical thinking. Or, it was the product of the same kind of technocratic mind that conceives of children as “mosquitos” who should “circulate less or will become vectors,” in one telling analogy adopted by a top Biden COVID adviser.

The mask wars have polarized American society and undermined the possibility of reasonable compromises on masking in mask-wary states. For one, zealotry around cloth face coverings has actually undermined the potential effectiveness of masking by drowning out consideration of better masking. Only once omicron arrived did experts begin acknowledging what had always been known about N95s in comparison to cloth masks. Likewise, the “my mask protects you” language, which insisted that masks provided almost no self-protection, has made it very hard to sell the fact that N95s do protect the wearer. This has inhibited conversation about one-way masking, which offers a compromise position between those who want additional protection and those who no longer want to wear masks.

Many liberal elites can cite examples of misbehavior by anti-mask protesters, but fail to recognize similar hubris on their side. This is not just in extreme examples like the local politician who used her “Masks Save Lives” sign to hit a woman on the head. It was also seen in the pervasive—and untrue—sentiment held by many that if only more people wore masks we would reach zero COVID. This led to moral panic and demonization—perhaps part of the same rising tide of illiberalism that apparently led more than a quarter of Democrats in a recent Rasmussen poll to support temporarily removing parents’ custody of their children if parents refuse to take the vaccine.

In what may be the longest-lasting ramification of our flawed national discussion about masks, the opportunity to do good science was lost. Indeed, Stanford scientist and Tablet contributor John Ioannidis’ much-misrepresented warning that our response to COVID might be a fiasco because of insufficient data may prove one of the few accurate predictions of the pandemic. There was no appetite to do randomized control trials of masking, the gold standard for evidence and which were badly needed to evaluate when and how masks should be used. Unfortunately, proponents of masking proclaimed almost immediately that masks were so obviously useful that it would be unethical to study masking. Even if it were ethical, there was no room in academia for discussions. Who, after all, would study something that was known to be a panacea—and who would want to come to a “pro-Trump” finding? As a consequence, we have learned very little about when, how, or which masking policies are beneficial to help us respond to a future respiratory disease outbreak.

Some say it is unfair to criticize public health for messaging flip-flops—whether about cloth masksherd immunitynatural immunity, or the vaccines’ effects on transmissibility—because they were just “following the science” as it changed. But in many cases, what evolved was politics, not science. The critics of public health messaging do not begrudge scientific progress—indeed, most of them want more research. Rather, people are upset by unjustified dogmatic certainty in one direction, followed by an immediate swoop to utter confidence in the opposite course of action. The pandemic produced a headfirst leap into a series of unprecedented interventions, from masks to lockdowns to school closures. In the first weeks of the pandemic, speed was necessary, and mistakes were inevitable. What was not necessary or inevitable was the suppression of healthy skepticism and discussion.

Since the beginning of the pandemic, when doctors Vinay Prasad and Jeff Flier presciently warned about the toxic climate within the scientific community, debate, nuance, open-mindedness, and curiosity have been driven underground. Now, the same ham-fisted responses that badly damaged our ability to respond intelligently to the pandemic hamper our return to normal. Elites—even those who now want to convince us to “live with” COVID—now find themselves stuck. They inspire little trust. They’ve locked some into a “forever pandemic,” others into conspiratorial thinking, with the sensible middle in a place of frustration and distrust.

Why did they do this? Some of the explanation is institutional: The media and politicians are most likely to amplify the most exaggerated views. Moreover, elites may underestimate the cost of interventions—in part because so often the rules seemed not to apply to them. There was a seeming lack of empathy throughout the pandemic with how others might be differently affected by lockdowns or masks.

But perhaps even more salient is an elite belief in technocracy and perfectionism. The “follow the science” mentality wrongly framed issues that involved complex judgments, suggesting the existence of a singular, oracular science that could dispassionately decide complex policy issues which invoked nonscientific domains. Even more fundamental than suggesting elites had all the answers, it also suggested that all problems were solvable, which was never going to be true in a pandemic. And by leaving decisions to an elite few, and by labeling even good-faith backlash as disinformation, it inhibited the development of much-needed public trust—a resource whose value elites seemingly discounted.

Just as elites led us into this mess, the way out is unlikely to come from “experts” or the elite institutions that have fostered a climate of close-minded authoritarian disregard for the nuances of scientific work and openly show their contempt for people who hold opposing points of view. Instead, we see hope in the voices of dissent. The growing backlash by parents against school masking is often framed primarily as a political issue, and as a looming one for Democrats, which it may well be. But it is also a lesson in how public discourse can be reclaimed by the people.

No comments:

Post a Comment