Our recent Veteran’s Day was a poignant reminder of genuine personal sacrifice courtesy our men and women warfighters of today and the millions of volunteers and conscripts from past times. This is such a contrast to the shallow and politicized call for “freedom” by conservatives who insist that mask mandates “take” their personal freedom.
Many mask deniers latch onto conspiracy theories or whatever excuse they can to justify their insistence that masks don’t help. Some may claim that people like me use double standards because we insist that Phase 3 trials are needed for vaccines, but not for masks. Unfortunately, it is simply impossible to conduct the equivalent of a Phase 3 trial for masks. So where does that leave us?
One way to assess the efficacy of masks is to make broad comparisons at the state level. Doing so would be less meaningful if we just compare the state of Idaho (no mask mandate) to the state of Washington (masks mandated) because these two populations are so different and thus there are many factors that might contribute to the difference in COVID-19 infections. At an “aggregate” level, however, we can derive some useful inferences.
Consider, for instance, the difference in the per capita caseload (cases/100,000 people) for last week (available from the CDC) for states (plus Washington D.C. and Puerto Rico) that had mask mandates in place as of this fall. Those with mask mandates (34) had an average of 43 cases/100,000 whereas states without mask mandates (18) that had 80.8 cases/100,000. That is, mask mandates correlate with approximately 50 percent fewer COVID-19 cases.
It probably isn’t surprising that the case differences also map well to the 2020 electoral map with the 25 “Trump states” accounting for an average 72.4 cases/100,000 and “Biden states” accounting for an average 42.8 cases/100,000. Does this reflect mask wearing or other conservative vs. liberal bias in behaviors? It turns out that there are 10 Trump states that have had mask mandates and 15 states that haven’t. When we compare this subset, we find that Trump states with mask mandates experienced 47.4 cases/100,000 vs. 89.1 cases/100,000 for states without mask mandates. All of these differences are statistically significant.
Those of us working in science know only too well that “correlation does not imply causation” but in many cases experimental manipulation and controlled studies are not possible. In these cases, we look for “natural experiments” that may offer better control for some comparisons vs. others. Thus, while the comparison of all states with mask mandates vs. those without is informative, the fact that this relationship holds so well when restricted to Trump states alone adds considerable confidence to the inference. Mask mandates appear to “trump” political ideology.
And why should we care? When a pandemic is raging, hospital beds are being filled with critical cases and healthcare workers are being overworked and, in some cases, are dying when they contract COVID-19 from their patients. Medical services are deferred for many people, which could ultimately cut lives short. Distance learning is imposed with commensurate risks of reduced learning, retention and mental health challenges. Health disparities increase, particularly for low-income and minority households. Economic activity sputters because of lockdowns and reduced consumer confidence.
Imposing mask mandates after the fact, such as North Dakota did this weekend with 181.7 cases/100,000 already brewing, is like closing the barn door after the horses left. Had Trump rallied the entire U.S. population to accept the minor inconvenience of mask wearing from Day 1, he might have been reelected and we would likely be in a much better place today. Still, there’s no time like the present. Mask mandates now will likely reduce the duration of the massive third wave. Governor Inslee’s recently announced additional restrictions won’t be popular, but they will hopefully keep Washington from catapulting from 21.3 cases/100,000 to the 73+ cases/100,00 of Idaho.
For mask opponents – if you value your community, if you value America’s elderly, including many veterans, if you value our healthcare workers, our teachers, our local restaurants and retail stores, not to mention the broader economy, then let’s ditch the theatrics and start working towards recovery. Wear the mask.
Doug Call is a microbiologist and father of three. He first discovered the Palouse 37 years ago.