Covid-19 cases are on the rise again in the United States. Even President Biden is infected. But the biggest danger is not the virus—the now-dominant and highly contagious Omicron BA.5 variant—but the risk that public health officials will overreact.
Over the past two months, new Covid cases have risen by roughly 15 percent. Covid hospitalizations have risen even more. But BA.5 does not cause more severe disease than earlier variants. In fact, the percentage of Covid cases leading to bad outcomes appears to be declining.
The hospitalization increase is likely artifactual. The severity of illness among hospitalized Covid patients has been declining since autumn 2021—both intensive-care unit admission and mortality rates have been steadily falling. The likely explanation is that many Covid-positive admissions actually entered the hospital for other reasons before testing positive on routine tests for Covid. In fact, current cases and hospitalizations are still moderate when viewed over the history of the pandemic and are far lower than previous spikes. More importantly, Covid death rates have been relatively flat for the past three months.
But these facts have not kept Los Angeles County from planning to reinstate its indoor mask mandate on July 29. Multiple California universities and school districts have already reinstated mask mandates. Gwinnett County, Georgia, employees and schools have imposed new masking requirements. And it’s always possible that enterprising officials could inflict more restrictive lockdown-type measures if cases continue rising.
Yet no evidence exists that generalized mask mandates are beneficial. A pre-pandemic systemic review by the highly regarded Cochrane Library found that medical/surgical mask-wearing made little or no difference to the outcome of influenza or influenza-like illnesses compared with not wearing a mask.
A recent review of randomized controlled trials—the gold standard for scientific studies—came to a similar conclusion. Thirteen of 14 RCTs failed to find a statistically significant benefit from mask-wearing for non-Covid respiratory infections. Two RCTs of masking effectiveness concerning Covid-19 also showed little benefit: One found that surgical masks did not provide statistically significant protection to mask wearers; a second found no benefit from cloth masks and only a tiny, marginally statistically significant, reduction in viral transmission for surgical masks.
Unsurprisingly, the Centers for Disease Control and Prevention, the World Health Organization, British health authorities, and the European Center for Disease Prevention and Control all refrained from recommending widespread mask usage in the early days of the pandemic. When the CDC changed course and began recommending masks, it relied on observational studies rife with methodological problems that undermined the conclusions.
A study of Covid infection rates in all 50 states during the first year of the pandemic concluded that “mask mandates and use are not associated with slower state-level COVID-19 spread during COVID-19 growth surges.” Other studies comparing counties and states with different masking policies suggested that mandates could reduce Covid case growth, but these were generally conducted early in the pandemic, when multiple infection-prevention and control measures were in place, making it challenging to measure the independent impact of mask mandates. Moreover, these studies preceded the advent of more highly transmissible variants like Omicron, and especially the now prevalent and even more transmissible BA.5 subvariant, and therefore may not be directly relevant to the current situation.
The fact that President Biden, who still sometimes wears a mask and is surrounded by mask-wearing, physically distancing staff who are frequently tested, could become infected suggests that any efficacy masks may have had against transmission of earlier variants is substantially diminished with BA.5. Moreover, two and a half years into the pandemic, compliance with new mask mandates is likely to be spotty at best, further undermining their potential value.
Reinstating mask mandates won’t bring much in the way of health benefits but will impose costs. Masks interfere with normal social interactions and are especially damaging to the psychosocial and educational development of schoolchildren. Our kids have already lost years of education to school closures and mitigation measures that interfered with teaching and communication. This will have lasting impacts on their lives, especially children already in disadvantaged circumstances.
The reality is that Covid is now endemic. The virus will continue to circulate and mutate. Thankfully, while it has become more transmissible, it has not evolved into causing more severe illness. Nearly all the population has either vaccine immunity or natural immunity following recovery from earlier infections, or both, apparently protecting most infected people from progressing to severe illness or death.
Of course, the elderly, the immunosuppressed, and people with multiple underlying medical conditions—all groups more vulnerable to severe infections—should continue to exercise caution. But new, burdensome, population-wide mandates have no justification. Even the usually alarmist Anthony Fauci recently said in a White House briefing that Americans “should not let [Covid] disrupt our lives.” Finally, some good advice to follow.
Photo by Irfan Khan / Los Angeles Times via Getty Images