States across the country are actively removing mask mandates as localities open up for spring return to office, summer socializing and fall schooling. Concurrently, the Centers for Disease Control and Prevention has loosened mask recommendations for individuals fully vaccinated against COVID-19 in both indoor and outdoor settings.
Should masks be forgotten? Scrapped? Burned with glee, as some have suggested?
On the contrary: Masks should remain with us, becoming part of our everyday lives even as the COVID-19 pandemic, science willing, subsides. We should never fully return to our maskless society where only health care providers donned a mask, because judicious use of masks will continue to save lives.
While mask-wearing in the United States during the COVID-19 pandemic has been a contentious political issue at times, for many Asian countries, it has been part of the culture for a long time and was easily adopted during the pandemic. Masks are a simple, low-tech and inexpensive yet effective measure to protect against respiratory pathogens and have been shown to protect both the wearer and those around them.
Just as we all adjust to common-sense public health interventions that initially feel at best inconvenient and at worst an insult to our self-efficacy, we eventually see the value of preventive measures that save lives. We all agree to wear seat belts; understand that helmets protect football players, bicycle riders and skiers; wash our hands to prevent transmissible illnesses, and agreeably struggle to open up medication bottles because the safety locks protect children.
We are now accustomed to wearing masks and to seeing others wearing masks. The frequency of mask-wearing may be different for different people, but masks ought to remain with us. If they do, they will continue to save lives.
SARS-CoV-2, the virus that causes COVID-19, will remain a global infection for the foreseeable future. We will not likely reach herd immunity: Vaccination confidence is not universal, global vaccine rollouts are struggling and have not been rapid enough, and the virus continues to mutate, producing variants that may eventually lessen the effectiveness of current vaccines. The designation as an acute pandemic will give rise to a more permanent situation — an endemic virus, one that ebbs and flows, perhaps in a seasonal pattern similar to influenza, but one that will never fully disappear from our landscape.
To avoid larger outbreaks, we will need to take precautions when levels are high in our own communities, when we choose to go to crowded indoor venues, when we travel to areas having escalating cases of infection, or when a new variant becomes common. Although mask-wearing will likely be our individual choice, many of us will and should choose to do so — and because masks protect both the wearer and those around the wearer, we may want others to wear a mask in those same circumstances.
Many people in our families and communities live with chronic illnesses or may be on long-term medications that suppress their immune systems, putting them at risk for both a worse outcome from COVID-19 and a less robust immune response from the vaccine. Because the vaccine may not fully protect these populations, they may decide to wear a mask more often than most. And again to protect our most vulnerable friends, families and colleagues, we might all opt to be a part of the collective response to protect them and wear masks as well.
As our society has come to understand the benefits of wearing masks, many of us will also wear a mask when other respiratory viruses are active in our community. Unlike COVID-19, which can be transmitted when people are asymptomatic, influenza and other common respiratory viruses are most contagious when a person is symptomatic. It makes sense to wear a mask when a person has nasal congestion, sore throat, fever or other symptoms consistent with a respiratory illness. This common practice in other countries should now become common practice in the United States.
The 2020-2021 flu season in the United States was very mild. The CDC influenza surveillance site reports that the influenza hospitalization rate this year has been 0.8 per 100,000, one-tenth the rate reported at the same time during 2011-2012, which was the lowest recorded rate on record. The data on influenza during the period that intersects with the COVID-19 pandemic is stark and deserves reflection and attention from all. The reason for our mild flu season is multipronged and includes mask-wearing, decreased gathering and increased uptake of influenza vaccination. Of these, masking is a simple intervention that clearly contributed to lower rates of influenza this year.
Do not throw out your cloth masks or stop buying your surgical masks. They will still save lives.
Parkas and Forsyth are associate professors of medicine and infectious diseases at the Icahn School of Medicine at Mount Sinai, where they are co-directors of infection prevention for the medical and graduate students.
