In a nutshell

• Face coverings must be worn in public indoor spaces across Michigan.
• Evidence suggests that wearing masks is a low-cost and virtually risk-free way to reduce viral transmission in communities, in particular when combined with other factors (like physical distancing). 
• Public health policies have become heavily politicized. Playing politics with public health puts every person in society at risk.

While experts have known from the beginning that the coronavirus pandemic would not be a short-lived event, it seems this reality has yet to dawn on all corners of society. Michigan’s COVID-19 cases had initially been concentrated in Southeast Michigan, but events such as a night of fun in an East Lansing bar and massive July 4th gatherings illustrate the fact that the virus still poses a threat to all of Michigan. 

While Michigan experienced a temporary lull in the number of new cases and coronavirus-related deaths, we are now seeing a steady rise in new cases of COVID-19 since physical distancing requirements were loosened.

On July 10^th, Governor Gretchen Whitmer signed executive order 2020-147, reiterating that individuals must wear a face covering in indoor public spaces. Evidence suggests that widespread use of cloth masks—in combination with physical distancing, hand washing, and other efforts—reduces transmission of the novel coronavirus, ultimately saving lives and mitigating economic damages.

Unfortunately, some folks seem to really dislike masks.

Scientific Uncertainty and Public Confusion

Given problems with mixed messaging, it is easy to understand some of the public confusion and skepticism surrounding mask use. Early statements from the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) advised against public use of masks. At the time, there was concern that public demand for surgical masks could create supply issues for health care workers. There was also a belief that pushing for other measures (like physical distancing and hand washing) should take precedence, and that people might be less compliant with other recommendations if they believed wearing a mask offered complete protection. Additionally, understanding of the predominant pathways of viral transmission for the novel coronavirus was still developing at the time (and continues to do so).

This early mixed messaging stands as a glaring mistake in retrospect. The WHO and CDC guidelines and recommendations now support broad public use of cloth face coverings.

The confusion is far more widespread, however.

To put it as simply as possible: The appetite for news, any news, about this pandemic has run roughshod over what would be the usual course of scientific inquiry; even preliminary results from small studies are seized upon, amplified, spread via social networks, and then thrown into the recycling bin with dizzying speed. Bad actors on all sides can cherry-pick data, too.

To mangle a metaphor, “they say” misinterpretation of fact is halfway around the world while the truth is still putting its boots on. Scientific inquiry is never a one and done effort; studies must be reproduced, replicated, reviewed, refined, and revised in a long process of inching closer and closer to an answer with ever stronger evidence.

It is admittedly difficult to disrupt lives and businesses in the face of any degree of scientific uncertainty, but uncertainty is the hallmark of scientific inquiry. At present, however, little uncertainty remains about whether the public should wear masks (we should). 

Masks Prevent Disease and Save Lives

Cloth face coverings are effective for reducing source virus transmission and mitigating community spread of COVID-19. Numerous observational studies and randomized controlled trials have confirmed that there is a measurable benefit from public use of masks. Mask use has also been anecdotally linked to prevention of COVID-19 transmission in numerous real world instances, such as on an international flight from China to Canada, wherein none of the 350 passengers contracted COVID-19 from an infected individual wearing a mask.

The most compelling evidence in support of masks has come from epidemiological studies. States mandating use of face masks in public have had a greater subsequent decline in daily COVID-19 growth rates compared to states that did not issue such mandates (although it is very difficult to determine the proportion of this effect that is attributable to masks as opposed to physical distancing/isolation and other behavioral factors). The Institute for Health Metrics and Evaluation projects that more than 30,000 U.S. deaths could be prevented by October 1^st if at least 95 percent of people wear masks in public.

Masks are effective at reducing viral transmission; any remaining uncertainty over the magnitude of this effectiveness actually matters very little in the context of policy making. Given that masks are simple, inexpensive, and harmless to the wearer, requiring masks during the current pandemic is sensible public health policy.

But because controversy surrounding the use of masks has been elevated and politicized, implementing this simple, commonsense health policy has turned into an ostensibly Sisyphean endeavor.

Politicizing Public Health

The politicization of health issues is certainly not new, tracing at least as far back as Teddy Roosevelt’s 1912 push for a national health service, through contemporary debates surrounding Medicare and Medicaid. In a nation that prides itself on its rugged individualism, public health interventions that require collective compliance and behavioral changes are often met with pushback (remember the outcries of “tyranny” that came with the advent of seat belt laws?).

Many important public health issues, like vaccine policy, indoor smoking bans, or e-cigarette regulation, have taken on political undertones and revealed partisan differences in recent years. Similarly, various aspects of the current pandemic—and masks in particular—have also become politicized. For example, the Pew Research Center found that Republicans are less likely to adhere to mask recommendations.

Just as the pandemic response has become entangled in the politics of the day, it is also difficult to separate the experience of the pandemic from long standing social and cultural realities.

Factors of racism and economic inequality have left many Black communities hard hit by COVID-19. Yet, the admonition to wear masks brings up complicated anxieties for Black Americans. Some evidence suggests that Black males are perceived as more threatening when wearing a face mask or bandana; ultimately, the fear of potential police violence is, for some, overriding the fear of COVID-19.

On the front lines, public health workers in Michigan have reportedly experienced lies, evasion, or outright aggression. Pushback against mask orders—often culminating in threats of violence—have resulted in the resignation of public health officials across the country.

On the issue of rising death threats against public health officials, the Public Health Institute did not mince words:

“Instead of bulletproof vests and security details, our local public health officials deserve the protection and support of those who appointed them, and of those they serve. What we need now—from state leadership, from local and state elected officials, from healthcare and from the public—is a clarion call of solidarity, cooperation and concrete support of public health policy.”

We simply can’t afford to keep losing our experienced and knowledgeable public health officials at the moment when we need them most.

It is the responsibility of those who have assumed the honor and duty of holding office to base policy decisions on the most current data as interpreted by those with proven expertise. Our elected leaders also bear the responsibility to avoid the trappings of election-year politics, and to lead by example in both word and deed. This means acknowledging the reality of our shared challenges whether or not it is popular, and modeling the behaviors asked of the rest of us, from wearing a mask and maintaining physical distance from others to recognizing that this may not be the best summer to worry about getting the boat out on the lake.

Confronting a pandemic demands collective action, and motivating collective action requires real acts of leadership. It is essential that we resist attempts to politicize the sciences that underpin public health. Our collective well-being depends on it.