Pro-Mask Advocacy When
Even COVID-19 Is Polarized

Biden said he supported a national mask mandate for at least three months. He emphasized “outdoors” several times, and never mentioned indoors. Did he misspeak, saying “outdoors” when he meant “indoors”? Did he misunderstand the briefings he has been getting from experts, who surely told him transmission is at least an order of magnitude likelier indoors than outdoors? Reporters didn’t get a chance to ask, since he rarely takes questions. As far as I know, his campaign didn’t clarify. The mainstream media mostly avoided the question.

Biden also said the evidence was “overwhelming” that masks work – work so well that going without a mask exponentially (he actually said “expedentially”) increases the risk of transmission. This is a gross overstatement. The efficacy of various kinds of masks is hotly debated by experts; those who think transmission is mostly aerosol tend to think cloth nonmedical masks aren’t nearly as beneficial as those who think transmission is mostly larger droplets. Nobody that I’m aware of thinks the benefit is exponential. Over the long haul, this kind of exaggeration of benefits undermines credibility.

As far as I know, none of the public health heavies has publicly corrected Biden on either #1 or #2. (Marc Siegel did disagree with Biden on #1 on Fox.)

The constitutionality of a national mask mandate is also debatable. The United States is a republic. The powers of the federal government are enumerated in the Constitution, and do not include health; the unmentioned powers (including health) are left to the states. A court might conceivably rule that mask buying is commerce, and that the commerce clause therefore entitles the feds to regulate masks. But the Supreme Court’s Obamacare decision said the commerce clause can’t compel commerce (buying insurance – hence buying masks). And that was about Congress. A presidential executive order mandating masks would be more questionable still. Biden was on much solider constitutional ground when he urged governors to mandate masks.

The mask issue is politicized on both sides. It’s not just the right claiming that masks infringe unacceptably on their freedom; it’s also the left claiming that failing to wear a mask infringes unacceptably on everybody else’s safety. The middle position has few supporters.

It’s a well-established principle of risk communication that bandwagoning works better than finger-wagging. That is, a mask campaign that actually aims to increase mask-wearing would empathize with the holdouts’ reluctance to wear masks and in the context of that empathy, encourage them to consider joining the majority in a communitarian effort to reduce transmission and thereby help work toward something closer to normal life. Any messaging that ridicules or abuses the holdouts is so obviously less likely to be persuasive that we have to assume that it has a different goal. Among the candidates: venting a grievance, isolating the outgroup, virtue signaling, adding to polarization.

One sign that pro-mask advocacy has goals other than reducing transmission is the scant interest in improving the quality of masks people wear. Let’s hypothesize that the average mask in wide circulation reduces transmission by 30%, and that the most effective mask in wide circulation is twice as effective, reducing transmission by 60%. (These are wild-ass guesses for the sake of the argument.) Let’s also hypothesize that in a particular community 80% of people are wearing masks at appropriate times and places, and 20% are not. So at present transmission is reduced by 30% x 80% = 24%. If we convince the 80% to wear optimum masks, then transmission will be reduced by 60% x 80% = 48% – a gain of 24%. If instead we get the 20% to wear average masks, transmission will be reduced by 30% x 100% = 30%; that’s a gain of only 6%. In this hypothetical example, it is four times as useful to improve the masks the compliant majority are wearing as it is to get the holdouts to wear masks too.

And it’s easier: The compliant majority will be happy to wear more effective masks, whereas the holdouts are, well, holdouts. So why is so little effort going into maximizing the value of masks people are content to wear, and so much effort going into harassing the holdouts? In my risk communication work, I tried to assess the motives why people decide some risk is intolerable and mobilize against it. Five of the biggies are hazard, outrage, greed, ego, and ideology. The pro-mask side in this debate is motivated at least as much by ideology and outrage as by hazard.

Wearing a mask reduces the risk of people around you (and to a lesser extent your own risk) by an amount that varies with the situation. If there’s nobody around, or nobody except people you’re cocooned with, the benefit is zero. If you’re indoors in a crowded environment in which lots of people are shouting or coughing or singing, the benefit is at its height. The higher the risk of going unmasked in a particular situation, the greater the benefit of wearing a mask in that situation.

Ideally, we would be able to quantify this, so we could say (for example) that ten minutes in a crowded auditorium without a mask is equally risky as twenty minutes in the auditorium with a mask, which is equally risky as 120 minutes without a mask sitting alone on a modestly crowded beach, which is equally risky as 150 minutes with a mask sitting alone on a modestly crowded beach. If we had algorithms like that, we could decide how much risk we were willing to take and impose on other, and then allocate that risk as best suited us. It makes sense to assume that everybody is doing that already, though intuitively and with surprisingly little help from the experts. So in my hypothetical example, if one person sunbathes with a mask on the beach for 150 minutes while another spends 10 minutes in a crowded auditorium without a mask, they’re both taking and imposing the same risk – and we have no grounds for treating them differently.

Masks reduce risk by an unknown amount that varies with the situation. Consider three situations:

• If I don a mask and then go do exactly what I was going to do even if maskless, then the mask reduced the risk I’m taking and imposing.
• If I don a mask and then go do more dangerous things than I would have been willing to do if maskless, and if I guesstimate the value of the mask accurately, then the mask has enabled me to expand my activities without increasing the risk I’m taking and imposing.
• If I don a mask and then go do more dangerous things than I would have been willing to do if maskless, and if I overguesstimate the value of the mask, then the mask has given me a false sense of security and I have ended up taking and imposing more risk than if I were maskless.

Those who argue for masks usually assume the first paradigm: Protect everybody by wearing a mask while you do what you were going to do anyway. The most persuasive pro-mask argument is the second paradigm: Let’s everybody wear a mask so we can all get back more of our lives. The seldom-mentioned downside of masks (which used to be mentioned all the time back before the public health profession did a sudden about-face from anti-mask to pro-mask) is the third paradigm: Don’t think we’re all invincible as long as we’re all wearing masks.