{"id":10070,"date":"2021-04-19T09:23:15","date_gmt":"2021-04-19T13:23:15","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=10070"},"modified":"2021-04-19T09:25:12","modified_gmt":"2021-04-19T13:25:12","slug":"is-it-time-to-eliminate-outdoor-mask-mandates","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/is-it-time-to-eliminate-outdoor-mask-mandates\/2021\/04\/19\/","title":{"rendered":"Is It Time to Eliminate Outdoor Mask Mandates?"},"content":{"rendered":"<div id=\"attachment_10074\" style=\"width: 289px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-10074\" class=\"wp-image-10074\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2021\/04\/Screen-Shot-2021-04-19-at-9.04.03-AM.png\" alt=\"\" width=\"279\" height=\"356\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2021\/04\/Screen-Shot-2021-04-19-at-9.04.03-AM.png 688w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2021\/04\/Screen-Shot-2021-04-19-at-9.04.03-AM-235x300.png 235w\" sizes=\"auto, (max-width: 279px) 100vw, 279px\" \/><p id=\"caption-attachment-10074\" class=\"wp-caption-text\">Louie checks out our local town policies.<\/p><\/div>\n<p>I do the morning dog walk in our house. And every day, I put on a mask before going out, just as I have since March of last year.<\/p>\n<p>As the data accumulate on the dynamics of SARS-CoV-2 transmission, it&#8217;s definitely time to ask this question &#8212; why am I still doing this? After all, it&#8217;s just Louie and me &#8212; and even <em>he&#8217;s<\/em> wondering.<\/p>\n<p>It&#8217;s generated some interesting dialogue between the two of us:<\/p>\n<p><em>Why are you doing that?<\/em> he asks me each morning. <em>Who are you protecting?<\/em><\/p>\n<p>Good questions, Louie!<\/p>\n<p>It&#8217;s true, I&#8217;ll briefly pass an occasional person on the street or sidewalk. But they&#8217;re not going to get COVID from me, or the reverse. That&#8217;s not how this works.<\/p>\n<p>Even if I, as a fully vaccinated person, were asymptomatically carrying SARS-CoV-2 &#8212; already exceedingly unlikely on any given day &#8212; the virus would be rapidly diluted by the extraordinary ventilation conferred by just being outside.<\/p>\n<p>And while the vaccines aren&#8217;t 100% protective of me &#8212; nothing is, sports fans &#8212; they are amazingly good. Got to love these recent CDC data, interpreted by indefatigable COVID-19 optimist Dr. Monica Gandhi:<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">When CDC says &lt;1% vaccine breakthroughs, let&#39;s be specific &amp; say 0.008%. And in terms of severe disease, 0.0005% and in terms of deaths, 0.0001%. And Dr. Fauci  said severe disease in elderly with other health problems to NPR. Reduce hesitancy by optimism<a href=\"https:\/\/t.co\/mYLQ7G8psi\">https:\/\/t.co\/mYLQ7G8psi<\/a> <a href=\"https:\/\/t.co\/MsQJwGPtkT\">https:\/\/t.co\/MsQJwGPtkT<\/a><\/p>\n<p>&mdash; Monica Gandhi MD, MPH (@MonicaGandhi9) <a href=\"https:\/\/twitter.com\/MonicaGandhi9\/status\/1383210252347187203?ref_src=twsrc%5Etfw\">April 17, 2021<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p>With COVID-19, the most intensely studied viral respiratory tract infection in over a century, it&#8217;s worth emphasizing that clear documentation of outdoor transmission has been a challenge &#8212; and it&#8217;s not for lack of trying. In such rare cases, it&#8217;s often impossible to disentangle the indoor activities accompanying the outdoor events as contributing to the risk.<\/p>\n<p>Or the people were crowded together outside, facing each other and interacting. Or exercising together and breathing heavily.<\/p>\n<p>Transmissions do not take place between solitary individuals going for a walk, transiently passing each other on the street, a hiking trail, or a jogging track. That biker who whizzes by without a mask poses no danger to us, at least from a resipiratory virus perspective. Read more about the safety of being outside in <a href=\"https:\/\/slate.com\/technology\/2021\/04\/masks-outside-covid-risk-low.html\" target=\"_blank\" rel=\"noopener\">this excellent piece<\/a> by Shannon Palus, which also questions the need for masking outside &#8212; generating <a href=\"https:\/\/twitter.com\/shanpalus\/status\/1383403785129586688?s=20\" target=\"_blank\" rel=\"noopener\">quite the heated commentary<\/a>, as I anticipate this post will also.<\/p>\n<p>But what about the community solidarity engendered by wearing a mask outside in public? Isn&#8217;t this worth something? A way of showing that I&#8217;m 100% part of Team Mask?<\/p>\n<p>Maybe &#8212; certainly there&#8217;s a strong component of this messaging among the highly adherent mask wearers here in Boston. But this performative aspect of outdoor mask-wearing has a downside, too.<\/p>\n<p><em>You might think you need to wear a mask while walking me in the morning to set a good example for others,<\/em> said Louie the other day.<\/p>\n<p><em>But really you might be misleading people about how the virus is transmitted.<\/em><\/p>\n<p>Wise words, dog of mine! (He&#8217;s very articulate.)<\/p>\n<p>Here&#8217;s a bold proposal &#8212; let&#8217;s make public policy based on our best understanding of the science of SARS-CoV-2 transmission:<\/p>\n<p style=\"padding-left: 40px\"><strong>Dangerous<\/strong> &#8212; crowded indoor spaces with poor ventilation, in particular with unmasked individuals talking, shouting, singing. <em>Wear a well-fitted mask until case numbers are down and more people are vaccinated.<\/em><\/p>\n<p style=\"padding-left: 40px\"><strong>Safe<\/strong> &#8212; outdoors, especially while distanced. <em>Masks only needed for lengthy interactions with others at close distance.<\/em><\/p>\n<p>Some might wonder if this is too nuanced a message &#8212; the &#8220;people will get confused&#8221; argument.<\/p>\n<p><em>Give them more credit than that,<\/em> says Louie. <em>If I can understand it &#8212; and I&#8217;m a dog &#8212; so can they.<\/em><\/p>\n<p>He&#8217;s got a point, it&#8217;s not that hard. We&#8217;ve learned so much since the terrifying days early in the pandemic &#8212; why not share what we&#8217;ve learned and eliminate mandates that no longer make sense?<\/p>\n<p>To wrap up, Zeynep Tufekci kindly shared her thoughts on this issue. She&#8217;s been fighting something she&#8217;s called <a href=\"https:\/\/twitter.com\/zeynep\/status\/1379151132916912132?s=20\">&#8220;beach scolding&#8221;<\/a> for over a year now. It&#8217;s when public health officials and the media shame people or even worse prohibit outdoor activities &#8212; when they should be encouraging them since they&#8217;re so much safer. Examples &#8212; the dreaded yellow police tape outside the park or on the benches, the swings removed from the playground, the beaches and lakeside trails closed.<\/p>\n<p>In a way, it relates to outdoor mask mandates:<\/p>\n<blockquote><p>Sometimes people invoke the precautionary principle or what&#8217;s the downside argument to argue for universal masking outdoors. However, the precautionary principle is not necessarily appropriate after a whole year of epidemiological data showing little to no transmission outdoors outside of sustained close contact: precaution is what we do when we don&#8217;t know the answer, not something we invoke to continue doing things on autopilot.<\/p>\n<p>Plus, there is a very important downside that&#8217;s not being considered sufficiently: by mandating or normalizing masks outdoors at all times, we are miscommunicating about the real risk factors\u2014indoors, especially if they are crowded and poorly-ventilated\u2014which means that even a full year after the pandemic, people are not being properly informed about where and how they should increase their vigilance.<\/p>\n<p>It&#8217;s fine to tell people to continue wearing masks outside especially if they are unvaccinated and are about to engage in a sustained interaction at close distance, especially if it involves higher aerosol emitting activities like talking, yelling or singing, but it&#8217;s time for the excessive masking outdoors, and especially mandates, to go.<\/p><\/blockquote>\n<p>Bravo. Looking forward to seeing more outdoor faces soon.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I do the morning dog walk in our house. And every day, I put on a mask before going out, just as I have since March of last year. As the data accumulate on the dynamics of SARS-CoV-2 transmission, it&#8217;s definitely time to ask this question &#8212; why am I still doing this? After all, [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,9],"tags":[4601],"class_list":["post-10070","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-policy","tag-covid-19"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/10070","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=10070"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/10070\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=10070"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=10070"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=10070"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}