By now, President Donald Trump's position on face masks is clear. He wears one, except when he doesn't. And he thinks masks are useful in reducing transmission of the COVID-19 virus, except maybe they aren't.
Trump's persistently muddled message about masks, which he delivered once again during last night's presidential debate, may reflect his own dislike of wearing them or his attempt to seem responsible without alienating supporters who are leery of face coverings. But as was apparent during the debate, those tendencies are reinforced by the fact that, over the course of the pandemic, public health officials have switched from dismissing the value of general mask wearing to endorsing it as an essential precaution, sometimes in terms that are not justified by the scientific evidence.
"Are you questioning the efficacy of masks?" moderator Chris Wallace asked.
"No, I think masks are OK," Trump replied. "I have a mask right here. I put a mask on when I think I need it. Tonight, as an example, everybody's had a test and you've had social distancing and all of the things that you have to. But I wear masks when needed."
That seems like a reasonable position. Masks may be appropriate indoors when you are in close proximity to strangers but more trouble than they are worth in other contexts—say, when you are outdoors at a distance from other people. Yet when Joe Biden, Trump's Democratic opponent, asserted that "masks make a big difference," Trump could not resist contradicting him.
"His own head of the CDC [Centers for Disease Control and Prevention] said…if everybody wore a mask and social distanced between now and January, we'd probably save up to 100,000 lives," Biden said. "It matters."
Alluding to the CDC's initial dismissal of face masks worn by the general public as a helpful strategy, Trump replied, "They've also said the opposite…Dr. Fauci said the opposite…He said very strongly, 'Masks are not good.' Then he changed his mind. He said, 'Masks are good.'"
Back in March, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, was indeed questioning the value of general mask wearing. "There's no reason to be walking around with a mask," he said during a March 8 interview with 60 Minutes. "When you're in the middle of an outbreak, wearing a mask might make people feel a little bit better, and it might even block a droplet. But it's not providing the perfect protection that people think that it is. And often, there are unintended consequences. People keep fiddling with the mask, and they keep touching their face…When you think 'masks,' you should think of health care providers needing them."
Today Fauci's position on masks, consistent with the CDC's turnaround on the question in April, is quite different. "There should be universal wearing of masks," he told ABC News in August. "If you look at the scientific data, the masks clearly work," he told CNN this month.
Fauci has defended his original position by claiming that his main concern was preserving the supply of masks for health care workers. But he did not merely say that health care workers should have priority. As illustrated by the 60 Minutes interview, he also questioned the effectiveness of general mask wearing, including the use of homemade masks, which would have no impact on the supply of personal protective equipment for people dealing directly with COVID-19 patients.
Fauci also says the usefulness of masks became clearer as scientists recognized the importance of asymptomatic virus transmission—a rationale also cited by the CDC. "We learned that a substantial proportion of the transmissions occur from an asymptomatic person to an uninfected person," he told CNN. Yet given COVID-19's incubation period, typically four or five days, and early reports that many people infected by the virus either never develop symptoms or have symptoms so mild that they do not realize they are carriers, that concern was relevant months before the CDC and Fauci changed their positions.
Finally, Fauci says he responded to accumulating scientific evidence that masks work. "Science accumulates," he told CNN. "When you're having an evolving situation, like COVID-19, which clearly is evolving in a very rapid way, you make a recommendation or you make a policy based on the information that you have at a particular time, such as early on in the outbreak in February and March. As you get further information, you have to be humble enough and flexible enough to make your statements and your policy and your recommendation based on the evidence that you now have, which may actually change some of the policy."
Fair enough. While it remains true that masks do not provide "perfect protection," they do seem to provide some protection, which is better than nothing. But public health officials now tend to err in the opposite direction, exaggerating what we know about the effectiveness of masks (cloth masks in particular) instead of saying the weight of the evidence indicates that wearing them is a good idea. In particular, the projection by CDC Director Robert Redfield that Biden cited implies more certainty than is possible given the available evidence, as did Redfield's suggestion that masks would prove to be more effective than vaccines in curtailing the epidemic. And politicians such as Michigan Gov. Gretchen Whitmer have gone even further, citing pro-mask factoids with no scientific basis.
Given all this, it would not be surprising if someone like Trump, who is not exactly known for his intellectual curiosity or scientific literacy, was honestly confused about the merits of masks. His bottom line seemed to be this: "I'm OK with masks. I'm not fighting masks."
That's a pretty tepid endorsement, especially when compared to Trump's suggestion in July that wearing a mask in public is "patriotic." Trump's message is certainly much weaker than the strong language used by Biden and by Trump's own scientific advisers. But some of those statements, especially assertions about how many lives can be saved by masks, go beyond what the evidence actually shows.
Overconfident statements on both sides of the debate about face masks help explain how this scientific issue became so divisive. In late February, Surgeon General Jerome Adams was insisting that masks "are NOT effective in preventing [the] general public from catching #Coronavirus." He was not simply saying the evidence at that point was insufficient to support general mask wearing; he was asserting that science had proven the practice is ineffective, which was simply not true. Many mask skeptics continue to push that line, while mask enthusiasts say masks are better than vaccines or make easily debunked claims about exactly how effective they are.
Those extremes seem to leave no room for common ground, nuance, or honest disagreement. Trump's ambivalent comments may be his best attempt to reconcile the irreconcilable.
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