Public Health

Biden Calls Ending Mask Mandates 'Premature' but Can't Say When It Won't Be

The president is waiting until children, who have always faced an infinitesimal risk from COVID-19, are "more protected."

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"It's hard to say whether they're wrong," President Joe Biden said in an NBC News interview that aired yesterday, referring to the Democratic governors who have recently lifted face mask requirements for businesses and/or schools. "I think it's probably premature, but it's a tough call."

Why is it a tough call? In his interview with NBC's Lester Holt, Biden suggested that such decisions depend partly on "whether the omicron variant continues to dive." He also mentioned the Food and Drug Administration's pending approval of COVID-19 vaccines for children younger than 5. "Every day that goes by, children are more protected," he said. "The more protection they have, probably you're going to see less and less requirement to have the masks."

In other words, Biden has no clear idea of when it will no longer be "premature" to stop forcing masks on adults in public places and children in schools and day care centers. The administration will not say what threshold must be crossed before those steps would be prudent, and the two criteria Biden mentioned—daily new cases and vaccination rates—are of dubious relevance now that Americans, including those who are especially vulnerable to COVID-19, have the tools to protect themselves, regardless of whether everyone else is required to wear a mask.

Newly reported cases in the United States, which exploded from mid-December to mid-January, have fallen precipitously since then. Yesterday's seven-day average, according to the New York Times database, was less than 175,000, down 78 percent from the peak on January 17. Hospitalizations, which include patients who tested positive after they were admitted for other reasons, have dropped by 42 percent since January 19. The seven-day average of daily deaths, another lagging indicator, has been falling since February 1.

Also relevant as the Biden administration searches in vain for an "off-ramp": The currently dominant omicron variant, while highly contagious, tends to cause less severe symptoms than earlier iterations of the coronavirus, and vaccination provides additional protection. When I got COVID-19 last month, I was a bit congested for a few days, and that was pretty much it. I have had worse experiences with the common cold. Given omicron's relatively mild effects, my symptoms might have been about the same even if I had not been triply vaccinated, although I was grateful for whatever additional protection that provided.

Millions of Americans have had similar experiences, which is one reason mask mandates are an especially hard sell at this point in the pandemic. At the same time, those widespread, generally mild infections have boosted natural immunity, making Americans less vulnerable to the coronavirus.

What about vaccination rates? Overall, nearly two-thirds of Americans have received two doses, and rates are especially high in the older age groups that face the biggest risks: about 80 percent for ages 50 to 64, 91 percent for ages 65 to 74, and 85 percent for people 75 or older. In contemplating when mask wearing can safely be made voluntary, Biden apparently is focused on vaccination rates among children, which are 57 percent for 12-to-17-year-olds and 24 percent for 5-to-11-year-olds.

But that focus makes no sense because children are extremely unlikely to suffer life-threatening COVID-19 symptoms even if they are not vaccinated. Back in March, based on data collected before vaccines were available to anyone, the Centers for Disease Control and Prevention (CDC) estimated that the infection fatality rate for people younger than 18 was 0.002 percent. "A (pre-vaccine!) analysis from Germany shows that if a child is infected with COVID—with or without preexisting conditions—there is an 8 in 100,000 chance of going to the intensive care unit," University of California, San Francisco, epidemiologist Vinay Prasad notes. "According to the same study, the risk of death is 3 in 1 million, with no deaths reported in the over-5 age group. These risks are astonishingly low."

Yet Biden is suggesting that school mask mandates must be maintained not only until vaccination rates among 5-to-17-year-olds reach some unspecified threshold but until that same undefined goal is reached among children younger than 5, for whom vaccines are not yet approved. People younger than 18 account for about 22 percent of the U.S. population. But according to the CDC, they account for 0.09 percent of Americans who have died from COVID-19. Biden is nevertheless waiting for the day when "children are more protected."

The president's emphasis on children's safety is clearly a red herring. But what about teachers and other adults who might catch COVID-19 from students? Their best safeguard is vaccination, which dramatically reduces the risk of severe symptoms. And immunocompromised adults (or children) who might not get the same benefit can protect themselves from infection by wearing high-quality, well-fitting masks, no matter what everyone else is doing.

"At this point in the pandemic," New York Times columnist David Leonhardt writes, "there is a strong argument that a targeted approach—lifting restrictions while taking specific measures to protect the vulnerable—can maximize public health." The argument about broad restrictions vs. "a targeted approach," of course, has been going on throughout the pandemic. Lockdown opponents have been arguing for two years that the costs of population-wide mandates could not be justified by the public health payoff and that it made more sense to focus on "protect[ing] the vulnerable." The availability of vaccines, effective treatments, and high-quality masks makes that argument more persuasive than ever.

"I committed that I would follow the science, the science as put forward by the CDC," Biden told Holt. Unfortunately, "the science" is not always the same as "the science put forward by the CDC." The agency is still insisting on "universal masking" in K–12 schools and day care centers, which applies to children as young as 2, despite the lack of evidence that its benefits outweigh its costs and despite the dissent from a growing number of blue-state governors. The CDC also routinely exaggerates the evidence in favor of general mask wearing by adults.

"Does it begin to make the CDC irrelevant?" Holt wondered. Biden did not have a good answer, and neither does the CDC.