Parents face tough choices in a post-mask mandate world.
A judge invalidated the travel mask mandate just weeks before a vaccine is likely to be approved for children under 5.
Yesterday, a federal judge in Florida ruled that the current mask mandates on airplanes and other modes of public transportation are unlawful. In the hours after the decision was issued, several major US airlines dropped their mask requirements. The changes went into effect immediately.
As it happens, my family and I are mid-trip. We flew out to California with the impression that the transportation mask mandates would be in effect at least until after our trip. Now, we’ll have to return home in the post-mask mandate era. For all the talk of “personal risk thresholds,” we certainly didn’t appreciate that we made our choices based on one set of facts, only to find the rug pulled out from under us. We’ll probably be fine; our four-year-old is pretty good about masking, though she is not yet old enough to be vaccinated. But my heart really goes out to parents of infants and toddlers too young to mask who are on vacation and now will have to fly home with their children entirely unprotected. Hundreds of children under age 5 have died of Covid-19, and tens of thousands have been hospitalized.
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While I read swaths of the decision issued yesterday, I’ll leave the legal analysis to the relevant experts. But through the lens of public health, there are two key issues that I believe are important to consider in this moment: science and morality. And yes, I mean morality, not mortality. (Mortality falls into the scientific assessment.)
Let’s start with the science. Does SARS-CoV-2 spread on planes, trains, and buses? Certainly. The question is how much. We’ve seen examples of outbreaks on airplanes, particularly before masks became required. An epidemiologic report of an outbreak on a 2-hour flight in Japan in March 2020 found that the two leading predictors of being infected were not wearing a mask and being within two rows of the contagious person. Both proximity and not wearing a mask were associated with a 7-fold increase in the risk of infection. So, when people say, “Covid does not spread on planes,” what they mean to say is that during the mask era, planes have apparently not been a major site of spread. This is not surprising, given that airplanes have excellent air circulation and filtration. But, while those environmental factors help, they don’t eliminate the risk. Before the pandemic, influenza sometimes spread on planes. Now we are about to find out how well SARS-CoV-2, a far more contagious pathogen, can spread in the same environment. No one knows, but the reports from early 2020 – when the original strains of the virus were much less transmissible than those we are dealing with now – are not encouraging.
The second consideration is morality. There are two groups of people who merit our special attention right now: children under age 5 and the highly immune-compromised.
As of now, there is no approved vaccine for children under the age of 5. While Covid-19 is far less dangerous to children of this age than to adults, close to 300 children under 5 have died of the disease, with Delta and Omicron having exacted far higher tolls than previous waves. For comparison, around 430 children under age 5 die per year in motor vehicle accidents. And, as a society, we normally go to great effort to prevent smaller numbers of pediatric deaths. There are recalls of car seats that have minor problems, some of which caused zero deaths and none of which caused hundreds. A popular infant sleeper was recalled after it was linked to 30 deaths among 4.7 million units sold; that’s 1 death per 156,666 units sold. So far, the population fatality rate of Covid-19 in children under age 5 is around double that rate. If Covid-19 were a car seat and its manufacturer had covered up its safety record, the protests from parents and child safety advocates would be loud and furious. So, is now really the time to take away Covid safety measures for this group?
Now, if we were years away from having an effective vaccine for these children, this argument would hold less sway. But we are apparently weeks away from an effective Covid-19 vaccine for children ages 6 months to four years. As a society that purports to care about children, we owe it to the small number of parents and kids who might suffer due to the premature end of mask mandates to go a little further.
And while I may not agree that now is the time to drop mask mandates in other areas of life beyond airports, planes, and public transportation, it is more reasonable to let individuals decide what to do with respect to some other crowded activities (albeit, as I’ve argued before, people generally have no idea what their risks really are, making this ethically dicey). Parents with unvaccinated children can avoid indoor dining for now without great loss. Lifting the travel mask mandate places a much greater burden on parents who must use public transportation to get their kids to daycare and school, or who would like to take their children across the country to visit grandparents, in the face of unmitigated Covid-19 spread. A more moral society would keep the travel mask mandate in place until May or June, when we expect to have a vaccine for all ages. From there, linking mask mandates on public transit and planes to case rates might make sense, if we are concerned about the remaining high-risk populations. Considering how little time everyone spends on public transit, but how high the exposure rate is in those moments, it’s too bad that this is now seen as too much to ask.
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Lost in all of this, it seems to me, is just how little we are asking of people now. Masking in crowded public areas is not a major imposition. It is seen as one only because of politics. Surgeons wear masks for hours on end, day-in, day-out. Ask them if they find masks to be stifling, or some violation of their personal sovereignty. Because masks in everyday life became politicized, for some, the relief of removing them seems to me a little greater than it should be.
Given the news coverage, dominated by clips of unruly people being tackled on planes, it may surprise you to learn that most people continue to support mask mandates. As recently as the end of March, polls showed that over 70% of respondents who were expecting to travel in the next 3 months supported continued mask mandates. But airlines have recently pushed for the end of mask mandates. I can hardly blame them. Asking flight attendants to risk their personal safety to enforce public safety seems onerous, if not unsustainable. It’s just sad that the wishes of a loud and in some cases disruptive, or even violent, minority of passengers are able to override those of a polite and well-behaved majority willing to be slightly inconvenienced in order to help others. In urging the government to drop mask mandates, the airlines punished civility and surrendered to the acts of an occasionally unhinged mob. Maybe the airlines made the best choice they could, given the hand they were dealt. The problem is the hand they were dealt.
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