More than five months into the Covid-19 pandemic, the evidence for masks keeps getting stronger.
One study in Germany found that mask mandates reduced the growth of infections by about 40 percent. Another estimated that mask rules in 15 US states and Washington, DC, may have prevented as many as 230,000 to 450,000 cases. Meanwhile, evidence suggests protests against police brutality and racism in many cities this summer did not lead to big spikes in case counts, which some attribute to the fact that the demonstrations were outdoors and many participants were masked.
For all these reasons and more, many public health experts have been encouraging Americans to wear masks. When it comes to Covid-19, “the best treatment is prevention, and there are very good data to show how effective masks are,” Murtaza Akhter, an ER doctor in Phoenix and professor at the University of Arizona College of Medicine, told Vox.
In response to scientific findings — and the continued deadly march of the virus around the country — leaders from California to Pennsylvania have issued or strengthened mask requirements in recent weeks. But others are going in the opposite direction.
Gov. Brian Kemp of Georgia on Thursday sued Atlanta Mayor Keisha Lance Bottoms for issuing an order requiring masks in her city. Gov. Kim Reynolds of Iowa has also barred cities from introducing mask mandates, even as cases in her state spike. Meanwhile, President Trump wore a mask at Walter Reed Medical Center in mid-July, after months of being photographed maskless — only to suggest that masks are only important in hospitals.
Trump has begun to change his tune on masks in recent days, saying in a Tuesday press conference that the face coverings “have an impact.” But this admission came only after more than 100,000 Americans had already died — and after Trump had sent the opposite message with his words and actions for months. And despite the growing scientific consensus that masks have an important role to play in limiting the spread of the coronavirus, this seemingly small public health step remains intensely politicized.
The words of Trump and other public figures appear to be having an impact on the behavior of ordinary people, whose mask-wearing habits break down along party, racial, and gender lines. The result is that one of the cheapest and simplest ways to curb the spread of Covid-19 has been turned into a political football — and it’s costing people their lives. “We just really need a cultural shift,” Akhter said. “This isn’t even a debate in other places.”
Mask-wearing had become politicized in the US even before much of the country went into lockdown earlier this spring. Masks have been common for years in East Asian countries, where they’re seen as a simple way to protect yourself (and others) from disease, as Refinery29’s Connie Wang wrote in March. Wuhan, China, where the coronavirus outbreak began, started requiring them in January.
But in the US, mask-wearing quickly became stigmatized. Asian Americans wearing masks were targeted for racist attacks, as Wang notes, and their images became a go-to choice to illustrate American media stories about the coronavirus, even though the virus was by no means confined to Asian American communities.
The Centers for Disease Control and Prevention (CDC) and many health experts initially also cautioned against mask-wearing, citing a lack of evidence for their use and seemingly fearing shortages of personal protective equipment. Eventually, the CDC reversed its stance, but the change in messaging likely sowed distrust.
Rather than looking to Asian countries — which had already been through the SARS epidemic in 2003 — for guidance on masks, Trump relied on anti-Asian rhetoric in the early months of the pandemic, blaming China and using a racist name for the virus. “The way in which the US administration has addressed the pandemic from the beginning was simply to relegate Asians, China in particular, as the source of the pandemic,” Jasmin Zine, a sociology professor at Wilfrid Laurier University in Ontario, Canada, told Vox.
Even as the virus claimed more and more American lives throughout the spring, Trump, Vice President Mike Pence, and others in the administration routinely appeared in public without masks. For Trump in particular, refusing to wear a mask became part of a larger message that ignoring the risks of the coronavirus was the tough or strong thing to do.
For example, despite warnings from public health experts about the dangers of reopening the country too early, he said during a public appearance in May that “the people of our country should think of themselves as warriors” because “our country has to open.” He made that statement at a mask factory in Arizona — where he appeared without a mask.
Since then, there’s been more research to support the use of masks, as Vox’s German Lopez reports. A June study found that regional mask mandates in Germany brought down the number of Covid-19 cases between 2.3 percent and 13 percent over a period of 10 days. A study of mask requirements around the US, also published in June, found that the requirements were associated with drops in the growth rate of the virus and may have prevented hundreds of thousands of cases.
Incidents in recent months have appeared to reinforce the importance of masks. For example, two hairstylists in Missouri interacted with more than 100 customers while infected with Covid-19 but did not pass the virus on to anyone — perhaps because everyone wore masks. And protests against police violence in American cities do not appear to have caused an uptick in cases, even though they were attended by thousands of people, perhaps in part because most protesters wore masks.
Public health experts are quick to point out that masks are not a panacea, nor a replacement for physical distancing, testing, or other tools for Covid-19 containment. “Masks help,” Lindsay Wiley, a law professor at American University who specializes in public health law, told Vox. “You should wear them, but they are not enough by themselves.”
Still, wearing a mask is a simple action that almost anyone (excluding very small children and people with certain health conditions) can take, and most experts agree it can help slow the spread of the virus. Masks are a big reason why other countries, including those more densely populated than the US, have done a better job than America at controlling the virus, Akhter said. The face coverings are both very effective and “very cheap compared to the drugs that we’re trying to invent” to treat the virus, he explained. “Masks clearly save lives.”
Yet this simple activity remains heavily politicized. Trump himself is still one of the biggest culprits. In May, he was photographed touring a Ford plant in Michigan without a mask, despite being told by state authorities he had a “legal responsibility” to wear one. He later said that he had put on a mask behind the scenes but removed it because he “didn’t want to give the press the pleasure of seeing it.” Then in June, he told the Wall Street Journal that some people wear masks just to show that they don’t like him, and not because they actually care about fighting Covid-19 — thus sending a loud and clear message that masks are about partisan politics, not public health.
In July, he began to soften his stance on masks and was even photographed wearing one at Walter Reed. Still, that day, he downplayed the importance of masks for the general public, saying that the face coverings “have a time and a place,” such as “when you’re in a hospital.” Trump’s cavalier stance on masks also ignores the fact that, unlike most Americans, he reportedly exists in something of a bubble, with people around him constantly tested and monitored for symptoms.
It’s not just Trump. Republican governors around the country have hamstrung local officials’ efforts to require masks. Gov. Reynolds of Iowa has refused to mandate masks statewide and has said that cities cannot mandate them either — even though a leaked White House document shows that nearly half the state is in a “red zone” for dangerous viral transmission and recommended that face masks be required there.
Gov. Kemp of Georgia last week took the step of suing Atlanta Mayor Bottoms for requiring masks and trying to move the city back to an earlier phase of reopening. As of last week, cases of the virus in Georgia were surging, with an average of 3,100 cases a day, 1,100 of those in the Atlanta area, according to the New York Times. Bottoms herself has tested positive for the virus. But Kemp cast her restrictions as the real danger to Georgians, saying her “disastrous policies threaten the lives and livelihood of our citizens.”
When it comes to mask-wearing, the words of leaders matter, experts say. “Not everybody can pore through papers like I can as a physician and a researcher,” Akhter said. For many laypeople, “they’re going to listen to what their president says, even if their own experts are saying otherwise.”
The history of other public health threats, like smoking, has shown that “when you see someone you respect model a behavior, it influences your own views about that behavior,” Wiley said. And today, “when people we admire and respect and trust wear masks and model responsible behavior, it really has a big effect.”
By the same token, when people like Trump don’t wear masks and make wearing masks a political issue, their supporters are less likely to wear them. When the president says people wear masks as a way of showing their disapproval of him, “that’s a pretty clear signal, not just that he’s not modeling responsible behavior, but that he views it as a sign of disloyalty,” Wiley said. “That does definitely further politicize the decision to wear a mask or not.”
The effects of this politicization can be seen in recent polling on mask use. In a Pew poll conducted June 4 to 10, 76 percent of Democrats and Democratic-leaning voters said they wear a mask in stores all or most of the time. Just 53 percent of Republicans and Republican-leaning voters said the same. Men are also less likely to prioritize mask-wearing than women — in another Pew poll, conducted in mid-June, 42 percent of men said people in their community should wear masks in public places, while 53 percent of women said the same. The disconnect could reflect the fact that more men identify as Republican, as well as the fact that Trump and others have implicitly or explicitly linked a refusal to wear a mask with toughness and masculinity.
White Americans are also less likely than other racial groups to routinely wear masks, according to the early June Pew data. In that poll, 78 percent of white people said they wear masks in stores at least some of the time, compared with 86 percent of Black respondents, 87 percent of Latinx respondents, and 89 percent of those of Asian descent. While there are many possible reasons for the racial gaps, including party affiliation and the fact that many Black and Latinx communities have been especially hard hit by Covid-19, racist rhetoric by Trump and others may play a role in convincing some white people not to wear masks.
Eschewing a mask has become associated in America with a particular brand of white manliness, Jonathan Metzl, a professor of sociology and psychiatry at Vanderbilt University and the author of Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland, told Vox in May. You can see it in the unmasked men who protested stay-at-home orders in Michigan earlier this year. “There’s an assumption of a kind of invincibility that is tied to this idea of white masculinity,” Metzl said at the time.
It’s not too late for things to change. Republican governors in states like Alabama and Arkansas have issued mask orders in recent days as coronavirus cases surge around the country. Even the president on Monday tweeted that “many people say that it is Patriotic to wear a face mask when you can’t socially distance,” alongside a photo of himself wearing a mask.
And during a Tuesday press conference, Trump told Americans, “we’re asking everybody that when you are not able to socially distance, wear a mask. Get a mask.
“Whether you like the mask or not, they have an impact,” he added. “They’ll have an effect, and we need everything we can get.”
But he has continued to use a racist name for the virus that he’s been repeating for months. And even if he and others are truly committed to undoing the politicization of masks, it will take time to get ordinary Americans on board. Some people may oppose masks “regardless of what the president says, because to them it’s become a political issue,” Akhter said.
Still, experts say lives can be saved. “I do think it’s possible to turn things around,” Wiley said, noting that more leaders are moving to depoliticize masking. “Almost every public health initiative to change people’s behavior has been very controversial at the start,” she said. And despite opposition to masks, “from a public health perspective, I’m impressed by how rapidly people are getting on board.”
And while wearing masks won’t bring back the many thousands of lives that have already been lost, it can help the many who are still at risk, Akhter said. Americans’ attitude toward masks “played a big role in why the curves went the opposite direction of what we wanted, but it also can play a big role in stopping what may be coming,” he said.
He urges Americans to wear masks, if nothing else, as a sign of support for one another. “It can save lives; it does save lives,” he said, “and even if you don’t believe that, as a sign of solidarity, please wear a mask.”
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