At Congressional hearings this week, Southwest Airlines CEO Gary Kelly said that masks provide little incremental benefit in air travel given the safety of the aircraft environment. American Airlines CEO Doug Parker chimed in, “I concur.” And has since been walking that back, though over the summer when virus prevalence was low he and the CEOs of United and Southwest were talking about ending the mask mandate.
Commercial aviation is one of the most heavily regulated industries in the country (deregulation really just meant the government no longer told airlines where they could fly or what prices they could charge). They are heavily subsidized. Comments inconsistent with the position of the federal government are problematic, and Parker’s career legacy was tied to government largesse even before the pandemic. Nonetheless the question of masks on planes isn’t so easy in either direction.
The mask debate is fraught with sloppy thinking and motivated reasoning. Here’s how I parse it.
- People confuse whether masks are protecting them, or protecting others from them. An N95 mask, properly fitted and properly worn, can protect you from others. A ‘medical mask’ or something or similar or less quality might protect others if you’re effective, limiting how much virus you emit (‘source control’). If you wear a mask you should be wearing a better mask
- >We don’t know how much masks help, either in cabin environments or outside of them. Even what looked like some of the best work showing effectiveness for low quality masks doesn’t hold up so well.
Masks are probably less protective against the faster spreading variants than against the original Wuhan strain. But the greater the spread of a variant, less protective masks may have even greater benefits because each case prevented may have geometric benefits (if the limit on spread is only 50% as great, but each new case can cause on average 4 times as many new cases, the net benefit goes up). Finding that masks have only minimal reduction in spread doesn’t mean masks have very small benefit.
- Aircraft cabin environments are fairly safe and limit spread. United in particular is worthy of a call out for using aircraft power to circulate air and take advantage of HEPA filtration during boarding and deplaning. But airports – and especially crowded security and gate areas – aren’t nearly as protective. End-to-end travel isn’t nearly as relatively low risk as time on the plane.
- The reason we have transportation mask mandates isn’t because transportation is a riskier environment than other things people engage in – like restaurants, bars, theaters – but because the federal government had a plausible legal authority to impose mask mandates on travel but not other activities. (Even that legal justification is shaky at best.) I still believe that the mask mandate expires before the midterm elections.
- There are intriguing reasons Omicron may not be as severe as previous variants (and population-level immunity to severe outcomes appears to account for no more than 40% of observed difference). This is all very encouraging if true, but at really high levels of spread this can still get very bad – a smaller percentage of bad outcomes at a much higher level of spread can mean a whole lot of bad outcomes.
- The reason we care about a whole lot of spread all at once versus spread out over time is that overwhelmed hospitals lead to lack of treatment and worse patient outcomes. We’re all going to get it, and not getting infected now may increase the change you get it later – and indeed lengthens the pandemic.
So when we think about masks what we care about is how long we’re delaying infection, and how much treatment improves in the meantime and whether spreading out infections increase our capacity to provide care. The benefit to masks is delay of infection – delay until we had vaccines, delay until we had better treatments.
- We need access to better treatments now, and that will have far more juice than masks. The FDA is slow to schedule a meeting on Paxlovid, which shows incredible effectiveness against severe disease when taken within 3 days of symptom onset. As Tim Carney put it, “because it’s not a vaccine, and because it acknowledges the reality that everyone will catch COVID, Paxlovid has little love on the Left. Because it’s not Ivermectin and is made by Pfizer, it has little love on the Right.” Meanwhile the FDA is very busy.
🍕 and 🍫 anyone ?
This #NationalChocolateCoveredAnythingDay, everything is up for grabs!
— U.S. FDA (@US_FDA) December 16, 2021
- We should be betting heavily on third doses, focusing efforts and messaging on restoring protectiveness – against infection (which also reduces spread), against severe disease, and because virus covered in antibodies aren’t as likely to infect others as well.
- I am personally fine with masks but let’s not pretend they do more than they do. I wanted to wear them during flu season before all of this because I don’t want to get sick, I have too much going on for the forced downtime. And while I don’t love masks, I don’t hate them either. This isn’t about taking my aesthetic preferences and using those to frame the argument.
But we’ve been dropping the ball on third doses until recent days, and we’re probably too late on that to matter for an Omicron wave. So we need to act quickly on Paxlovid, get clinical guidance out on fluvoxamine, and ride it out.
I’d argue that people who want to protect themselves should wear properly fitted N95 masks, and that we should have spent the past two years and billions of dollars allocated to airports to improve ventilation and create safer environments (the same goes for schools, that we’ve done little on ventilation two years in is a crime but so is failing to tie stimmie checks to vaccination). Singling out transportation for a mask mandate makes little scientific sense, but a lot of political sense. And that we’re still doing politics this far into the pandemic says a lot.