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Is It Time to Eliminate Outdoor Mask Mandates? - HIV and ID Observations HIV and...

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HIV and ID Observations

An ongoing dialogue on HIV/AIDS, infectious diseases,
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April 19th, 2021

Is It Time to Eliminate Outdoor Mask Mandates?

I do the morning dog walk in our house. And every day, I put on a mask before going out, just as I have since March of last year.

As the data accumulate on the dynamics of SARS-CoV-2 transmission, it’s definitely time to ask this question — why am I still doing this? After all, it’s just Louie and me — and even he’s wondering.

It’s generated some interesting dialogue between the two of us:

Why are you doing that? he asks me each morning. Who are you protecting?

Good questions, Louie!

It’s true, I’ll briefly pass an occasional person on the street or sidewalk. But they’re not going to get COVID from me, or the reverse. That’s not how this works.

Even if I, as a fully vaccinated person, were asymptomatically carrying SARS-CoV-2 — already exceedingly unlikely on any given day — the virus would be rapidly diluted by the extraordinary ventilation conferred by just being outside.

And while the vaccines aren’t 100% protective of me — nothing is, sports fans — they are amazingly good. Got to love these recent CDC data, interpreted by indefatigable COVID-19 optimist Dr. Monica Gandhi:

When CDC says <1% vaccine breakthroughs, let's be specific & say 0.008%. And in terms of severe disease, 0.0005% and in terms of deaths, 0.0001%. And Dr. Fauci said severe disease in elderly with other health problems to NPR. Reduce hesitancy by optimismhttps://t.co/mYLQ7G8psi https://t.co/MsQJwGPtkT

— Monica Gandhi MD, MPH (@MonicaGandhi9) April 17, 2021

With COVID-19, the most intensely studied viral respiratory tract infection in over a century, it’s worth emphasizing that clear documentation of outdoor transmission has been a challenge — and it’s not for lack of trying. In such rare cases, it’s often impossible to disentangle the indoor activities accompanying the outdoor events as contributing to the risk.

Or the people were crowded together outside, facing each other and interacting. Or exercising together and breathing heavily.

Transmissions do not take place between solitary individuals going for a walk, transiently passing each other on the street, a hiking trail, or a jogging track. That biker who whizzes by without a mask poses no danger to us, at least from a resipiratory virus perspective. Read more about the safety of being outside in this excellent piece by Shannon Palus, which also questions the need for masking outside — generating quite the heated commentary, as I anticipate this post will also.

But what about the community solidarity engendered by wearing a mask outside in public? Isn’t this worth something? A way of showing that I’m 100% part of Team Mask?

Maybe — certainly there’s a strong component of this messaging among the highly adherent mask wearers here in Boston. But this performative aspect of outdoor mask-wearing has a downside, too.

You might think you need to wear a mask while walking me in the morning to set a good example for others, said Louie the other day.

But really you might be misleading people about how the virus is transmitted.

Wise words, dog of mine! (He’s very articulate.)

Here’s a bold proposal — let’s make public policy based on our best understanding of the science of SARS-CoV-2 transmission:

Dangerous — crowded indoor spaces with poor ventilation, in particular with unmasked individuals talking, shouting, singing. Wear a well-fitted mask until case numbers are down and more people are vaccinated.

Safe — outdoors, especially while distanced. Masks only needed for lengthy interactions with others at close distance.

Some might wonder if this is too nuanced a message — the “people will get confused” argument.

Give them more credit than that, says Louie. If I can understand it — and I’m a dog — so can they.

He’s got a point, it’s not that hard. We’ve learned so much since the terrifying days early in the pandemic — why not share what we’ve learned and eliminate mandates that no longer make sense?

To wrap up, Zeynep Tufekci kindly shared her thoughts on this issue. She’s been fighting something she’s called “beach scolding” for over a year now. It’s when public health officials and the media shame people or even worse prohibit outdoor activities — when they should be encouraging them since they’re so much safer. Examples — the dreaded yellow police tape outside the park or on the benches, the swings removed from the playground, the beaches and lakeside trails closed.

In a way, it relates to outdoor mask mandates:

Sometimes people invoke the precautionary principle or what’s the downside argument to argue for universal masking outdoors. However, the precautionary principle is not necessarily appropriate after a whole year of epidemiological data showing little to no transmission outdoors outside of sustained close contact: precaution is what we do when we don’t know the answer, not something we invoke to continue doing things on autopilot.

Plus, there is a very important downside that’s not being considered sufficiently: by mandating or normalizing masks outdoors at all times, we are miscommunicating about the real risk factors—indoors, especially if they are crowded and poorly-ventilated—which means that even a full year after the pandemic, people are not being properly informed about where and how they should increase their vigilance.

It’s fine to tell people to continue wearing masks outside especially if they are unvaccinated and are about to engage in a sustained interaction at close distance, especially if it involves higher aerosol emitting activities like talking, yelling or singing, but it’s time for the excessive masking outdoors, and especially mandates, to go.

Bravo. Looking forward to seeing more outdoor faces soon.

Categories: Health Care, Infectious Diseases, Policy
Tags: COVID-19

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33 Responses to “Is It Time to Eliminate Outdoor Mask Mandates?”

  1. Gretchen Snoeyenbos Newman says:

    Agree completely with the science, but would add one thing to the “performative aspect” of mask wearing. I think it’s really important that we remain in compliance with local mandates and guidelines. I am all for lobbying for local/state/federal guidelines and mandates to change, but we need to be visibly complying with them while they last.

  2. Patrick says:

    Great post Dr Sax.

    I struggle to understand how anyone could make the case for wearing a mask outdoors. As you say, like much of what we’ve done (or been told to do) over the last year it is mostly a performance. The risk of outdoor transmission has always been negligible and religiously wearing a mask outdoors has always been more about political identification than anything else. The N-95 masked runners and cyclists who scowl at me every morning say it all…

    Public health people should focus on reducing risks that actually exist. Telling noble lies to engineer pro-social behaviour – for example telling people to mask outdoors to ‘show solidarity’ with someone or other – has been a huge mistake over the last year and I’m glad you’re drawing attention to it here.

    • Mel Snyder says:

      Dear Dr Sax:

      I respect your opinion, but I most strongly disagree. As we have seen nationally and globally, the public has difficulty reacting to changes in directives – changes that the anti-vaccine community seizes on and feeds back as opposition when facts on the ground change.

      The facts on the ground are most certainly going to change. You practice and live in a near-hermetically sealed bubble here in MA. We as a community believe in science. Yet nationally the picture is very different, as demonstrated by https://surgoventures.org/newsroom-all/analysis-surgo-projects-us-covid-19-vaccination-rates-will-plateau-in-late-april.

      We are not going to hit national herd immunity from this research/forecast. Vaccine hesitancy predicted that BEFORE the J&J “pause”, and that resistance will likely be invigorated by FDA advisory community discussions if/when AstraZeneca/Oxford submit their vaccine for EUA – and the belief by some politicians that ANY masking is a massive infringement on their rights.

      As the objective of herd immunity becomes more and more delayed, and more and more variants are free to continue to emerge, it’s very likely that much of America will be a high risk for Michigan-style resurgence. Pulling back on outdoor masking will result in less indoor masking.

    • BP says:

      If they’re wearing N95s while they run/cycle, how can you tell they’re scowling at you?
      Sure, its safer outside, but not everyone is as enlightened (or blessed with xray vision) like you. We need to stay vigilant until the danger has passed for everyone. Calling public health people liars and judging people for staying safe does nothing to end the pandemic..
      We need to row together or we go nowhere together.

  3. Stuart Ray says:

    Paul,

    Where you say, “Masks only needed for lengthy interactions with others at close distance”, what would you think about replacing “lengthy” with “continuous or continual”?

    I’m thinking about the difference between the hikes I take in the woods in Maryland, versus a crowded sidewalk in New York City. Is a latter really safe if one is never distanced from others, even though the others vary?

    I agree with your post overall, and acknowledge lack of evidence that crowded outdoor exposures are risky, so I honestly am not certain of the right answer to my question.

  4. Craig C. says:

    Agree that outdoor COVID-19 risk is <<<<indoor risk. Outdoor crowds may pose some risk, especially with variants, eg see: https://www.cbc.ca/news/canada/saskatoon/covid-19-coronavirus-variant-outdoor-gatherings-southwest-sask-1.5987813. (Epi investigation is needed to determine if indoor exposures also occurred)

  5. Robert Kalantari says:

    I 100% agree with Dr. Sax. The entire mask wearing mandate has no basis. I went to the restaurant Saturday night, while walking I had to have my mask on, when sitting down I took the mask off. Why, is the virus smart enough to know if I was liking or sitting down? While I agree that COVID-19 is a serious disease and very infectious, wearing these so called masks or face covering does not do anything to protect yourself. Why, because the paper mask that we put on our face does not filter the small particles of this various and the mask is not sealed against your face. Even it was, these toilet paper masks cannot filter COVID virus. Just think about it, what happens when you put your mask and your reading glasses on, the glasses fog up. Why, because you are breathing around the mask. So these masks have no filtration capability, and it is foolish to tell people to wear these paper masks or a face covering to protect you from others and others from you. In fact, in my assessment, telling people to wear these masks is giving them a false sense of security and protection. People think that by wearing a mask they become immune to this virus, and those who have COVID cannot transmit this virus to them, from from the truth. I know for fact that people who wore masks visiting relatives who had COVID, sadly, they all got infected and some died. Working with nuclear power plants, I know the importance of wearing masks to protect you from small particles. And as I said, I do not underestimate the seriousness of this disease, but please, don’t tell the public that masks save lives, they actually kill lives. Vaccination is the key, the only way we can stop the spread of this virus.

    • i e rabinovitz says:

      [1] Some masks on the continuum of filter-paper plainly do protect. Do you believe that the doctors and nurses wearing *their* masks are merely engaging in superstitious performance?
      [2] “the particles” and “the toilet paper filters”. The the billiard ball analogy is not operative at the scale in question. Look up: [a] brownian motion; in the presence of [b] electrostatic potential lattice.

      • Robert Kalantari says:

        Yes, doctors were masks, and they were mask that seals around their face, and they know how to were them, this gives them some protection, not full protection. In fact, doctors do get COVID from their patients and I know some who sadly died from it. Again, even the good N95 masks are only effective to some point, not 100% not even 50%, maybe 20%, with face shield and mask, you are protected a lot better. But again, the average public wearing these masks lose on their face have big zero protection against this sneaky virus. If you want adequate protection, then you need to wear a mask with right filters. These masks have rubber face piece that fully covers your face and you only breath in through the filters. But even these masks you breath out through an exhaust port. So, you are protected from someone who has COVID, but even these masks will transmit COVID if the person wearing it is infected. And no mask will work if you have facial hair.

        • BP says:

          Okay so name all the doctors you know who caught covid from their patients, including the ones who died.
          Next please show the source(s) you reference stating that N95s are effective not even 50%.

  6. Eduardo Pozzobon says:

    You must go to a crowded beach in Rio de Janeiro to think about distance and transmission. There’s a virtual distance between people. How can you control how mutch people can go to the beach until it’s considered crowded?

  7. Gil A says:

    Mask wearing while on bike trails, walking/running trails has become a series of mask “yanking up” when passing fellow trail users. And instantly “yanking down” when passing. This becomes laughable at its face and virtue signaling at its best. To think that yanking up a mask for the split second interaction between passing on a trail is preventative is down right hysterical. The only reason to have a mask outdoors is if it is really cold, or if you need to come into close contact for greater than 15 minutes with people you do not live with. So go for a run, keep the mask or gaiter on the neck, or in a pocket. If you have a long conversation with someone put the mask on. Otherwise stop with the “YANK”.

  8. B. Horn says:

    I applaud your science-based analysis. One other comment and a suggestion. Is it possible that a coronavirus only knows to stick to the mask and not anywhere else on the face? One might argue this may be true because a person is inhaling via the nose and mouth and the virus may be drawn in with inhaled air. But this presents a dangerous false sense of security that somehow a mask protects one from infection; mask wearing alone falls well short of proper infection control. The virus can also enter via other mucosa like the eyes of if the virus is also on a person’s face this also presents a more dangerous risk to the person who feels they are somehow protected with a mask. People constantly touch their face, remember the famous press conference when the health care official was constantly touching her face while admonishing others on infection control? We tell people to wash their hands but we should be telling them to wash their hands AND FACE. I wonder how many infections could have been prevented and could still be prevented if our health care leaders told people to wash their hands and face. After all, if you wash your face you also wash your hands, for much longer and to much greater infection control effect than a quick hand rinse.

  9. B. Horn says:

    A comment on the Lillian Brown’s statistics. For all the experts and general public pontificating about scary dangers of Covid I wish some of our health care leaders or mathematics professionals would use the attention to the pandemic to provide the general public with some simple education about probability and statistics. The following does not attempt to describe all the moments and descriptive statistics of the probability distributions referred to but consider the following.
    Per Lillian Brown’s statistics, for a vaccinated person to:
    become infected: 5800 / 77 million = .0075% or 1 in 13,275
    become hospitalized 396 / 77 million = .00051% or 1 in 194,444

    Now let’s compare those chances with the probability of being hit by lightning in your lifetime which according to Erie Insurance is 1 in 15,300 = .0065%

    So you should be about as worried about being hit by lightning in your entire life as being infected after vaccinated and you should be far more worried about getting hit by lightning in your lifetime than being hospitalized from Covid after being vaccinated, at least according to the statistics up to the present time.

    lightning strike reference: https://www.erieinsurance.com/blog/struck-by-lightning

    Anticipating being slammed for being insensitive, please know the writer understands the seriousness of Covid and is not making light of the impact on human lives in the pandemic nor being struck by lightning to be fair to both life threatening risks.

    • math is hard says:

      It makes no sense to compare lifetime risk of lightning strike to a two-month risk of post-vaccination COVID exposure. the rate of lightning storms is relatively stationary, the risk of COVID is nonstationary in a statistical sense (both because of antibody persistence declining over time and because of the relative base rate of COVID around you and the mix of variants in circulation). It’s a facile observation. This cuts both ways, by the way, because it’s also the case the people involved in the sample population for the post-vaccination infects are not a random sample of the population, they are disproportionately older people in semi-congregate populations and/or medical professionals (because, again, this is a dataset based on ~2 months of post-vaccine exposure among the very earliest vaccinated)

      The vaccines work and people should get vaccinated and post-vaccine they should feel less worried about the risk of COVID. People should maintain the measures that are most likely to continue reducing risk, but not take for granted the additional safety that they’ve bought by being vaccinated. There’s no need to engage in theatrics to prove that point, and that’s precisely what the lightning comparison is.

  10. Aliza Dash says:

    I disagree for now. I am not a doctor, much less an infectious disease specialist, but I do understand human nature. Give them a finger and they will take the hand. If we lighten up restrictions in one area people will become complacent and feel safe. We are not out of the woods yet. Not everyone is vaccinated yet. Look how covid rates are going up instead of down in many areas. Is it really a good time to relax mandates? I do not think so. Let’s keep the masks on, even outside, until most of the adult population has been vaccinated. Let play it safe, because with Covid it could be life or death and why risk anyone’s life? We can see the light at the end of the tunnel, no need to crash before we get to the end of the tunnel. Let’s take it safely and slowly. Again I have no credentials, so just my opinion as a educated Cambridge resident.

    • Robert Kalantari says:

      Again, wearing mask gives the public’s a false sense of protection. The masks we wear are absolutely garbage, they provide no protection. I would not doubt if people with COVID wear masks and go out, they are not supposed to, but they think wearing a mask they won’t transmit their disease to someone else. That Apis what we are told, wear a mask to protect you from others and others from you. It does not do anything, it kills people.

  11. Deb C. says:

    I’m not inclined to wear a mask outdoors while I’m hiking, biking, walking, playing pickleball, etc. Massachusetts is mask obsessed which is why I’m now a Florida resident! The Massachusetts virus numbers are no better than Florida here Governor DeSantis let’s adults make their own decisions.

  12. J B says:

    So glad I live in the world of common sense.

  13. Joseph Horowitz says:

    Most people walking on my somewhat rural road are not wearing masks. There’s a mask mandate in the center of town, and I would certainly wear one there at least for social solidarity as well as to follow the rules.

    It’s probably irrelevant, but, although it’s clear that Louie is very intelligent, he should have said, “Whom are you protecting.” I guess he can be forgiven this once, as he is a dog.

  14. Olarn Seriniyom says:

    My country Thailand was the first in the world to report Covid infection outside of China. We braced for a fire storm of infection and went into early lockdown. Mask wearing in urban areas was already common before Covid due to air pollution and quickly became the new norm. People were compliant with government requests for anti-Covid measures. As a result, for a year after the beginning of the pandemic, Thailand had only about 3000 cases up until March 2021, and only 90 deaths. People were wearing masks indoors, outdoors, some people even while driving! It has literally become the new normal.
    Thailand is now in the midst of a new surge of cases, with clusters originating in venues where masks are removed such as clubs and bars. After a year of economic pain, the Thai government is now prioritizing the economy and has stated there will be no new lockdown. The message of wearing masks has been reinforced. It remains to be seen how well this surge can be suppressed. The new normal of mask wearing can only help to limit Covid spread and for us Thais, we feel it’s not even a big ask and we simply do not understand why it has become a civil liberty issue in other countries.

  15. Glen Hiss says:

    I agree with the science, it is difficult to find a case of Covid that was contracted from an isolated contact that occured only outside. However we are dealing not just with science. Football, soccer and NASCAR, all occur “outside” and there have not been studies that look at 50,000 to 100,000 people in a stadium or grandstand without masks. Political rallies held outside in India seem to have been super spreader events. People who are tired or just resistant to mask wearing will take take the no masks outside as license to not wear them at all. With the increasing incidence of variants and the unknown duration of immunity to the current vaccines, wearing a mask outside your “pod” seems like a minimal inconvenience.

  16. Shishir Gokhale says:

    Your point is very valid. The level of precaution has to be commensurate with the level of risk. Under or over enthusiasm and precautions could be counter productive.

    In a developing country like Nepal, we use common sense. We always carry a mask. Apply it on mouth and NOSE while indoors whether it is a store, an office, a cafe or any other place where there is someone else than I.

    While on a street or a park for a stroll, we are always on the look out and guard. We cover mouth and NOSE if we encounter anyone closer than 6 feet irrespective whether the other person has mask or no mask. If there is none within our “Personal sphere” of 6 feet radius, we may take off the mask.

    I wonder why such explicit instructions can not be give, advocated, communicated and followed? It needs nothing more than common sense. But perhaps Common sense is uncommonly prevalent.

  17. John Leung says:

    While I respect and agree with Dr. Sax that it is scientifically and logically unnecessary to put on a mask while walking a dog in an open uncrowded environment, may I add one more suggestion. Do not reuse the same mask, but put on a new mask every time. In Hong Kong we were hit badly by the first corona virus epidemic 18 years ago. Many health workers came down with the infection and at least two doctors in public hospitals died in the prime of their lives. One of the many causes for the heavy casualties in public hospital personnel was the policy of false economy and reuse of masks, caps and gowns, not only for the same day but even over a number of days. I have talked to the chief of a respiratory unit who had a successful record of keep the infection statistics low in her hospital, and she said one of the major cause of infection lies in the way of putting on and off protective gears. So if you have taken a mask off for some time better not use it again unless you can be sure it is virus-free.

  18. Neil Watter says:

    Ever since the pandemic started I only wear a mask when I’m interacting indoors like in a grocery store. I walk my dog 2-3 times a day and go for solo walks for another hour or so and only wear a mask as a courtesy to others if I interact with them other than passing them on the sidewalk. I’m now fully vaccinated and there are even fewer reasons to wear a mask except when interacting with unvaccinated people indoors.

  19. Alvaro Ernani Georg says:

    Dr. Sax,
    I am interested on the results of the ivermectine trials. The ones that you talked about some weeks ago and gave us some hope. Any of them was good news? Thank you.

  20. Karim Sahyoun says:

    I am so glad to see that I am not the only one who has conversations with his dog. Mine too is very wise. The problem is that, like my wife on the dancefloor, he likes to lead. I can’t get him to understand that I am the boss. We have watched multiple episodes of Cesar Milan and he inevitably says “you see, it is always the humans who are the problem”. He asked me to let you know that he completely agrees with you in terms of mask wearing.

  21. Sam says:

    I applaud Dr. Sax’s Frank honesty and freedom of speech here!
    Add an ICU nurse, the dangers of the pandemic are very real to me, but the autopilot approach public officials are taking in regards to masking mandates is getting nonsensical. Masking mandates should be seen as emergency measures, not new norms. We need to see each other’s faces, there’s a legitimate psychological toll masking imposes – especially on our developing children.

  22. jim says:

    I think for many people it is simply easier to wear a mask at all times rather than sorting through a complicated set of what if’s every time they walk out their front door.
    And let’s be clear that it’s a different decision when you live in the suburbs with spacious, empty streets as opposed to a crowded urban setting.
    And if you’re out hiking in the Maine woods it’s a completely different discussion.
    I want to ditch the mask as much as anyone. I really miss seeing faces. However, if the worse thing that ever happens to me is having to wear a mask during a pandemic I’m a pretty lucky fellow and I’ll deal with it.

  23. Brooke says:

    Guess what? Your opinion doesn’t matter here. Science does. Whether you agree or not? Beside the point. Each of us have all sorts of opinions throughout our lives that are factually inaccurate, wrong, biased, lacking insight, etc.

    So our opinions mean nothing with regards to wearing masks outside.
    What does matter? Science.

    Here are two articles that compile a lot of research about how wearing masks outside is does almost nothing to prevent spreading or getting COVID:

    https://link.medium.com/b3XG12R6Bfb

    https://link.medium.com/kae18206Bfb

  24. Vincent says:

    Masking mandates anywhere at this juncture is senseless. In the past year we’ve learned who is most vulnerable and those folks should be protecting themselves by staying isolated untill vaccinated. The airline industry packs their planes, no distancing when boarding or deplaning, checking luggage, in line at the counter. Airports themselves are very crowded with no distancing. Allowing one industry to circumvent the ” science” is unfair to everyone and financially motivated. Covering the mouth and nose without the eyes helps no one. Billions of chlorox wipes were used for no benefit. Individuals need to know if they’re vulnerable and decide what risks to take. The inconsistent message and information helps no one. Instead of a Mask for All mandate, the vulnerable should be wearing ppe that prevents them for acquiring the virus and free the vaccinated, healthy, young, and previously infected to live normally.

  25. Brooke says:

    Another article, of many, regarding the SCIENCE (not mere personal opinions) of why mask mandates outdoors and largely ineffective, silly, and overkill. This piece is newly published in The Atlantic.

    https://link.medium.com/IjRM3FHgCfb

  26. Clem Ward says:

    No, it’s not time to stop wearing masks anywhere. Seriously, there’s no argument that is convincing otherwise. And as for your opinion, only scientific FACT matters. Real scientific fact. People are still dying from Covid-19. Many people refuse to get bloody vaccinated! These are appropriate topics to discuss. And, this sort of nonsense leads other scientifically illiterate people to stop wearing masks in general.

    I would explain with more eloquence, but I am an ICU Nurse Practitioner with Covid-19 patients to attend to right now. I work 12 hours a day with 2 days a month off. I live in a hotel so my family is safe. You may be sheltering yourself from the truth and/or reading like-minded material. Educate yourself on what’s really happening.

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