The Case for Wearing Masks Forever

Hamartia Antidote · Jan 1, 2023

The Case for Wearing Masks Forever

A ragtag coalition of public-health activists believe that America’s pandemic restrictions are too lax—and they say they have the science to prove it.

www.newyorker.com

A ragtag coalition of public-health activists believe that America’s pandemic restrictions are too lax—and they say they have the science to prove it.

Last December, the Centers for Disease Control and Prevention announced that it was shortening the recommended isolation period for those with covid-19 to five days. Getting exposed to the virus no longer meant that people needed to quarantine, either, as long as they were fully vaccinated and wore a mask. It was a big moment, and it occurred just as the Omicron variant was surging. Mindy Thompson Fullilove, a professor of urban policy and health at the New School, was livid.

Fullilove, who is Black, has spent her career studying epidemics: first aids, then crack, then multidrug-resistant tuberculosis. She has seen how disease can ravage cities, especially in Black and working-class communities. From the beginning, Fullilove was skeptical of how the federal government handled the coronavirus pandemic. But these new recommendations from the C.D.C., she said, were “flying in the face of the science.” Not long after the announcement, she sent an e-mail to a Listserv called The Spirit of 1848, for progressive public-health practitioners. “Can we have a people’s CDC and give people good advice?” she asked. A flurry of responses came back.

What emerged was the People’s C.D.C.: a ragtag coalition of academics, doctors, activists, and artists who believe that the government has left them to fend for themselves against covid-19. As governments, schools, and businesses have scaled back their covid precautions, the members of the People’s C.D.C. have made it their mission to distribute information about the pandemic—what they see as real information, as opposed to what’s circulated by the actual C.D.C. They believe the C.D.C.’s data and guidelines have been distorted by powerful forces with vested interests in keeping people at work and keeping anxieties about the pandemic down. “The public has a right to a sound reading of the data that’s not influenced by politics and big business,” Fullilove said.

No one is in charge of the People’s C.D.C., and no one’s expertise is valued more than anyone else’s. The problems of “the pandemic and its response are rooted in hierarchical organizations,” Mary Jirmanus Saba, a filmmaker and one of the volunteers, told me. Roughly forty people come to each weekly meeting, but many more are involved. (This spring, after a few of the group’s organizers published a manifesto of sorts in the Guardian, several thousand interested people reached out, Fullilove said.) The group sends out a weekly Weather Report—put together by a team composed, in part, of doctors and epidemiologists—summarizing data about transmission rates, new variants, and death rates. They’ve published explainers on testing, masks, and ventilation, among other topics, typically with a call to action: call the White House, call your congressperson, demand free tests and treatment for all. On their Web site, they recently posted a guide for safer gatherings, which recommends that all events be held outdoors with universal, high-grade masking. The organization has nearly twenty thousand followers on Instagram, and it prides itself as a resource for various groups, including people who are immunocompromised and want to find a way to protect themselves and activists who are trying to lobby their local government for more covid restrictions.

Although the group has been scathing in its critiques of the C.D.C., it has received support from respected institutions in the public-health world. It has also received blue-chip funding from organizations such as the Kresge Foundation, which focusses on expanding opportunities in American cities, and the Robert Wood Johnson Foundation, one of the most influential health-focussed philanthropies in America, which gave the group a hundred and fifty thousand dollars. As it happens, Robert Wood Johnson’s C.E.O., Richard E. Besser, is a former acting director of the C.D.C.

Fullilove would neither confirm nor deny whether there are any current C.D.C. employees involved with the People’s C.D.C., but, in a recent Webinar, Edgar Rivera Colón, who often serves as the group’s meeting facilitator, claimed that there has at least been some moral support: “We have comrades that are within the C.D.C. who are saying to us, ‘Go ahead with your bad selves.’ ” The volunteers don’t necessarily agree among their bad selves about what, exactly, their larger goal is—whether their project is a protest, an act of mutual aid, or an exercise in shadow governance. What’s clear is that the People’s C.D.C. interprets evidence about this stage of the pandemic, and what we should do about it, differently than the C.D.C. and the White House. Their goal is to provide the public with an alternative source of information. The organization is part of a much broader ecosystem of left-wing public-health groups that advocate more persistent mitigations: there are support communities for those experiencing long covid, including Survivor Corps, which has almost two hundred thousand members on Facebook; research groups like the U.K.’s Independent sage, which reviews the British government’s pandemic policies; and nonprofit activist groups such as Public Health Connected, which provides resources to health-care professionals. This constituency is loud on Twitter, and they are influential in the press.

“There’s a second story of the pandemic happening, which is not about ‘It’s time to go back to normal,’ ” Gregg Gonsalves, a Yale epidemiologist and activist, told me. “Normal for whom, and who’s getting left behind? I think that’s where the People’s C.D.C. and others are trying to stake a claim and trying valiantly to make an impact.” Gonsalves was deeply involved in aids activism in the nineteen-nineties and early two-thousands; though he is not part of the People’s C.D.C., he’s sympathetic to their project. Throughout the past six months or so, he has watched with dismay as big public-health organizations have lined up behind the White House’s relaxed covid policies, even as more than three hundred people, on average, die from the virus each day. Gonsalves and like-minded colleagues had assumed that, after Joe Biden was elected, they’d feel more aligned with the government’s covid policies. That’s not what happened, though. “It wasn’t just Trump. It wasn’t just Biden,” Gonsalves said. “There’s a struggle going on right now for the soul of public health.”

In November, I met with some members of the People’s C.D.C. on Zoom. The meeting was a snapshot of how these strangers, who are scattered across the country, have encountered one another during the past year—it’s a new form of activism that takes place, partly as a matter of principle, not in the streets but from behind a computer screen. Rita Valenti, a retired nurse in Georgia, who sat in front of a curio case full of dishes, explained that the People’s C.D.C. wasn’t created in order to shame people for not wearing masks in the grocery store. “What endangers others is when a President says the pandemic is over,” she said, referring to a comment that Biden made in a television interview, this past September. (The White House later backtracked.) The group takes issue with the way that the C.D.C. emphasizes individual choices over collective action; as the current C.D.C. director, Rochelle Walensky, has put it, “Your health is in your hands.” Zoey Thill, a family physician in Brooklyn, who was Zooming in from a room full of potted plants, got heated just thinking about it. “When we say, ‘Do your individual risk assessment and plan accordingly,’ that says to certain people, ‘Stay inside forever—for fucking ever!’ ” she said. “For me, it’s about countering that. It’s about saying, ‘No, that’s not O.K.’ ” The other People’s C.D.C. members threw up emojis in approval: red hearts, clapping hands.

In the organization’s written materials, a few specific grievances come up again and again, with varying degrees of scientific support to back them up. First, they hate the new map that the C.D.C. débuted in February, which reflects covid “community levels” around the country, instead of raw case counts. The map tries to account for how hard the virus is hitting health-care systems in a given area, factoring in things like hospitalization rates and the availability of hospital beds. On the community-levels map, covid looks as if it’s largely under control, with much of the country shaded green to indicate a “low” level of spread. “The C.D.C.’s pastel-green map creates the false impression that the pandemic is over,” Thill said, in an Instagram Reel posted in June. The map that the People’s C.D.C. circulates, which is based on individual transmission rates, is bright red. “At the People’s C.D.C., we want you to know that the community-levels map masks the state of the pandemic,” she continues. “It pretends that covid transmission doesn’t matter. It pretends that it’s O.K. for people to continue dying.”

More grievances: the People’s C.D.C. believes that the C.D.C. downplays the risk of long covid, a post-viral syndrome that can follow the initial infection. The People’s C.D.C. matter-of-factly reports that getting covid more than once increases your risk of death and hospitalization, and of developing chronic conditions affecting your lungs, heart, brain, and other organs. No amount of covid is safe, and no number of shots can protect you: “We want to say plainly that you can have a mild infection and still get Long COVID,” the organization wrote, in a Weather Report in June. “Vaccinated people can also get Long COVID.” They frequently cite the figure that one in five cases may lead to long-covid symptoms, based on a C.D.C. study of data gathered, in part, before vaccines were widely available. All of this is an argument against treating covid like any other inevitable seasonal yuck, the People’s C.D.C. argues—instead, we should think about it as a “mass-disabling event.”

And then there are masks. The People’s C.D.C. strongly supports mask mandates, and they have called on federal, state, and local governments to put them back in place, arguing that “the vaccine-only strategy promoted by the CDC is insufficient.” The group has noted that resistance to masks is most common among white people: Lucky Tran, who organizes the coalition’s media team, recently tweeted a YouGov survey supporting this, and wrote that “a lot of anti-mask sentiment is deeply embedded in white supremacy.”

This kind of accusation is common for the People’s C.D.C. Their messaging has the unmistakable inflection of activist-speak, marked by a willingness to make eye-popping claims about the motivations of politicians, corporations, or anyone in power. “To name it clearly, the CDC’s policies are eugenic,” the Weather Report team wrote, in August. “They rely on and promote the indefensible stance that disabled and elderly, poor and working class people are disposable, unworthy of care, and unworthy of participation in society.” Eugenic policies have a long and ugly history, commonly associated with the Nazis, white supremacists, and others who advocate the racial purification of humanity. I asked Thill whether she truly believes that the C.D.C. is eugenicist, along these lines. “Just because a charge is difficult or impactful doesn’t make it a wrong charge,” she said.

The group’s saltiest spokesman is Rob Wallace, an independent scientist and researcher who anchors another weekly rundown called COVID This Week. In ten-to-twenty-minute-long video briefings, Wallace runs through slides mapping the rise of new variants and levels of covid detected in wastewater—an indicator of spread that, he claimed in a November dispatch, will become increasingly important as states follow “the N.I.H. and C.D.C.’s lead [by] abandoning covid-surveillance reporting.” Wallace saves the most colorful part of his reports until the end, when he comments on the political and corporate influences shaping public-health policy. In August, when the C.D.C. announced an internal reorganization to address its pandemic failures, Wallace observed that “the whole affair has an air of rearranging the chairs on the deck of a sinking ship.” He added, “The U.S. is on the far side of its cycle of accumulation and its high point in building empire. Its political class is now in the business of helping its financial supporters cash out, turning capital into money.” All the talk about empire-building and capital accumulation—a key component of Marxist economic theory—made me wonder whether “the people” in the People’s C.D.C. are those people. When I asked Wallace this on Zoom, he gruffly denied that the members are all communists. “There’s certainly an edge of Red-baiting on your part,” he said.

At its core, “public health is an argument,” Amy Fairchild, a professor and dean of the College of Public Health at the Ohio State University who is not part of the People’s C.D.C., told me. “It’s an argument about what we owe to—and what we must sometimes do to—each other, in the name of the common good.” The People’s C.D.C. is staking out a radical claim about our mutual obligations in a pandemic. “All of us believe that there’s no acceptable number of deaths,” Jirmanus Saba, the filmmaker, said. “We’re all responsible for the safety of all life.”

If your goal is to get as close as possible to zero covid deaths, the available policy options are not great. If the United States were an island in the South Pacific with a population smaller than that of New York City, we could pursue a policy similar to New Zealand’s in the early months of the pandemic, strictly limiting travel to and from the country. Or, if the government were willing to follow China’s longtime strategy, we could lock down whole cities, confine children at their boarding schools for months at a time, and forcibly send people to state-run quarantine facilities. The People’s C.D.C. members weren’t willing to talk about what it would take to achieve zero covid cases in the U.S. “It’s not our job to dictate policy,” Thill said. “We’re filling gaps. We’re trying to change the narrative. And we’re trying to lean into love and equity.”

For the public-health leaders who do actually dictate policy, though, the question of how you put an ideal into practice is not one that can be sidestepped. “The goal initially was to eradicate and eliminate this virus,” Howard Koh, a Harvard public-health professor and former Assistant Secretary of Health, told me. “A couple years into it, everyone now realizes that that’s not a realistic goal.”

I called Tom Frieden, who led the C.D.C. during the Obama years, to see what he made of the People’s C.D.C. He had never heard of the group before I got in touch, but he took a look at their materials ahead of our call. He praised the organization’s guide to self-protection for immunocompromised people, and agreed that some of their recommendations, like universal masking in times of high covid spread, were good ideas in theory. “But is that going to happen? Absolutely not,” he said. The next best thing is to try to get people vaccinated and boosted and to increase access to high-quality masks and Paxlovid. “If you’re giving recommendations that no one’s going to follow, that’s not only nonproductive,” he said. “It’s counterproductive, because that undermines your credibility.”

The scientific claims that the People’s C.D.C. makes about the real C.D.C.’s policies are not necessarily straightforward, either. The People’s C.D.C. says that a five-day isolation period for vaccinated people is unsupported by evidence, but some studies suggest that most transmission happens right before and right after people develop symptoms, and that vaccinated people spread the virus for a shorter period of time than unvaccinated people. The group argues that one-way masking is insufficient, but some experts in airborne transmission argue that it’s strongly protective for vulnerable people. Although the People’s C.D.C. tends to see large, corrupting forces at work behind shifts in public-health policy, sometimes the actual explanations are more mundane. Anne Zink, Alaska’s chief medical officer and the president of the Association of State and Territorial Health Officials, pushed back on Wallace’s claim that states are in cahoots with the C.D.C. to abandon basic covid data-gathering. Her department doesn’t have the money or political backing to set up daily nasal-swab testing sites. Instead, it’s investing in wastewater testing, but not as a conspiracy to obscure what’s happening—the practice is just more sustainable.

It’s tough to definitively adjudicate these disputes. In the progressive imagination, science is sometimes treated like a static text that’s easy to interpret, with clear takeaways for behavior. “One of the big mistakes in our field is this mantra ‘Follow the science,’ as though science is not contested, as though there are not evidentiary gaps, as though there are not conflicting reports and data points you have to navigate your way through,” Fairchild, the O.S.U. professor, said. The People’s C.D.C. talks about “science” as proof that the members’ position is correct, when in reality they’re making a case for how they wish the world to be, and selecting scientific evidence to build their narrative. It’s a kind of moralistic scientism—a belief that science infallibly validates lefty moral sensibilities.

This approach falls flat in areas where scientific knowledge is lacking, such as long covid. Leana Wen, a professor at George Washington University’s school of public health and the former health commissioner of Baltimore, told me that there’s a distinction between patients who have trouble recovering from a bad covid case or who experience lingering symptoms and those who are truly debilitated afterward. “That’s not one in five patients,” she said, of the latter group. The People’s C.D.C. rejects any suggestion that long covid is less than a crisis. Wallace told me that Wen is “a quintessential minimizer” who has benefitted professionally by advocating, for example, to scale back mask mandates. She is widely distrusted by progressive activists who work in public health; earlier this year, a group calling her views on the pandemic “unscientific, unsafe, ableist, fatphobic, and unethical” circulated a petition to get her kicked off a panel at the annual American Public Health Association meeting, where Wen won one of the top prizes only a few years ago.

Among the people I spoke with who have actually led public-health agencies, all were sympathetic to some of the critiques that the People’s C.D.C. makes. “The pandemic has opened what were cracks in our health-care system and exposed them as large chasms,” Zink said. “The systems that we have built have failed America and failed us individually.” But these experts also found it hard to take the group seriously because of its strident analysis. “To make claims that C.D.C. is beholden to big business—this is just nonsense, frankly,” Frieden, the agency’s former leader, said. “Once you’re sitting at C.D.C., your goal is not to say the thing that makes you feel best or sounds most politically correct or radical.”

The C.D.C. has become “the punching bag of our country,” Zink told me. She recognizes that the pandemic has been scary, sad, and frustrating for many people. Her reaction to “hearing those criticisms, particularly the eugenics comment—it’s just more sadness.”

Perhaps when we look back on this time, the People’s C.D.C. will look like other activist groups that have agitated against the status quo of health care from the margins, ranging from the Black Panthers and the Young Lords of the nineteen-sixties and seventies to the aids activists of the eighties and nineties. They take explicit inspiration from groups such as act up, which pursued its own medical research, provided treatments, and staged protests in response to the government’s inaction during the aids crisis. Those groups all found ways to help members of their communities when they felt that society had left them behind. One way to look at the People’s C.D.C. is as a movement to recapture our sense of interdependence, both in terms of our health and our communities; whether we acknowledge it or not, we all help determine one another’s health. “Nothing has underscored that as powerfully as the covid-19 pandemic,” Fairchild said.

In much of America, the pandemic has seemed over for a long time. I asked the People’s C.D.C. members what they made of the fact that, in large swaths of the country, people don’t seem to care that much about covid. “I would just disagree with the statement that they don’t care,” Hope Brasfield, an embroiderer who lives in Tennessee, replied. “How can you judge whether or not somebody cares about something if they don’t even know about it?” She pointed out that, in red states like hers, politicians have consistently downplayed the pandemic. “I don’t accept the idea that it is our fault—the people’s fault—for this pandemic continuing,” Valenti, the retired nurse in Georgia, said.

America is heading into its third covid winter, this time paired with high rates of flu and RSV. Mayor Eric Adams just urged New Yorkers to put their masks back on. People are tired of it all. But the People’s C.D.C. members do not feel deterred. “The reality is, I feel so hopeful,” Thill said. Testing, masking, moving events outdoors—“if we do these things, it’s not a slog,” she added. “It’s uplifting. It’s a demonstration of care and solidarity and love.