HIV and ID Observations

Louie checks out our local town policies.

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.