We are public health scientists who conduct research to inform evidence-based policy. We were disappointed when the federal Centers for Disease Control and Prevention (CDC) took a radical turn in its COVID-19 prevention policy recommendations.
The CDC recently released new guidance on the assessment of community COVID-19 risk, lifting masking recommendations for most of the country. In their new metrics, the CDC has made a judgment call about what level of severe illness, disability and death is acceptable. Overnight, much of Minnesota was reclassified as low or medium risk, even as we were seeing COVID deaths every day.
We need to ask ourselves whether this is morally tolerable. Many Minnesota entities — cities, schools and institutions, including the University of Minnesota, have followed the CDC's lead.
The CDC's new goal is to focus on medically relevant disease and avoid overburdening health care systems. Their guidance suggests that it is now reasonable to forgo the use of masks in situations that previously were considered a high risk of COVID-19 exposure. The assumption is that, if infected with COVID-19, you will likely not be hospitalized, and if you are, there is hospital capacity to care for you.
As we have seen through previous waves of the pandemic, this is tenuous. It is true until it is not.
The CDC's guidance also assumes that frequent and repeated COVID-19 infections cause minimal long-term harm or severe illness. This ignores the poorly understood risk of long COVID, a risk that may be reduced but not eliminated by vaccination. This ignores the elevated risks of cardiovascular events, diabetes diagnosis and cognitive impairment observed in the months following a COVID-19 infection, including in initially mild cases. While much remains unknown, the evidence we do have is sufficiently compelling that long-term COVID-19 impacts should not be ignored.
We have good information about what works to reduce COVID-19 transmission: vaccination, ventilation and masks. A recent CDC study estimated that consistent N95 mask use reduces the odds of infection by 83%. We also know that universal masking is more effective than one-way masking. When one person masks, they reduce their own exposure to the aerosols of others. When everyone masks, there are far fewer aerosols released into the air in the first place.
The latest CDC guidance does away with universal masking recommendations in favor of putting the onus on individuals at high-risk of severe outcomes to protect themselves. In issuing this guidance, folks at the CDC are making lots of assumptions about your risk tolerance, your aversion to masks and your risks of long-term COVID-19 health consequences.
Mask requirements make public spaces safer for everyone. All Minnesotans deserve to participate in public life, from the young to the old, from the immunocompromised to the immunocompetent, from children under 5 still not eligible for even a first vaccination dose to the vaccinated adults whose immunity is now waning. This means being able to safely attend school, safely receive services, and safely shop for food and other essentials.
For an inclusive Minnesota, we need to normalize the routine use of masks.
Federal, state and even citywide mask mandates are increasingly unlikely. This means the decision to require masks, and make our common and public spaces inclusive, falls to organizations, businesses and school districts.
A person's safety should not depend on the altruistic choices of others. Requiring masks eliminates impossible guesswork for those most vulnerable and ensures our common spaces are accessible to all who need them. To leaders setting mask policies, we hope you will choose the path that makes us all safer.
Some Minnesotans have voiced concerns about personal freedom, arguing that requiring masks infringe on individual rights under all circumstances. This is an unconvincing argument, in our view. It is a core tenet of American morality that one person's freedom does not come at the cost of endangering the lives of others. High-risk individuals and households deserve the freedom to participate in necessary daily activities.
And we will not necessarily mask forever. Recommendations for mask use can change when we've ensured that our indoor environments are safe for all Minnesotans. And when new risks arise, we may mask again because the evidence shows that universal masking protects us all. It strikes us as wise to follow the wisdom of the great poet Maya Angelou: "Do the best you can until you know better. Then when you know better, do better."
All relevant COVID-19 metrics are receding in Minnesota as we come out of the omicron wave. However, we must remain vigilant. New variants are already here. Vaccination and/or prior infection provide little durable protection against future infection. The next variant may be even more contagious than omicron and there is no guarantee that it will be less severe.
The CDC is suggesting a new framework — one that accepts a significant amount of COVID-19 infection, disability and death as a part of daily life. But Minnesotans may personally and collectively have a different set of values in wanting to keep each other safe from the immediate and long-term harm that COVID-19 can cause.
Since the beginning of the COVID pandemic, we have worked as researchers with state leaders to inform Minnesota's policies and, on a personal level, we have worked to protect our families. We believe we should keep masking up in Minnesota.
Eva Enns is associate professor at the University of Minnesota School of Public Health. Katy Backes Kozhimannil is Distinguished McKnight University Professor at the University of Minnesota School of Public Health, director of the University of Minnesota Rural Health Research Center and Rural Health Program, and senior adviser to the Center for Antiracism Research for Health Equity. Follow her on Twitter: @katybkoz.