Tuesday, May 31, 2022

The Morning: Why masks work but mandates haven’t

And what to do now that cases are rising.

Good morning. Masks work. So why haven't Covid mask mandates made much difference?

Aristotle, inverted

Covid cases and hospitalizations are rising again in the U.S., and deaths are starting to rise, too. In response, many people are understandably asking what the country can do to minimize the virus's toll in the weeks ahead.

Chart shows 7-day daily average. Data as of May 29. | Source: U.S. Department of Health and Human Services

So far, a lot of discussion has focused on mask mandates. Schools in Philadelphia; Providence, R.I.; Berkeley, Calif.; and Brookline, Mass., have reimposed theirs, as have several colleges. Elsewhere, some people are frustrated that officials, like New York City's mayor, Eric Adams, have not done so.

Critics have accused these leaders of a lack of political courage, saying that they are yielding to Covid fatigue rather than imposing necessary public health measures. But I think that the criticism misreads both the history of public health and the recent scientific evidence about mask mandates.

The evidence suggests that broad mask mandates have not done much to reduce Covid caseloads over the past two years. Today, mask rules may do even less than in the past, given the contagiousness of current versions of the virus. And successful public health campaigns rarely involve a divisive fight over a measure unlikely to make a big difference.

The evidence

From the beginning of the pandemic, there has been a paradox involving masks. As Dr. Shira Doron, an epidemiologist at Tufts Medical Center, puts it, "It is simultaneously true that masks work and mask mandates do not work."

To start with the first half of the paradox: Masks reduce the spread of the Covid virus by preventing virus particles from traveling from one person's nose or mouth into the air and infecting another person. Laboratory studies have repeatedly demonstrated the effect.

Given this, you would think that communities where mask-wearing has been more common would have had many fewer Covid infections. But that hasn't been the case.

In U.S. cities where mask use has been more common, Covid has spread at a similar rate as in mask-resistant cities. Mask mandates in schools also seem to have done little to reduce the spread. Hong Kong, despite almost universal mask-wearing, recently endured one of the world's worst Covid outbreaks.

Advocates of mandates sometimes argue that they do have a big effect even if it is not evident in populationwide data, because of how many other factors are at play. But this argument seems unpersuasive.

After all, the effect of vaccines on severe illness is blazingly obvious in the geographic data: Places with higher vaccination rates have suffered many fewer Covid deaths. The patterns are clear even though the world is a messy place, with many factors other than vaccines influencing Covid death rates.

Yet when you look at the data on mask-wearing — both before vaccines were available and after, as well as both in the U.S. and abroad — you struggle to see any patterns.

Almost 30 percent

The idea that masks work better than mask mandates seems to defy logic. It inverts a notion connected to Aristotle's writings: that the whole should be greater than the sum of the parts, not less.

The main explanation seems to be that the exceptions often end up mattering more than the rule. The Covid virus is so contagious that it can spread during brief times when people take off their masks, even when a mandate is in place.

Airplane passengers remove their masks to have a drink. Restaurant patrons go maskless as soon as they walk in the door. Schoolchildren let their masks slide down their faces. So do adults: Research by the University of Minnesota suggests that between 25 percent and 30 percent of Americans consistently wear their masks below their nose.

Maskless travelers on a plane last week.Hiroko Masuike/The New York Times

"Even though masks work, getting millions of people to wear them, and wear them consistently and properly, is a far greater challenge," Steven Salzberg, a biostatistician at Johns Hopkins University, has written. Part of the problem, Salzberg explains, is that the most effective masks also tend to be less comfortable. They cover a larger part of a person's face, fit more snugly and restrict the flow of more air particles.

During an acute crisis — such as the early months of Covid, when masks were one of the few available forms of protection — strict guidelines can nonetheless make sense. Public health officials can urge people to wear tightfitting, high-quality masks and almost never take them off in public. If the mandate has even a modest benefit, it can be worth it.

But this approach is not sustainable for years on end. Masks hinder communication, fog glasses and can be uncomfortable. There is a reason that children and airline passengers have broken out in applause when told they can take off their masks.

In the current stage of the pandemic, there are less divisive measures that are more effective than mask mandates. Booster shots are widely available. A drug that can further protect the immunocompromised, known as Evusheld, is increasingly available. So are post-infection treatments, like Paxlovid, that make Covid less severe.

(For young children, who are not yet eligible for the vaccine, Covid is overwhelmingly mild, similar in severity to the flu.)

Continuing to expand access to these treatments can do more to reduce Covid hospitalizations and deaths than any mask rule probably would. "People have the wherewithal to protect themselves," Dr. Robert Wachter, chair of the medicine department at the University of California, San Francisco, told me. Absent a much larger surge in Covid hospitalizations, he added, the case for mandates is weaker than it used to be.

Dr. Aaron Carroll, the chief health officer of Indiana University, recently wrote for The Times's Opinion section: "Instead of continuing to bicker about things that have become hopelessly politicized like mask mandates, those in public health could focus on efforts that might make much more of a difference."

The available data also suggests that more than half of Americans have had Covid in the past six months, making many of them unlikely to contract it again now. As Jennifer Nuzzo, an epidemiologist at Brown University, told Vox: "Many of the people who are not wearing masks have already had Covid, so they're like, 'I've been vaccinated, I already had it — how much longer do you want me to do this for?' And it's kind of hard to say, 'No, you absolutely must wear it.'"

One-way masking

The country is probably never going to come to a consensus on masks. They have become yet another source of political polarization. Democrats are more likely to wear masks than Republicans, and Democrats who identify as "very liberal" are more likely to support mandates.

Fortunately, the scientific evidence points to a reasonable compromise. Because masks work and mandates often don't, people can make their own decisions. Anybody who wants to wear a snug, high-quality mask can do so and will be less likely to contract Covid.

If anything, that approach — one-way masking — is consistent with what hospitals have long done, as Doron, the Tufts epidemiologist, points out. Patients, including those sick with infectious diseases, typically have not worn masks, but doctors and nurses have. "One-way masking is how we have always used them," she wrote.

The same system can work for Covid outside of hospitals. Wachter, for example, believes that the time for mandates has passed but still wears one at the supermarket, in classrooms, on airplanes and elsewhere. Different people can reasonably make different choices.

THE LATEST NEWS

Uvalde Shooting
Rearranging a memorial for 10-year-old Jose Flores.Ivan Pierre Aguirre for The New York Times
War in Ukraine
Other Big Stories
Opinions

"No matter what the law in Virginia says, I will not prosecute a woman for having an abortion," Steve Descano, a prosecutor, writes.

Russia is to blame for the war in Ukraine. But the U.S. has escalated it, Christopher Caldwell writes.

Subscribe Today

When you subscribe to The New York Times, you're supporting the work of 1,700 journalists who provide deeply reported journalism that examines the issues and forces shaping the world. Become a subscriber today with this special offer.

MORNING READS

The Cuban boxer Osvel Caballero, right, and Jhosman Reyes of Mexico.Todd Heisler/The New York Times

Professional boxing: Cuba steps from amateur glory into the prize fighting chase.

Start-up culture: The end of the "girlboss"?

Trilobites: Dinosaurs started out hot. Then some of them turned cold.

A Times classic: Stop being so hard on yourself.

Advice from Wirecutter: The best — and quietest — air-conditioner.

Lives Lived: Kenny Moore, a two-time Olympic marathon runner, used his understanding of athletes to become a pre-eminent track writer at Sports Illustrated for nearly 25 years. He died at 78.

ARTS AND IDEAS

The United We Eat staff in Missoula, Mont.Janie Osborne for The New York Times

A kitchen run by refugees

A weekly program where immigrants cook takeout meals, called United We Eat @Home, has turned Ghalia Ahmad Fayez AlMasri into a local celebrity in Missoula, Mont. "When I cook, my meal goes very, very fast — 15 minutes this time," AlMasri, who fled Syria in 2017, told The Times.

The program has helped refugees apply for farmers' market permits and find restaurant jobs. And it has diversified the city's dining scene: Without it, there would be no place for Missoulians to order Congolese, Pakistani or Guinean food. Here's more about the program, as well as mouthwatering photos.

PLAY, WATCH, EAT

What to Cook
Andrew Scrivani for The New York Times

Baba ghanouj, grilled eggplant purée, has a smoky flavor.

What to Read

David Sedaris, the chronicler of dysfunctional families and oddball enthusiasms, has a new essay collection, "Happy-Go-Lucky."

Concerts

Abba is back onstage in London. (Well, sort of.) The Times critic called it "triumphantly fun."

Now Time to Play

The pangram from yesterday's Spelling Bee was entombed. Here is today's puzzle.

Here's today's Mini Crossword, and a clue: Chutzpah (five letters).

And here's today's Wordle. After, use our bot to get better.

Thanks for spending part of your morning with The Times. See you tomorrow. — David

P.S. The word "unputdownability" — praise for a book — appeared for the first time in The Times recently.

"The Daily" is about the police response in Uvalde, Texas. "The Ezra Klein Show" provides a conservative take on Roe v. Wade.

Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti, Ashley Wu and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.

Need help? Review our newsletter help page or contact us for assistance.

You received this email because you signed up for the Morning newsletter from The New York Times, or as part of your New York Times account.

To stop receiving these emails, unsubscribe or manage your email preferences.

Subscribe to The Times

Connect with us on:

facebooktwitterinstagram

Change Your EmailPrivacy PolicyContact UsCalifornia Notices

The New York Times Company. 620 Eighth Avenue New York, NY 10018

Monday, May 30, 2022

What to Cook Right Now

A ham and jam sandwich offers sweet, savory and salty bites, and more ideas for lunch.

What to Cook Right Now

Good morning. For a bunch of mornings now, I've been adding a smear of marmalade to my buttered breakfast bagel and sliced hard-boiled egg, with a sprinkle of kosher salt. I like the hint of sweetness against the egg and salt and bread.

Accordingly, I was thrilled to see Ali Slagle's new recipe for a lunchtime version: the ham and jam sandwich (above). It's an expansion of the Parisian sandwich known as jambon-beurre: a split baguette with jam for sweetness, ham for salt and Dijon mustard and black pepper for a little heat. Won't you give that a try?

Also in the midday realm, I like Naz Deravian's new recipe for borani-yeh esfenaj, an Iranian spinach yogurt dish, which makes for a delicious lunchtime dip with toast, or as an accompaniment for rice. (More lunch ideas: an Italian-style tuna sandwich; a superior egg salad sandwich; sardine toasts with tomato and sweet onion or a quick tomato soup with grilled cheese.)

Which brings us inexorably to dinner. You might give this slow-cooker shrimp in purgatory a try. If you work from home, set the sauce up after lunch and let it burble along pleasantly all afternoon, then add the shrimp right before serving. If you'd prefer to move faster, there's always spaghetti with fried eggs, a four-ingredient meal that punches well above its weight.

How about one-pot chicken and rice with ginger and cumin? I like the golden raisins in there so much.

Or you could make a cast-iron steak, which uses a technique that my father used for hamburgers when I was growing up: You salt the pan rather than the meat, and then flip the steak every 30 seconds or so over very high heat until it develops a serious golden crust. It'll be medium-rare in about 4 minutes, but check the temperature with that instant-read thermometer I'm always telling you to buy. You want the steak at about 120 to 125 degrees, and the temperature will continue to rise as it rests. (Bonus points if you do this while drinking a bourbon and branch water, and hossing me about my homework.)

There are thousands and thousands more recipes to cook right now waiting for you on New York Times Cooking, and inspiration to spare on our TikTok, Instagram and YouTube accounts. You need a subscription to access them. We've talked about that before, I think. Subscriptions support our work and allow it to continue. It you haven't already, would you consider subscribing today? Thank you.

We can help if you run into problems with that, or with our technology. Just drop a line to cookingcare@nytimes.com. Someone will get back to you.

Now, it's nothing whatsoever to do with rhubarb or strawberries, but Jill Lepore on bicycles is delicious reading. That's in The New Yorker.

In The Atlantic, Kaitlyn Tiffany wrote about why the viral online challenge is never coming back.

In a recent newsletter, I made note of an annual boats-with-no-motor run up the Inside Passage from Washington State to Ketchikan, Alaska. A subscriber just put me on to Zach Carver's 2020 documentary, "The Race to Alaska." Here's the trailer, and it delivers.

Finally, André De Shields played his last performance as Hermes in "Hadestown" last night on Broadway. Here he is accepting his 2019 Tony Award for best actor in a musical. Enjoy that, and I'll be back on Wednesday.

We want to hear from you.
Tell us about your experience with this newsletter by answering this survey.

ADVERTISEMENT

ADVERTISEMENT

Need help? Review our newsletter help page or contact us for assistance.

You received this email because you signed up for Cooking from The New York Times.

To stop receiving these emails, unsubscribe or manage your email preferences.

Subscribe to NYT Cooking

Connect with us on:

facebooktwitterinstagrampinterest

Change Your EmailPrivacy PolicyContact UsCalifornia Notices

LiveIntent LogoAdChoices Logo

The New York Times Company. 620 Eighth Avenue New York, NY 10018