Last week, the Editorial Board of the Yale Daily News published an editorial entitled “Mask Off.” In the piece, it asserts that Yale’s requirement of universal masking in classrooms and public transportation should be dropped. It bases this recommendation on a series of cherry-picked and biased arguments, all of which have little to no grounding in epidemiology, the practice of public health. Moreover, the editorial is deeply ableist, ignoring the fact that some students, faculty and staff at Yale may still be at high risk of serious complications of COVID-19 due to immunosuppression or other underlying conditions.
We are professors at the Yale School of Public Health and Yale School of Medicine. Our professional duty is to educate Yale students and the greater public, and our ethical obligations often include issuing corrections to misinformation about the pandemic. Last week’s piece is an example of such misinformation, which we will try to correct here.
First, the field of public health aims to protect the health of everyone in the population. This includes the able-bodied as well as the vulnerable. Though there have been some who have suggested that we should be now addressing the pandemic as a matter of personal risk assessment and subsequent private decisions, this idea ignores the fact that in a pandemic, individual choices affect others. In fact, as Aparna Nair, a historian of public health said recently, framing one’s health as a matter of personal choice “is fundamentally against the very notion of public health.”
Next, the Editorial Board incorrectly claims that “The Centers for Disease Control says that 95 percent of Americans, including 100 percent of those in Connecticut, don’t need to wear masks.” This is an inaccurate, selectively abstracted statement. The CDC’s guidance provides a nuanced recommendation about masking in public settings, which stipulates that for many people — such as those in certain age groups or who have certain medical conditions — continued mask use is recommended. The CDC further extends this guidance to apply to anyone who resides with a person who is at high-risk.
On college campuses, the definition of “cohabiting” may be a bit blurry. Nonetheless, from a disease transmission standpoint, there is little argument that spending 50-75 minutes in a closed, indoor environment qualifies. When in-person classroom attendance is required, it is critical that Yale’s policies recognize and protect the most vulnerable among us. In other words, we should all behave as though we live with a person who is at high-risk.
Now for some numbers on immunocompromising and other health conditions that put people at high risk. An estimated 6.2 percent of adults aged 18-64 are medically immunosuppressed. This translates to an estimated one in 16 people on this campus. Staff and faculty older than 65 years are also at high risk for severe outcomes were they to contract the virus.
One-way masking is insufficient in these cases. Universal masking prevents the transmission of COVID-19 because the virus is airborne, and transmission can occur in indoor settings because aerosols can remain suspended in the air and travel farther than conversational distance. Furthermore, because people may be infectious while asymptomatic or presymptomatic, it is essential that all individuals remain masked indoors in congregate settings with lengthy exposure periods, such as 50 minutes or more (i.e., the college butteries would not qualify here). Moreover, although one-way masking with a high-quality mask affords some protection, for individuals with vulnerabilities the assurance is not enough.
Beyond the crude understanding of public health in the editorial, the board engages in circular logic to make its case — for instance, asserting that because Yale’s campus has enjoyed little classroom transmission, the mask mandate is unnecessary. This is faulty reasoning since a universal masking policy is the reason in-class transmission has been so low. For evidence of this, one need only examine what has occurred in public school settings in the absence of universal masking. Multiple classroom-based outbreaks have been documented.
What we find especially troubling is that the members of the Editorial Board seem to be borrowing tropes of populist pundits on cable news channels, assuming that the pandemic is over and that mask-wearing is simply a form of virtue signaling. It is not. While it is possible that we are at the final stretch of the pandemic, and that we will see a decline in COVID-19 infections that together with the increased availability of antiviral drugs will make the risks acceptable, we simply are not there yet. In fact, on the week the News’ editorial was published, infections were increasing again in the Northeast. In Connecticut that week, 3799 people were infected compared to 2623 a week earlier, the positivity rate climbed beyond 5 percent and hospitalizations increased by 30 percent. Given the risks to the immunocompromised, the highly transmissible nature of the BA.2 variant, and the fact that infections and hospitalizations are increasing in Connecticut, the timing of a call to end protections in the classroom seems to signal privilege — indifference to the fates of those who are less healthy, who are at risk.
Instead of a message of solidarity, of a commitment to protect the weaker among us, the Editorial Board chose to suggest that the burden of mask wearing is too much to bear as it detracts from one’s college experience. The board suggests that removing the inconvenience of masking for a few hours a week in classrooms is more important than preventing someone from getting sick or hospitalized. Over the past two years, Yale’s mitigation policies were distinguished by inclusion and respect for science. These efforts afforded protection while maintaining employment and education for those at risk, and Yale enjoyed one of the highest grades on the Higher Ed COVID Policy Report Card. Yale has relaxed many mitigation efforts since this pandemic has begun while trying to minimize harm to members of our community. Currently, there are many spaces on campus in which mask wearing is optional, balanced with mask policies that ensure that the most vulnerable among us, who must gather in enclosed spaces for several hours each week, remain safe. As experts in public health, epidemiology and medicine, we were quite proud of the efforts Yale has taken to protect students, faculty and employees; sadly, we cannot say we feel the same about the position of the editorial board.
Finally, the pandemic has had terrible effects on human lives — millions have died or had severe, debilitating disease. Tens of millions have suffered and will continue to suffer from the mental and financial implications of prolonged isolation and economic impacts. The pandemic has also disrupted many social and educational experiences. While we understand the wish to wave a magic wand and make this all go away, we know that there is no such magic wand. We also know that the request to stop wearing masks in class is an expression of this wish — as if by pretending that COVID-19 is over, it will be over. As an educational institution, Yale must recognize the ableist and escapist nature of this request. Thus we must remind you of the goals of your education here; to teach you to think beyond yourselves, to recognize your significant privilege and to make a significant positive impact on the world. Withdrawing the call to stop wearing masks to class is an obvious important step toward achieving these goals.
Gregg Gonsalves is an associate professor at the Yale School of Public Health. Contact him at gregg.gonsalves@yale.edu.
Naftali Kaminski is a Boehringer-Ingelheim Endowed Professor of Internal Medicine at the Yale School of Medicine. Contact him at naftali.kaminski@yale.edu.
Marney White is a professor at the Yale School of Public Health and Yale School of Medicine. Contact her at marney.white@yale.edu.