A depressing mask epilogue as we turn to vaccine communications

Those arguing in favor of indefinite lockdown measures premise their position (implicitly, usually) on the distribution of a successful vaccine before those measures cause more suffering and harm than COVID-19. That reality seems on the imminent horizon, albeit still without any clear endgame articulated. Can our failures on mask communication teach us something about vaccine communication? Are those who can act on it willing to listen?

Recap: In an August 6 impassioned / strung-out diatribe, I cited the popular “pee-pants” meme to symbolize the staggering hubris that U.S. health experts and institutions have displayed when communicating about face masks. I argued that future messaging must prioritize repairing the foreseeable damage to public trust.

It took three more months for the CDC’s official stance to catch up to the pee-pants meme. In mid-November it released new guidance that mentions — rather breezily — that masks help protect the wearer. The academic-looking “scientific brief” version with ~45 footnotes here; the fun graphic version with ~30 bulleted “recent studies” instead of footnotes here.

What is going on here? The CDC should not need dozens of citations to support the proposition that a barrier over the nose and mouth helps reduce the likelihood of catching a virus spread through droplets or through the air. Admitting that I only spent a few minutes looking, other subpages under “Prevent Getting Sick” have no “recent studies” listed, let alone thirty. Why is the CDC so intent on sourcing itself on this particular issue and not others, say, distancing or handwashing?

Certainly there is the matter of masks being like, so ridiculously effective at reducing transmission, and the more ways we can get that shit in people’s faces, the better. 70%+ reduced risk baby!! Even setting aside the whole making up for months of lost time / having to work harder to convince people because of the manufactured debate thing, the numbers are nice to have, and I’m glad researchers got them. And yeah, to the extent that a bunch of people with advanced degrees legit needed conclusive studies to conclude that “cloth mask materials can also reduce wearers’ exposure to infectious droplets through filtration,” I’m super glad we will never have to go through this asinine debate again. But either these studies’ results are (a) unsurprising, in which case the Surgeon General was reckless when he yelled at people that masks aren’t effective and the CDC was seriously misguided in pushing its “masks protect other people [not you]” campaign; or … (b) surprising, in which case they are worthy of more attention than a casual weaving into sentences like “Masks offer some protection to you and are also meant to protect those around you, in case you are unknowingly infected with the virus that causes COVID-19.” (Like was this really one of the places that you needed to shove “the virus that causes” in there?). If the goal is awareness, then, the current messaging (citations and all) does not seem particularly tailored to it.

If the goal is to absolve public health authorities of wrongdoing, though, this rollout makes more sense. They’ve buried the initial bad judgment in hopes that no one recognizes or remembers the major course reversal. (“Nothing to see here — see, we still say that protecting others is ‘the main function’!”) Simultaneously, they set up a defense for themselves in case someone does notice that. (“No really, how could we have known?! This is 45-footnotes-level complicated.”)

Indeed, the world seems to be letting all the experts off the hook. Grey’s Anatomy showed us an “April 2020” in which masks appeared to be normalized completely among the public — even while showcasing the PPE shortage that everyone now uses to justify discouraging mask-wearing. And the news coverage of the CDC release barely acknowledges the dissonance. From Fox News:

“Some people may be confused since we’ve heard the guidance change on this issue,” Dr. Sonja Bartolome, a lung disorders expert from UT Southwestern, not involved with the CDC, wrote to Fox News. “However, in this COVID-19 pandemic we are seeing science work in real time. Science takes time, and we must observe the infection in real-time to understand its spread.”

(Yes, I get this talking point, but we are applying it to “cloth mask materials can also reduce wearers’ exposure to infectious droplets through filtration,” really?)

Virtually no source called out the about-face in any meaningful way, aside from the South China Morning Post’s headline “Masks do protect wearers from COVID-19 after all, US CDC finally admits” to find any catharsis. And maybe that is the “behavioral economics” takeaway; most people who have lived in Asia have experienced public mask-wearing before. They were introduced to it in circumstances where its benefits were accepted and obvious. No epidemic-panic or PPE shortage would have led to such confusion or paternalism in Asia that the population absorbs the message that face coverings might not help. I can see the mess in March/April as a casualty of the absolute mass hysteria going on at that time.

It’s harder for me to get on board with the ongoing hubris about it, though, especially as we are starting to hear a similar tone on vaccines. There were no “anti-maskers” before the bungled messaging in February; without any way to prove a counterfactual, I tend to think this contingent would have been much smaller and less influential had we embraced masks from the get-go. On the other hand, “anti-vaxxers” are a known and powerful propaganda force.

Fauci cult: VACCINES ARE SAFE! BECAUSE SCIENCE!
Rabid anti-vaxxers, COVID-truthers, others who are full of rage at anything the mainstream scientific authorities say (“Ragers”): LIES!!!!!! CONSPIRACY!!!
Others on a subconscious level (we’ll call them “Skeptics”): Just bc science? This is a really new disease right? And I remember that you said masks don’t work.
Fauci cult: That never happened.
Skeptics: I’m pretty sure it did.
Fauci cult: It didn’t. But whatever it’s because there was no science and as soon as we got science we told everyone to wear them and also I think you’re confused we just said don’t buy N95s bc of the whole healthcare workers thing and you know, because science, the whole cloth face covering thing didn’t occur to us til later.
Ragers: LOOK AT ALL THESE PPL WHO DIED / WERE INJURED / BECAME CHRONICALLY ILL BC OF VACCINES THESE PPL ALSO SAY ARE SAFE.
Skeptics: I generally think vaccines are safe. But there’s just a lot to process here and I don’t really trust the people I’m hearing it from.

I get that this is really hard. I acknowledge the view that “saying we were wrong will erode credibility further.” I just cannot agree with it under these circumstances, in this climate.

To be authentic, transparent, credible in the United States, I believe those regarded broadly as scientific authorities must be circumspect. Media spin is a problem, but an inevitable one; the primary source material makes clear that those at the podium cannot blame the media for all that has gone wrong. Authentic acknowledgement of the mistakes made here is really important, and I am increasingly skeptical that it will ever occur.