Dr. Joshua Liao explores how public health leaders should stick with indoor masking policies to avoid decision fatigue that could weaken the response.
This week, the CDC urged Americans in areas with high or substantial Covid-19 transmission to wear masks indoors. The guidance reverses a relatively recent recommendation that only unvaccinated people needed to mask in those settings.
This change might frustrate some. But it is still a welcome change for a few reasons – and one that should continue for the foreseeable future.
First, the virus still represents a serious risk to unvaccinated Americans. Only half of the country is fully vaccinated, and the vast majority of Covid-19 deaths now occur among those who haven’t received a vaccine. While increasing vaccination rates clearly remains a goal, leaders should also use other measures – like having vaccinated people mask in higher risk settings – to reduce infection and suffering among the most susceptible.
Second, Covid-19 still affects vaccinated people. No vaccines are 100% effective, and unfortunately vaccinated people can contract and spread the Delta variant. Even if vaccination reduces that person’s risk of severe illness and death, it doesn’t completely remove the risk of passing the virus to others, or suffering consequences like long-haul Covid-19. Public health guidance should reflect these realities, framing vaccination as one important solution, not the solution. Another is to implement indoor masking regardless of vaccination status.
Unfortunately, we likely need this guidance for the foreseeable future. Part of the reason is pragmatic: the fall will bring in-person work and school, as well as changes in weather that increase the amount of time vaccinated and unvaccinated people alike spend inside – all of which underscore the wisdom of indoor masking as a safety measure.
Part of the reason to continue this guidance is behavioral. It’s understandable that leaders want to unwind Covid-19 restrictions in their communities as quickly as safety permits. But there are psychological costs to repeatedly changing masking guidance over time.
Overloading Americans with masking-related choices risks both poor decisions and paralyzing indecision.
One is distorted perceptions of Covid-19 risks. Humans are susceptible to ambiguity aversion, a behavioral principle that describes the tendency to favor the known over the unknown – even if the known comes with greater risks. In the context of Covid-19, repeatedly changing masking guidance could create ambiguity; cause some Americans to associate public health information with the unknown; and lead people to reject that guidance in favor of other information and riskier actions.
Avoiding decision fatigue is another reason to maintain indoor masking policies for the time being. The concept acknowledges the fact that making choices requires effort, and that long, extended, or complex decisions can take particularly heavy cognitive tolls on people. Repeated cycles of relaxing and tightening masking guidance – particularly based on lagging information about viral transmission that isn’t readily accessible to some communities – could trigger decision fatigue. Overloading Americans with masking-related choices risks both poor decisions and paralyzing indecision.
Instead, local officials could translate the latest CDC guidance into policies that are clear, streamlined, and maintained over time. Well-defined stipulations and rationales can reduce ambiguity. Avoiding multiple choices and vague contingencies can reduce decision fatigue. Maintaining some form of masking policy creates stability and underscores the right messages about safe behaviors and vaccines. These types of policies would also avoid putting the onus on residents, business owners, travelers, and the public to interpret mask rules.
Of course, none of these policy measures are panaceas. All of us also look forward to the day when masks aren’t needed, indoors or out. But given where we are with Covid-19, the latest CDC indoor masking guidance is a step in the right direction. We should stay this course for the foreseeable future, translating guidance into indoor masking policies that account for both public health and human behavior.
Joshua Liao reports stock investments in Novavax, Inc., a Covid-19 vaccine developer.
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