April 19, 2022 – The fallout from Monday's decision by a federal judge to lift mask mandates on airplanes, trains, and buses was applauded by some travelers and members of the public, while others expressed concern that the move would drive more infections as case numbers are already rising in many areas across the U.S.
Mike Dudgeon, an engineer from Atlanta, was about to board a Delta Air Lines flight to Las Vegas with his wife on Monday when he learned of the judge’s decision. He mentioned the news alert to a flight attendant, who said masks were still required for the moment.
"About 2 hours in, the pilot came on and said Delta had dropped the mandate, and there was a cheer from many. I would say 80% of the plane took them off, including most of the crew. I twirled mine on my finger over my head in celebration,” he says.
But what do infectious disease and public health experts think of the new ruling?
"I think it is unfortunate," says Bruce Hirsch, MD. "I believe this is occurring when cases are increasing and we still have 39,000 COVID cases per day, and many cases we are not seeing counted because of home testing."
It’s the wrong time to "decrease our guard against this highly infectious virus," says Hirsch, an infectious disease specialist at Northwell Health in New Hyde Park, NY.
"It's unfortunate that that were not sticking to science and to the public health [guidance] on masks. It just is not something that that should be challenged from a political context," Gigi Gronvall, PhD, senior scholar at the Johns Hopkins Center for Health Security says.
Masks work because they act as a barrier to minimize transmission, she says. "It's better to avoid having to give your vaccine a run for its money by actually getting infected and making your immune system handle the work."
John Segreti, MD, was more tempered in his response.
"The judge ruled that CDC can’t mandate that travelers wear masks,” he says. “The airlines can mandate masks if they wish, but most have announced that they won’t. This does not mean that people can’t wear masks."
Segreti, medical director of infection control and prevention at Rush University Medical Center in Chicago, says he’ll continue to wear a mask when he flies.
The timing of the ruling "is ironic because I went for my first flight in over 2 years," Gronvall says. "I just got back from a vacation yesterday and flew from Hawaii to BWI [Baltimore-Washington International airport] with a mask on. It was fine."
Jason Johnson, PhD, is among those travellers shocked to hear airlines were dropping mask mandates in the middle of a flight.
“I don't like wearing masks on the plane,” says Johnson, a professor of politics and journalism at Morgan State University in Baltimore. “But I know COVID is real and don't want to get sick. It seems crazy to me that anyone who would take off a mask mid-flight as if suddenly the pandemic was over just because of an announcement.”
Know Your Risk
The now-common personal protection measures can reduce risk when traveling in confined transportation spaces with multiple strangers.
Masks, especially N95s or other high-quality face coverings, protect against exposure, says Hirsch, who also emphasizes the need for vaccinations.
Segreti has more direct advice. "If you are nervous, wear a mask," he says.
The recent guidance from White House chief medical adviser Anthony Fauci, MD, to consider personal risk for COVID-19 would apply to airplanes, trains, and buses as well.
The ventilation system on planes "is pretty good," Gronvall says, but it won't help much if someone close to you is infected and coughing. Another concern, she says, is people standing very close together while waiting to get off the plane, a time when some airplanes turn off their air handling systems.
"The other thing that I would do, depending on people's circumstances, is get tested on a more frequent basis," Gronvall says. Earlier detection of infection can allow for more effective treatment such as with antiviral medications, she says.
"I would recommend wearing a mask if you feel you are at higher risk of severe disease if you get infected,” Segreti says. “This would include unvaccinated people, immunosuppressed, people over 65, and people with comorbidities such as diabetes, heart disease, lung disease, etc."
Vivian Leal of Reno, NV, is among those with real concerns about the judge’s ruling.
“This is rough news for the millions of us who are immunosuppressed,” Leal says. “Healthy folks resist wearing a mask on a plane -- such a small inconvenience. You've no idea what we go through.”
The real effect of lifting of the federal mask mandate may not be known for weeks. Generally, there is a lag between infections and positive tests, hospitalizations, or deaths.
In addition, the ruling came right on the heels of gatherings of friends and families for Easter and Passover, which could likewise contribute to changes in the infection rate in the near future.
"What concerns me is a judge takes it upon themselves, a significant public health issue, to remove the masking with no legal basis, all during a time of a respiratory virus pandemic. We are setting ourselves up for, potentially, another surge," Hirsch says.
Asked what he will do the next time he flies, he said, "I got my second booster and plan on wearing a surgical mask to reduce my vulnerability and the vulnerabilities of people around me."
The judge's ruling arrives at a time of confusion between individual rights and community obligations, Hirsch says. He remains concerned because even though the death rate is lower, COVID-19 is still linked to about 425 deaths every day.
"We have many of us whose immune systems are weak, we have among us people who are of advanced age, and the idea of taking care of each other has become lost in this recent dialogue."