The head of the White House’s response to COVID-19, Dr. Ashish K. Jha, downplayed the importance of local mask mandates in December 2022 — going into the third year of the global pandemic — even as he claimed it was not an “either/or” regarding the importance of masks, compared to upgrading indoor ventilation.
Jha made the remarks while being interviewed with Dr. Cheryl Bettigole, the city’s health commissioner, by the Philadelphia Inquirer newspaper on December 15 2022, saying that improving indoor ventilation was the “most important long-term thing” that the White House could do for schools and nursing homes:
Indoor quality has just not got the level of attention it deserves. Most experts believe that if we make some basic investments in indoor air quality, we can reduce all respiratory infections by 30, 60, even 80 percent. I mean, the notion that you could cut respiratory infections [using masks] — there is no study in the world that shows that masks work that well. So you’re never gonna get the kind of benefit from mandatory year round masking as you would from making substantial improvements in indoor air quality, plus it’s a lot easier to implement as well. So this is an area where we’re doing a lot and trying to encourage people to use the resources they have to make those investments and start really improving ventilation filtration.
“This is wrong, and dangerous misinformation,” Tran wrote directly to Jha on the platform. “You need to retract your statement and issue a correction.” He added:
The reason the White House wants to downplay masks and say all we need is indoor air quality infrastructure is because they want to get away with doing almost nothing, and push people to continue consuming and ignore harm from the pandemic.
“I think there’s this question we get into of, ‘Do masks even work or not’ and I think the evidence is pretty clear: if you’re wearing a high-quality mask it clearly makes a difference, and I don’t think that evidence is all that controversial,” he said.
Inquirer health and science editor Letitia Stein and reporter Jason Laughlin did not respond to Jha’s contradictory remarks. The newspaper’s article summarizing the interview also failed to mention Jha’s apparent disparagement of research involving masking measures.
In April 2022, a story by science reporter Tom Avril noted that past studies had shown that even cloth masks provided limited protection:
Researchers who study airborne transmission of viruses say there is no question that masks — even the cloth variety — reduce the spread of the coronavirus.
Exactly how much depends on the type of material, how well the mask fits, and how many virus particles an infected person is shedding, among other factors. No mask is bulletproof, but that’s not a reason to reject them entirely. No infection-control measure is absolute, short of complete isolation.
Stein and Laughlin did not respond to a request for comment. The interview aired shortly after Philadelphia public schools instituted a ten-day mask mandate for students returning to class after the holidays.
“If you don’t want to get sick and you don’t want to go to the hospital and you don’t want to die of COVID or influenza, or if a very young child, RSV, then you should be wearing a mask indoors in a public place,” Dr. John Swartzberg of the University of California-Berkeley told Reuters regarding the benefits of wearing masks in public spaces.
Bettigole said during the Inquirer interview that she was “very strongly supportive” of the School District of Philadelphia’s move toward a ten-day mandate.
“What they’re trying to do is what we want them to do — keep kids in school. And if kids have COVID, they can’t come to school. I think it’s a good decision,” she said. “It’s relatively brief, it’s just ten days after the break. But I think it probably will help prevent some of the absences that we’ve seen previously — missing a lot of school [days], short of staff and so on. Trying to make sure our kids are learning.”
However, Jha stopped short of endorsing mask mandates across the United States.
“We have a broad and diverse country and leaders understand their communities well and understand it best,” he said. “What may be right for Philadelphia may not be right for San Antonio and maybe different than what Seattle wants to do. I do think that’s reasonable, and that’s OK. I’ve been very supportive of the decisions that individual cities and counties and states have made.”
The Inquirer also reported in August 2022 that school officials had said that they would not be able to provide air conditioning — a ventilation upgrade — for every school in the district until 2027. Neither Laughlin nor Stein mentioned this during the December 15 interview.
We contacted both Tran and the Centers for Disease Control (CDC) seeking further comment but neither responded. But other health experts called on clarity from U.S. President Joe Biden’s administration about health policies overall.
“I have found the public health communication from top officials in the Biden Administration — Dr. Jha, Dr. [Rochelle] Walensky in particular — to be oftentimes confusing to me, and I have graduate training in public health,” said Matthew Cortland, a senior fellow with the progressive group Data For Progress.
“I have worked on pandemic response since the start of the pandemic. I am an expert who does this for a living, is my point. And if I find their statemsnts to be confusing and contradictory, the average American who didn’t go to graduate school for public health, who doesn’t work in public health, who doesn’t do this for a living, is going to be completely lost.”
Cortland’s group found in a December 2022 poll of 1,532 likely voters that most of them supported mask requirements for indoor public spaces by a 56 percent to 43 percent margin.
But Cortland also echoed Jha’s point that COVID-19 mitigation is not an “either/or” scenario, citing October 2022 polling that also showed voter support for increased air quality requirements for schools and workplaces.
“Some have suggested or argued that improvements to indoor air quality are necessarily both expensive and time-consuming; that’s not true,” they added, citing Corsi-Rosenthal (CR) boxes and High Efficiency Particulate Air (HEPA) filters as devices that can help reduce the spread of airborne viruses for relatively low cost.
“You can deploy CR boxes to an entire school building in roughly a day,” Cortland said.
Dr. Julia Raifman, the leading researcher for the the COVID-19 U.S. State Policy (CUSP) Database and a supporter of Philadelphia’s mask mandate, said people are “looking for leaders to lead” when it comes to mitigation efforts.
“Not just guidance, but policies that help everyone mask together,” said Raifman, who is also an assistant professor at the Boston University School of Public Health. “And I think many people are aware of the evidence that it is more effective for people to wear masks together than for anyone to mask just on their own. Certainly masking on our own is better than nothing, but what’s really important is to ensure that the people with COVID and the people around them are both wearing masks, and that’s what mask policies achieve.”
A temporary mandate like the one Philadelphia is implementing, she said, does not diverge from the support seen in polling.
“It is aligned with evidence and it is aligned with reducing the inequities that are exacerbated by COVID surges,” Raifman said.
The misinformation (and disinformation) around using masks took another turn in January 2023, when a study published by the Cochrane Library — a group of databases maintained by a British research group — was used to justify anti-masking beliefs. As the Toronto Star summarized:
Their analysis was based on a dozen studies that compared people wearing medical masks to their barefaced counterparts, couched inside a broader look at physical pandemic measures. Despite a line cautioning that the shakiness of the data “hampers drawing firm conclusions,” the authors concluded that masking in the community made “little to no difference.”
Specifically, the study said that “the high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.”
Cochran released a statement saying that the study’s reviews were “inconclusive” and could not be taken as evidence against the benefits of wearing masks:
The original Plain Language Summary for this review stated that ‘We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.’ This wording was open to misinterpretation, for which we apologize. While scientific evidence is never immune to misinterpretation, we take responsibility for not making the wording clearer from the outset. We are engaging with the review authors with the aim of updating the Plain Language Summary and abstract to make clear that the review looked at whether interventions to promote mask wearing help to slow the spread of respiratory viruses.
The same day Jha’s interview aired, the Biden administration posted a “winter COVID-19 preparedness plan” graphic that did not mention masking:
By comparison, the World Health Organization published its own advisory on December 2022 that included both indoor ventilation and using a mask:
The administration also resumed the delivery of free COVID-19 tests (but not masks) through a government website; that service ended on May 11 2023 with the expiration of the the Department of Health and Human Services’ (HHS) Public Health Emergency mandate.
A day later, the CDC released a new advisory concerning indoor ventilation, recommending that Americans provide enough ventilation for “five air changes per hour” (5 ACH) — in other words, enough to change the available air supply five times over per hour.
“Rather than a hard-and-fast rule, the 5 ACH target provides a rough guide to air change levels likely to be helpful in reducing infectious particles,” the agency said.
The CDC has also asked parents to “consider” allowing their children to wear masks at school.
“If your child has a disability or chronic health condition, wearing a mask can give extra protection to help them stay healthy,” the agency said in a separate release, “Masks also help to prevent children from spreading COVID-19 to other people around them. Make sure the mask covers your child’s nose and mouth.”
Jha again downplayed the use of masks against the virus in a July 31 2023 op-ed for the Boston Globe, suggesting that it only made sense in cases like “a friend [who underwent] a recent organ transplant.” He also claimed that cases where people develop long-term COVID infections — a.k.a. Long Covid — tend to be “shorter-lived and less severe,” without citing evidence. At the time of the article’s publication, Jha was listed as the dean of the School of Public Health at Brown University.
Jha did mention that the Food & Drug Administration (FDA) is planning to make an updated vaccine available in fall 2023 that will account for the more recent variant, known as XBB.
Update 3/13/2023, 2:53 p.m. PST: Updated to reflect controversy around a study published by The Cochrane Review in January 2023. — ag
Update 5/15/2023, 1:50 p.m. PST: Updated to reflect updated advisories from the Centers for Disease Control. — ag
Update 7/31/2023, 2:26 p.m. PST: Updated to reflect a new op-ed by Dr. Ashish Jha that again downplays the use of masks against COVID-19, as well as the Food & Drug Administration’s plans to unveil a new vaccine in the fall of 2023. — ag