An Unlikely Defense of the Mask Mandate

Why do we need a mask mandate? Perhaps not for the reasons one might expect.


It's no secret that resistance to masks remains at an unsettling high in the United States.


Although we'd like to blame conspiracy theories or bad messaging, well-informed and otherwise rational people generally have the tools to see through such obstacles or to assign appropriate value to the words they hear.


We might instead consider that it is our rational nature, and perhaps even our capacity to make hip-shot risk assessments using solid scientific data, that is behind some of this resistance. And this is because some people have taken a good look at their individual risk from COVID-19, and the evidence is telling them "FOR YOU, this is probably not a deadly threat."


For the vast majority of people, that assessment would be correct. And because it is not very fatal, a mandate is needed.


But that sounds crazy, right? Wouldn't that logic be counterintuitive? Not exactly.


Consider that COVID is looking to be about as deadly as flu for most age groups, especially otherwise healthy people under 70 years old (see linked study showing 0.04% case fatality rate among <70). It is not the virulence of this disease that is leading to such high numbers of dead relative to seasonal flu, rather it is it's contagiousness.


There is no proportionate value of life, and no young person's life is worth more than any senior citizen's. Life is life, and every death is a tragedy. Yet millions die every year in the United States, the majority from heart disease and cancer. COVID now represents the 3rd most common cause of death, but the statistics suggest that the burden or risk is carried predominantly by the old, with fatal outcomes most common in the 70+ age group. As such, most people below 70, which is the majority of the US population, will have no personal connection to a young person who has died of COVID, even 10 months into this Pandemic.


People under 70 don't believe they will die if they get this, and the statistics support that sentiment.


Furthermore, unlike smallpox, the mental image of being infected with COVID isn't necessarily scary to many people.


And finally, although we are disgusted at the thought of a stranger's 'secretions', we view risk differently around friends/family and hesitate less to share their air. For whatever reason, we feel more in control of something over which we have none.


And most importantly, we aren't wired to understand large numbers and long odds - even those of us trained in statistics.


Consider the case of auto accidents and seatbelts. It’s because driving is generally not so dangerous (you have a 1 in a million risk of dying for every 600 miles you drive) that we need seatbelt laws. People perceive that they are rarely in accidents, and when accidents occur, the majority are minor. Despite how common accidents are, few families have an immediate member that has died in one.


But by mandating seatbelts, we save millions of lives because all 350M of us are exposed to the risk.


So it matters little that COVID has a 0.04 percent fatality rate. If the epidemiological and public health communities are correct, that 60-70% of us will get this disease without a mask mandate, that means 250,000,000 infections. That .04 percent fatality rate suddenly translates to over one million lives lost.


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