Near the end of Monday’s Flagler County Commission meeting, Commissioner Greg Hansen was blunt about one of the more contested protocols of the coronavirus era: “Wearing a mask–there’s half the medical community out there says that’s bullshit, you shouldn’t be wearing a mask,” Hansen said. He then made his own recommendation: if you’re worried, stay home or wear one.
Hansen did not elaborate on his data and did not respond to email and phone inquiries. Hours later both Bob Snyder, who heads the Flagler County Health Department, and Jonathan Lord, the county’s emergency management chief, strongly disagreed with Hansen’s characterization.
“All public health officials at the federal, state and local levels that I’ve spoken to totally disagree with that characterization,” Snyder said. “Mask-wearing is essential to protecting all of us in our community because of the asymptomatic rates for the virus being up to 50 percent.” In other words, half the people who have the virus may not know it or show symptoms, but are still spreading it. “This is more about protecting others, including our families, neighbors, friends, grandparents from getting the virus. That’s what it’s all about, protecting others.”
Hansen had caught reporters’ attention with his remark: during a roundtable with reporters on hurricane season early Monday afternoon, WNZF News Director Rich Carrol asked Lord about Hansen’s statement. “Is that misinformation? Are you seeing reports that mask wearing is BS, and does that concern you, that type of rhetoric is coming from our own Flagler County Commission.”
“I would say that mask-wearing is an extremely important tool in limiting or mitigating the spread of Covid-19 and other airborne diseases,” Lord said. “We’re not changing our message. It is important to stick to that. I mean, on the Internet, you could find anything that would back up any position anyone has. That’s I guess the wonder of the Internet. You can find anybody and anything, and people can create stuff., But at this point in time, everything that I have seen and all the messaging from the public health experts–and I’m not a public health expert, but I do trust them and everything that they say–is that mask-wearing does make a difference, and we are not changing that.” He said that will be enforced in shelters, for example, should shelters be needed during the hurricane season, just as the practice is being enforced on the county administration’s own grounds, at the Emergency Operations Center, for example.
But Hansen wasn’t necessarily picking out information off the Internet. No less an authority than the World Health Organization, which sets the tone for public health policy across the globe, especially in countries that don’t have as powerful a public health arm as America’s Centers for Disease Control, has consistently stated that mask-wearing is not essential for most.
“If you do not have respiratory symptoms such as fever, cough or runny nose, you do not need to wear a medical mask like this one,” says April Baller of WHO’s Health Emergency Program in a WHO video. “Mask alone can give you a false feeling of protection. It can even be a source of infection when not used correctly. Masks should only be used by healthcare workers, caretakers or by people who are sick with symptoms of fever and cough. Why? Because health care workers and caretakers are in close contact with ill individuals, so they are at higher risk of catching Covid-19. And sick people should protect others from droplets when they come out when they cough or sneeze.”
The video has been widely cited as evidence of a fundamental contradiction between guidance from the World Health Organization and diametrically opposed guidance from the CDC, which does recommend mask-wearing.
But citing the WHO video without context is risky: the video dates from March 9, still only a few months into the pandemic, and not long after even the CDC itself had recommended the same approach–because there weren’t enough masks to go around for those who needed them, especially healthcare workers. That’s no longer the case in the developed world, but it’s still the case in much of the developing or poorer world. Speaking to ABC News, Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases, said that “advising universal mask wearing in a place where it’s impossible to adhere to that guidance could hurt the WHO’s reputation in those countries.”
Just as important: numerous studies since March have indicated that the asymptomatic rate for Covid-19 infections is much higher than originally believed, while other studies have concluded that wearing masks, even among health people, could significantly reduce the incidence of infection and deaths–but only if mask-wearing was “universal,” meaning at 80 percent or better.
Stephen Bickel, the medical director of the Flagler and Volusia County Health Departments, has also been advocating mask-wearing for its sheer numerical advantages: he said in interviews last month that even if 60 percent of people wore masks and masks were a mere 60 percent effective in reducing infections, that alone would stop the infection rate from growing.
Another caveat: mask-wearing recommendations by the CDC refer to mask-wearing when social distancing is not likely or possible, not when individuals are walking or driving alone or with members of their close family. In other words, wearing a mask while taking a walk on a trail, jogging on the beach, or doing other outdoor activities distanced from others is not necessary. But wearing a mask is necessary in public places with likely common public traffic, such as retail stores, grocery stores, medical and other high-traffic offices, and so on, because infectious droplets don’t travel or stay attached to the person sneezing or coughing, but can remain airborne long enough for others to ingest them. It’s in those cases that the wearing of masks is not so much to prevent ingesting infected droplets, but to stop oneself from spewing them.
That’s what statements such as “if you’re worried, stay home or wear one” misunderstand about mask-wearing: they’re not worn as self-protection. They’re worn in deference to the protection of others.
“It’s a very small, inexpensive inconvenience and sacrifice to stop transmission,” Snyder said, stressing the point about wearing them for others’ benefit, not one’s own.
Hansen had brought up the matter because, like other local officials–like officials everywhere–he’s been repeatedly asked by constituents about the seeming contradictions in recommendations. While Hansen did not dispense disinformation, he and the brief discussion he started with County Administrator Jerry Cameron and other commissioners did reveal recurring misunderstandings about CDC and local public health recommendations–and an impatience with that “very small, inexpensive inconvenience.”
“There are things I can’t rationalize to people that come ask me about them, like how come we can’t play softball when Walmart never closed, Home Depot never closed, Lowes never closed, and people are this close to each other in those places,” Hansen said during the discussion. “So it’s hard to answer the question: Mr. Commissioner, how come we can’t play softball. All these other places are open, they’re not wearing masks, they’re just running into each other. Why can’t we play? And I understand, it’s just a hard question to answer.”
All county parks are open except for team sports that would exceed the limit on gatherings of 10 people or more. The prohibition on team sports is actually a simple matter of numbers. The governor’s order in the current phase (expected to lift soon) restricts gatherings to 10 people or less. It was for that reason that when it met Monday, the County Commission did so behind closed doors. The public was not allowed in, so as to comply with the 10-person limit. Neither Hansen nor other commissioners objected. Hansen could have easily explained to constituents that the same recommendation applies to softball and other team sports.
But mask-wearing has taken on ideological hues, with mask-wearers falling on one side of this latest of partisan divides and non-wearers, taking their cues from President Trump, who has refused to wear masks anywhere even as his administration recommends them, on the other. There’s been a similar divide locally. None of the commissioners wore masks at their first joint, in-person meeting in more than two months Monday, even though all, being 50 or older are now in the higher-risk category, while every in-person town hall Palm Coast has held weekly through the emergency has featured officials wearing masks. But commissioners, including Hansen, had worn masks coming into the building, as required by building protocol, had their temperature check, and were issued a wrist-band indicating they were cleared to go in. The commission chairman explained at the beginning of the meeting that they’d also been cleared not to wear masks during the session as long as they maintained distances from each other.
“Our enforcement arm on those things is the sheriff’s office, using education rather than penalties, Cameron said. “I will point out that regardless of what we do, the governor can enforce his orders.”
“That’s the answer I give, we’re kind of tied by what the governor says we can do, that’s my only answer to these things but this doesn’t make sense,” Hansen said.
“We could choose to de-emphasize some of the enforcement, maybe not participate, but there are consequences for that,” Cameron said. “Even if we just flat said we aren’t going to enforce any part of this, the governor can come in and enforce it anyway.” Cameron then added: “On a personal basis, a lot of these things mystify me, but I’m trying to act in the best interest of Flagler County, and that’s not necessarily to get them in a fight with the governor.”
“The governor does leave some leeway in his pronouncements,” Commission Chairman Dave Sullivan said.
“The guidance keeps changing from CDC,” Cameron continued. “If you remember, is don’t wear a mask, then you have to wear a mask.” He did not explain why the guidance had changed, though that information has been readily available for months. “And you can pick this up off solid surfaces, then the guidance was you probably don’t pick it up. The latest guidance we’re getting, coming in last week, is that it’s not probable that you get this outdoors, if you’re practicing any kind of social distancing. That gives you a different pointer. The experts don’t get it right because they’re working off of incomplete information, but they’re more expert than we are.” He then added a derisive coda: “Supposedly,” and chuckled.
“If you fear, stay home,” Commissioner Joe Mullins said. “Nobody is making anybody come out.”
“That is correct, you do have the opportunity to self-isolate,” Cameron said.
It was soon after that that Hansen made his BS comment: “Wearing a mask–there’s half the medical community out there says that’s bullshit, you shouldn’t be wearing a mask. I think we’re at the point where we have to treat people as adults and human beings, and if you’re worried, stay home. If you’re worried, wear a mask. Otherwise, go about your business.”
Snyder said the statement misses the point. “From the public health perspective, our position is still the same that if there’s a need for you to venture out, get groceries, pick out medication, go to the restaurant, go to retail places, our economy is opening up, we encourage you to please wear a mask and wash your hands constantly. That is a very positive, and a very beneficial act to take in protecting yourself and your family against Covid-19.”
Sullivan in a brief interview subsequently said Hansen’s “was not a commission position.” He said the county “has agreed to the process and we encourage wearing masks.”