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While the transporation mask mandate ruling is appealed, is public health at risk?


For the moment, the CDC cannot order you but does advise you to mask up on public transit. That's the most the agency can do while the Justice Department appeals a ruling against a mask mandate. Many airlines and public transportation systems have made masks optional this week. So what is the effect on public health? We're going to talk it through with Dr. Tom Frieden, who was the CDC director from 2009 to 2017 and is now the president of the health organization Resolve to Save Lives. Good morning.

TOM FRIEDEN: Good morning.

INSKEEP: So the Justice Department is appealing because the CDC says we really need a mask mandate. Do you agree with your former colleagues at the CDC that the mandate is essential?

FRIEDEN: It's certainly essential that public health maintain the authority to do things that protect us, whether in society we protect your kid from getting run over by a drunk driver or make sure that you don't get a deadly infection from your local restaurant or that the medicines you pick up at the local pharmacy aren't contaminated. It's really important that we preserve the ability of the government to protect you.

INSKEEP: Oh, that's interesting. So you're saying that this is not, in your mind, a case about this particular mandate that a lot of people were ignoring anyway? It's about the principal for future cases.

FRIEDEN: I think there's certainly a specific issue here. And the reality is that we're at relatively low rates of COVID and low rates of hospitalization from COVID. So on an individual basis, if you're immunosuppressed, if you're older or medically vulnerable or you live with someone who is, you probably want to continue to mask up and, in fact, up your mask game to an N95 and make sure you're up to date with vaccination and, if you do get sick, get promptly treated. On the other hand, the bigger issue, I do think, is whether we may lose the tools we need to protect ourselves, not just now but against a future variant or a future health threat.

INSKEEP: Because you mentioned a better mask, an N95, can better masks truly make this an individual choice? If I'm worried, I can wear an N95, and it protects me for quite a long time, even if I'm in the room with somebody who's infected.

FRIEDEN: The safest thing, if there's a lot of COVID around, is for everyone to be masked. This greatly reduces the concentration of infectious virus in the environment. But the next best thing, if people around you aren't masked, is to up your mask to a tightly, snuggly fitting N95 mask, which is much more protective than other types of face mask.

INSKEEP: I want to ask, Dr. Frieden, about the situation the U.S. government is in now. The CDC has taken multiple steps against the virus over the past couple of years and has been knocked down multiple times in multiple ways by conservative judges and justices, and, of course, there's so much political and partisan opposition. Could the agency have accomplished more by doing less, taking less sweeping measures that would generate less opposition and could be applied more consistently?

FRIEDEN: Steve, there's an underlying reality here, which is that we are all connected, though some people don't like to recognize that. Your right to swing your fist does not extend to someone else's nose. And we do have a special responsibility to protect the vulnerable among us. I am quite concerned that public health is essentially getting a one-two punch here. On the one hand, we're seeing funding drying up and the real risk that we're not going to fund things that are crucially needed, not just to fight this pandemic but to give us a much stronger reboot of our public health system. And second, not only less money but less authority, less ability to protect the public.

And there are times when it is essential to use public health authority. I think some of the other measures - immigration, housing - CDC was asked by both administrations to do something that was, you know, a gray-zone issue because Congress hadn't acted. And I think that is something that has clouded the waters sometimes. But it is really important to be clear that there are certain clear cases where public health has not just the authority but the absolute responsibility to take measures that protect you from an infectious disease.

INSKEEP: I'm just wondering if public health is in trouble in part because two administrations took these steps without building the necessary political support. And maybe it was impossible in this partisan environment to build the necessary political support with so many conspiracy theories out there. But they went beyond what the body politic seemed willing to go along with.

FRIEDEN: Ultimately, whatever the laws and regulations, there has to be some consent of the governed; people have to agree with it. And what we've seen over the past few years is partisanship infecting individual measures like vaccination and masking and, more broadly, public health measures. I'm concerned, Steve, not just about CDC; I'm concerned about state, city and local health departments all over the country, where you're seeing attacks on public health officials, state laws that undermine fundamental authorities to ensure vaccination and the safety of our kids in schools. There's a broader issue here, and it is - will we give public health the funds and the authority needed to protect us against this virus, future strains of this virus and future health threats? Or will we lose some of the most powerful tools we have, not just to save lives but to keep our economy and our educational system and our society moving forward?

INSKEEP: Dr. Tom Frieden is a former director of the Centers for Disease Control and Prevention. Thank you so much, sir.

FRIEDEN: Thank you. Transcript provided by NPR, Copyright NPR.