Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.
Over the last 18 months, the story of the pandemic in the United States has steadily evolved, from rising terror as the virus took hold, to a long winter of anguish and then to profound relief as a scientific triumph– vaccines!– arrived and did their job amazingly well. But then the story shifted again, darkly, as the Delta variant thwarted our happy ending, largely because of vaccine refuseniks in about a third of the country.
Covid-19’s latest resurgence means we are stuck, unable to escape our national squabbling about masks and shots, mandates and protocols. We are about to restart a particularly bitter battle over public travel – what to do about trains, planes, boats, buses and subways.
The travel issue seems to have no chance at resolution. It’s public health 101 re-worked into the same old tiresome political shout-fest of right versus left, individual freedom versus social responsibility, I don’t have to clean my room versus yes you do. If I believe my wearing a mask helps only you, not me, either because I am already vaccinated or I think the whole Covid-19 thing is overblown, how should I behave? Is the masked life worth living?
The US Centers for Disease Control and Prevention is once again being pressed by Republicans to consider easing mandates for masks and social distancing when traveling. In the get-tough words offered by Texas Senator Ted Cruz recently, “It’s long past time for President Biden and the CDC to follow the science.”
You bet it is. But the actual science is real and it’s spectacularly in opposition to Senator Cruz’s Rambo claims. Indeed, there is scientific data galore that demonstrates risk when using public transportation and additional data that supports masks and distancing.
The most thorough and compelling study on this was published a year ago. The authors set out to define who was at risk for Covid-19 while traveling in China on high-speed trains. Starting with 2,334 people who were known to have ridden the train while infected, they used information from the China State Railway Group to see how many of their 72,093 fellow riders during the three- month study period also got Covid-19.
Because of the quality of the data available (it helps to have a surveillance state for a public-health investigation), the authors were able to quantify the risks of infection depending on where you sat on the train and how long you rode.
Overall, the authors found that among those sitting to the immediate left or right of someone with Covid-19, one in 30 developed infection, a rate 18 times higher than the other tens of thousands of travelers. Those in front of and behind infected passengers also had an elevated risk, though not as high. The authors also showed that longer trips are riskier, raising transmission rates 0.15% an hour. They even produced a simple “heat map” of how proximity and duration affect the risk of catching Covid-19 on a train.
The science is clear: public travel increases your risk. Yes, it’s true that air filtration and circulation on various forms of transportation aren’t exactly the same as on a high-speed train from China. And the China study was conducted before the Delta variant took hold. But the fact remains: sitting next to a Covid- infected person carries risk, and the longer you are seatmates, the higher the risk.
The effectiveness of masks and social distancing similarly has been well shown to lower the risk of catching the infection. The studies are endless and all point one direction – though not the direction Sen. Cruz seems to think.
In other words, unless you know your seatmate has been vaccinated, you don’t want to sit next to them without a mask, no matter how fascinating you find them. And since at least 40% of the US is not vaccinated and the wing-footed Delta virus is wreaking havoc across the country, your risk of having an infected neighbor is real.
The push to pressure the CDC to lift mask restrictions is likely borne not of a desire to follow the science, but rather to make experts across the government seem indecisive, as if changing recommendations were the product of a bloated bureaucracy that only knows how to send weaselly memos. It’s a familiar refrain: big government is screwing up again!
This latest “discussion” about restrictions is completely irrelevant at this moment in the pandemic. After so many arguments and so many lives lost, there is only one salient fact and it is not debatable.
Vaccination works. Refusal to be vaccinated is endangering the health and well-being of the public. We are at a moment of historic cruelty, when some Republicans are deliberately scaring people away from a medical breakthrough that will save their lives. And this, not the pandemic itself or the scientific response to it, likely will be what historians puzzle over in the decades ahead.