The next COVID mandate? Focus less on masks and more on those behind them

Last week, a federal judge overturned the Biden administration’s mask mandate for public transportation. When a reporter asked whether people should wear masks on flights, President Biden responded, “That’s up to them,” signaling another step toward the “new normal” and a shift from government-issued mandates to individual decision-making. 

Lifting mask mandates at this moment makes sense. COVID isn’t going away, yet vaccines, therapeutics and tests are widely available. Deaths and hospitalizations are low. What’s more, it’s clear from real-world, state-level data that mask mandates in the omicron era have not had any meaningful effect on community transmission. And one-way masking works well for people who want, or need, added protection.

In other words, it’s time for people to assess their personal risk for COVID and act accordingly. It’s time to graduate from a one-size-fits-all to a more nuanced approach to risk mitigation. The problem? Not everyone has access to information and proper medical guidance to do so. In fact, approximately 80 million Americans don’t have access to a primary care provider.

As we face this next chapter of the pandemic, it’s time to arm people with individualized guidance and the tools they need to protect themselves against COVID — plus the myriad non-COVID health threats all around us. This starts with giving people unfettered access to a trusted guide. 

We primary care doctors spend most of our time helping to marry broad public health advice with the patient in front of us. From mitigating the risk of COVID to addressing depression or diabetes, patient care has never been about mandates; it’s about tailoring medical advice to the individual’s medical needs and goals by centering empathy, empiricism and medical evidence.

COVID risk varies widely based on age, underlying conditions, immune status and exposures. Navigating decisions about boosters, testing and mask-wearing has become increasingly complex. Yet people without a medical “home” have been forced to make complex medical and behavioral decisions in the face of conflicting public health advice and rampant misinformation. 

Who do you trust in a global health crisis to make everyday health decisions if not your primary care provider? Who better to apply broad public health advice to your unique medical conditions and risk factors than someone who understands your vulnerabilities and risk tolerance? 

When asked who they trust for COVID advice, only 30.8 percent of Americans said they trusted Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and only 15.5 percent said they trusted President Biden. Many Americans have sought advice from internet salesmen and media personalities whose interests don’t always align with public health.

The common thread between countries who successfully navigated the pandemic was surprisingly not GDP, smoking, cancer rates, population density or even health insurance coverage; it was trust. A Lancet study concluded that higher levels of trust in public health measures were the most predictive factors of lower COVID infection rates.

Sixty-three percent of Americans trust their medical providers, many of whom are members of their own communities. Their children attend the same schools, they root for the same football teams, they attend the same places of worship. During regular check-ups, patients engage with their physicians in face-to-face conversations where empathy and reason can reign — an impossible feat to accomplish on social media. Establishing rapport with a primary care physician (PCP) can be literally lifesaving. For example, data show that COVID vaccine uptake increases with the number of PCPs per capita. In the confusion and fear of a global pandemic, primary care providers can cut through the noise. 

Primary care providers are also the first line of defense against conditions such as diabetes, hypertension and obesity — the very conditions that can increase one’s chances of dying from COVID. According to the CDC, six in 10 Americans have a chronic disease and four in 10 have two or more — a reality made worse during the pandemic. These conditions are best managed by generalists who treat the body as a complex ecosystem. Treatment requires listening, counseling and monitoring over multiple visits — not quick trips to the emergency room or urgent care facility. 

Primary care physicians are also the chief navigators of a complex American health care system. Patient-centered medical care can save money and lives, and lead to better health outcomes. 

This could not have been clearer during the pandemic as an influx of patients quickly overtaxed hospitals and their staff. Emergency rooms were overrun by patients lacking a PCP to call for advice and care. Without more PCPs now — and certainly in the next pandemic — we can expect the merry-go-round of increased wait times, staff burnout, and potentially diminished quality of care.

As we transition to the “that’s up to them” phase of COVID, we must meet the moment and invest in the unmet needs of millions of Americans. Primary care medical providers, if well-funded and scaled up, are the best line of defense against our most insidious health problems and the vacuum of trust. It’s time to focus less on masks and more on the faces behind them. That should be our only mandate.

Lucy McBride, M.D., is a practicing internist in Washington, with two decades of experience. She is a health care educator, mental health advocate and author of the COVID-19 newsletter. Follow her on Twitter @drlucymcbride and her podcast, “Beyond the Prescription.”