A group of 10 pilots at Jet Blue, American Airlines and Southwest Airlines are suing the Centers for Disease Control and Prevention (CDC) over the federal transportation face mask mandate. The Southwest flight attendant union is taking a more placid approach, simply asking that the face mask mandate be ended when practical. The CEOs of all the major airlines, as well as the leading cargo carriers have also expressed a call to end the mandate.
The pilot’s lawsuit cites numerous health issues brought about by mandated face masks on airplanes and in the air system. They also claim that face masks are ineffective in preventing transmission of the SARS-CoV-2 virus, and that the recent surge in air rage incidents on airplanes has been fueled by the face mask mandate.
A closer examination of the points raised in the lawsuit expose the many challenges associated with face masks in the nation. Although there are studies that refute the benefits of face masks, as the lawsuit notes, there are also credible studies that tout their value.
One issue raised in the lawsuit is the types of masks that should be worn. It took over 18 months for the CDC to recognize that well-fitted N95 face masks are the gold standard for personal protection against COVID-19. The CDC provides a comprehensive list of face masks that are NIOSH-approved. The challenge is sorting through this list, which gets reviewed and updated weekly, and using the information in practice. The difficulty during the early stages of the pandemic were finding such masks, and once they became available, having people wear them properly and keeping them in place. Wearing a face mask only around one’s chin is equivalent to not wearing a mask at all.
Face masks cannot stop the total spread of the virus. What they can do is reduce the risk of transmission. Just like when rolling a pair of fair dice, getting “snake-eyes” is highly unlikely, but if you roll the pair of dice enough times, it will eventually come up.
Airplane air filtration and circulation systems reduce the risk of virus transmission during flights. But the risk on jet bridges, especially when boarding a plane, and in crowded airport concourses are where respiratory barriers such as face masks provide the most benefits.
The most disturbing aspect of the federal face mask mandate, and the many responses to it, has been how a mostly benign issue has become so politicized. We are not talking about forcing people to be infused with chemotherapy. We are talking about a simple face covering placed over a person’s nose and mouth for a designated time period.
For those who are not in support of face masks to reduce the spread of the virus that causes COVID-19, it is notable that other viruses have been dampened during the pandemic. This includes the mild 2020-2021 and 2021-2022 influenza seasons. This does not provide causal evidence that face masks have contributed to these decreases, any more than the 22,000 COVID-19 cases amongst Transportation Security Administration (TSA) screeners is causal evidence that face masks are ineffective to stop the spread of the virus, which the lawsuit cited.
What it does demonstrate is with complex virus transmission, observations of associations may not be anything more than anecdotal.
What is worth noting is that when a surgeon performs an operation, everyone in the operating room is required to wear a face mask. No one would want to be operated on by a surgeon and medical team who did not take such precautions.
The good news for the 10 pilots and the Southwest flight attendants is that the federal face mask mandate is set to expire on April 18. Unless there is a massive increase in new cases, accompanied by a surge in hospitalizations, the mandate will end as planned.
Of course, even without a face mask mandate, many passengers will continue to choose to wear a face mask in airports and on flights. This will be particularly true for those who remain vulnerable to severe outcomes, like those who are immunocompromised. In most cases, it is impossible to know who such people are by just looking at them.
Let’s thank the group of pilots for raising many worth points about face masks, and the Southwest flight attendant union and airline CEOs for expressing their wishes and concerns. Let’s also thank the Federal Aviation Administration (FAA), the CDC and the TSA for issuing the face mask mandate and for allowing it to expire when the time is appropriate, not when political pressures and uninformed opinions think it should be.
Sheldon H. Jacobson, Ph.D., is a founder professor of computer science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public policy.
Janet Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign. She is an infectious disease and public health physician.